Utility of Endoscopic Naso-Gallbladder Drainage (ENGBD) for Acute Cholecystitis

Abstract

Aim: The efficacy of endoscopic naso-gallbladder drainage (ENGBD) as a drainage for acute cholecystitis has been reported. In this study, we evaluated the effectiveness and problems of using ENGBD from the results achieved in our center. Subjects and Methods: Endoscopic procedure was performed as follows. Firstly, cannulation of the bile duct was achieved using standard ERCP techniques, and then an 0.035” angled hydrophilic guidewire was passed though the cystic duct. Finally, a ENBD tube (5Fr. or 6Fr. pig tail type) was inserted into the gallbladder. Ninety one patients underwent ENGBD for acute cholecystitis between April 1997 to October 2008. ENGBD was indicated as follows; medication of anti-coagulant, bleeding tendency, advanced age or complications, the presence of bile duct stones or cholangitis, or suspicion of gallbladder cancer. Evaluating points were 1) success rates of the technique, 2)drainage effects, 3)complications Results: 1) ENGBD tube was successfully placed in 81.3% (74/91) of all patients; its breakdown by the disease degree was 81.6% (31/38) in mild cases, 80.5% (33/41) in moderate cases and 83.3% (10/12) in serious cases, showing no significant difference among them respectively. 2) Effective drainage was achieved in 98.6% (73/74) of the cases where drainage placement was successful; in 1 case, ENGBD was changed to percutaneous transhepatic gallbladder drainage (PTGBD). 3) Complications developed in 8.8% (8/91); cholangitis in 3, pancreatitis in 3, and injury to the cystic duct in 2. Conclusion: ENGBD was thought to be an effective treatment for acute cholecystitis. However, there are some cases difficult to treat using this method, and thus advancement in technique and improvement of tools are necessary.