Percutaneous transhepatic gallbladder drainage facilitates endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis

Abstract

AbstractDrainage of gallbladder is important for the management of acute cholecystitis in inoperable elderly patients. Endoscopic transpapillary gallbladder drainage (ETGBD) is an ideal option because this internal drainage has more advantages such as life convenience, no need for exchange of the tube and low possibility of tube dislodgement, compared with external drainage such as percutaneous transhepatic gallbladder drainage (PTGBD). However, ETGBD is challenging because it demands competence in ERCP skills. Moreover, for patients with biliary tract infection, the biliary tract is inflamed, edematous and full of sticky dirty bile, causing selective cannulation into cystic duct more difficult and low successful rates of ETGBD. Herein, we hypothesized that the drainage with PTGBD attenuates the biliary inflammation and facilitates the subsequent ETGBD. Therefore, we conducted this retrospective study to compare the clinical outcomes, procedure outcomes and complications of ETGBD in patients of cholecystitis with and without prior PTGBD. Nineteen patients of acute cholecystitis were retrospectively included. Ten of them had no PTGBD while nine of them had PTGBD based on clinical conditions. All of them underwent ETGBD either for drainage or for infectious source control or for converting external drainage to internal drainage. Basic demographics, laboratory data, procedure time, technical success, early clinical success and complications were compared in both groups. Baseline demographics, pre‐procedural laboratory data (bilirubin, C‐reactive protein) were similar in both groups. ETGBD was technically successful in eight of the nine patients with PTGBD, superior to those without prior PTGBD (88.9% vs 70%, P = .31). The early clinical success rates of PTGBD group were both 100%. The procedure time of ETGBD was shorter in PTGBD group (28.4 minutes vs 39.4 minutes, P = .09). The rates of significant post‐ERCP hyperamylasemia/hyperlipasemia was lower in PTGBD group (22.2% vs 30.0%, P = .7). On the analysis of logistic regression, the odd ratio of technical success was 3.4 in PTGBD group. Our study demonstrated that ETGBD was easier to perform in patients with PTGBD. After the infection source is controlled with PTGBD, selective cannulation into cystic duct seems to be easier to manipulate. Beside higher technical success rate, ETGBD in patients with PTGBD required shorter procedure time and contributed to less complications. Although the statistics was not significant, yet the trend toward to the superiority in PTGBD group was confirmed. Consequently, PTGBD possibly facilitates ETGBD insertion in patients with acute cholecystitis.