Endoscopic Naso-gallbladder Drainage Research Articles

Preoperative visualization of mucin-producing gallbladder carcinoma by using peroral transcatheter cholecystoscopy technique (with video)

A 73-year-old woman was referred to our institution for a gallbladder tumor detected by abdominal US examination during a routine checkup. CT demonstrated papillary lesions in the gallbladder with enhancement (A), and EUS clearly showed papillary lesions with several striations of variable width (B). Duodenal endoscopy revealed mucin extravasating from the ampulla of Vater. We performed endoscopic nasogallbladder drainage (ENGBD). The lesion appeared as an irregular, papillary-like filling defect (C) on a contrast study performed through the ENGBD tube. On ERCP, a catheter (Tandem XL; Boston Scientific, Natick, Mass) was inserted to the origin of the cystic duct, followed by passage of a guidewire. Once positioning was secured in

Su1359 A Clinical Comparison of Endoscopic Naso-Gallbladder Drainage Verses Percutaneous Transhepatic Gallbladder Drainage for Acute Cholecystitis

Su1359 A Clinical Comparison of Endoscopic Naso-Gallbladder Drainage Verses Percutaneous Transhepatic Gallbladder Drainage for Acute Cholecystitis

TG13 indications and techniques for gallbladder drainage in acute cholecystitis (with videos)

Percutaneous transhepatic gallbladder drainage (PTGBD) is considered a safe alternative to early cholecystectomy, especially in surgically high-risk patients with acute cholecystitis. Although randomized prospective controlled trials are lacking, data from most retrospective studies demonstrate that PTGBD is the most common gallbladder drainage method. There are several alternatives to PTGBD. Percutaneous transhepatic gallbladder aspiration is a simple alternative drainage method with fewer complications; however, its clinical usefulness has been shown only by case-series studies. Endoscopic naso-gallbladder drainage and gallbladder stenting via a transpapillary endoscopic approach are also alternative methods in acute cholecystitis, but both of them have technical difficulties resulting in lower success rates than that of PTGBD. Recently, endoscopic ultrasonography-guided transmural gallbladder drainage has been reported as a special technique for gallbladder drainage. However, it is not yet an established technique. Therefore, it should be performed in high-volume institutes by skilled endoscopists. Further prospective evaluations of the feasibility, safety, and efficacy of these various approaches are needed. This article describes indications and techniques of drainage for acute cholecystitis.Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.

急性胆嚢炎に対する内視鏡的経鼻胆嚢ドレナージ(ENGBD)の有用性と問題点

急性胆嚢炎に対する内視鏡的経鼻胆嚢ドレナージ(ENGBD)の有用性と問題点

Endoscopic naso-gallbladder drainage by using cholangioscopy for acute cholecystitis combined with cholangitis or choledocholithiasis (with video)

P Acute cholecystitis is one of the most frequent emergency situations, and laparoscopic cholecystectomy within 72 hours is the treatment of choice. However, cholecystectomy has a significant morbidity and mortality rate in elderly people with severe comorbidities and in patients who are poor surgical candidates such as those with sepsis, liver cirrhosis, thrombocytopenia, and coagulopathies.3-6 Percutaneous cholecystostomy (PC) is an alternative to surgery in these high-risk patients. Although PC is a simple procedure, there are several complications including hemorrhage, liver hematoma, hemobilia, bile leak, pneumothorax, and catheter dislodgment. The complication rate of PC ranges from 9% to 27% and increases in patients with bleeding tendency or a large amount of ascites.7-10 Endoscopic transpapillary gallbladder drainage has been used when the percutaneous approach is contrain-

Endoscopic transgastric pure NOTES cholecystectomy with naso‐gallbladder drainage tube placement and injection of a hyaluronic acid mixture (with Video)

Endoscopic transgastric pure natural orifice translumenal endoscopic surgery (NOTES) cholecystectomy is a difficult procedure, and most human female cases are performed as hybrid NOTES, using a transvaginal route. We tried a transgastric pure NOTES procedure without laparoscopic procedure in an animal study after placing an endoscopic naso-gallbladder drainage (ENGBD) tube and injecting a hyaluronic acid (HA) mixture. We performed the method in four pigs, using a standard single-channel endoscope. The ENGBD tube was placed first and the HA mixture was injected between the gallbladder (GB) serosa and liver bed. We determined the gastrotomy site using an ENGBD tube, which made the GB approach easy under fluoroscopic guidance. The scope was not retroflexed, but was rotated at the stomach fornix. The connecting tissues between the GB serosa and liver bed expanded following the injection of the HA mixture, facilitating GB removal with a Hook knife. The GB wall, liver, and vessels were observed clearly during the procedure, and there were no incorrect cuts. We successfully performed a transgastric pure NOTES cholecystectomy in pigs. An ENGBD tube was useful as a guide to the GB, and for recognizing the cystic duct, and injecting the HA mixture facilitated the GB dissection.

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

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.

Benefit of Endoscopic Naso-Gallbladder Drainage (ENGBD) and Endoscopic Gallbladder Stenting (EGS) for Acute Cholecystitis

Benefit of Endoscopic Naso-Gallbladder Drainage (ENGBD) and Endoscopic Gallbladder Stenting (EGS) for Acute Cholecystitis

INTRADUCTAL ULTRASONOGRAPHY OF THE GALLBLADDER IN APPLICATION OF THE ENDOSCOPIC NASO-GALLBLADDER DRAINAGE

Background: Although endoscopic naso-gallbladder drainage (ENGBD) for gallbladder disease is useful, the procedure is difficult and investigations involving many cases are lacking. Furthermore, reports on transpapillary intraductal ultrasonography (IDUS) of the gallbladder using a miniature probe are rare. Methods: A total of 150 patients (119 suspected of having gallbladder carcinoma, 24 with acute cholecystitis (AC), and seven with Mirizzi’s syndrome (MS)) were the subject. (i) ENGBD: We attempted to put ENGBD tube into the GB. (ii) IDUS of the gallbladder: Using the previous ENGBD tube, we attempted to insert the miniature probe into the gallbladder and perform transpapillary IDUS of the gallbladder. In five patients, we attempted three-dimensional intraductal ultrasonography (3D-IDUS). Results: (i) ENGBD: Overall success rate was 74.7% (112/150); the rate for the patients suspected of having gallbladder carcinoma was 75.6% (90/119), and was 71.0% (22/31) for the AC and MS patients. Inflammation and jaundice improved in 20/22 successful patients with AC and MS. Success rate was higher when cystic duct branching was from the lower and middle parts of the common bile duct than from the upper part, and was higher when branching was upwards than downwards. (ii) IDUS of the gallbladder: Success rate for miniature probe insertion into the gallbladder was 96.4% (54/56). Lesions could be visualized in 50/54 patients (92.6%). Of these, detailed evaluation of the locus could be performed in 41. In five patients attempted 3D-IDUS, the relationship between the lesion and its location was readily grasped. Conclusion: IDUS of the gallbladder is superior for diagnosing minute images. Improvement on the device will further increase its usefulness.

NASOGALLBLADDER DRAINAGE FOR MIRIZZI’S SYNDROME

The authors experienced a case of Mirizzi’s syndrome successfully treated with endoscopic nasogallbladder drainage (ENGBD). The patient was a 63‐year‐old man. He was admitted with abdominal pain and jaundice. Laboratory data indicated leukocytosis and elevation of serum bilirubin level. Abdominal ultrasound showed marked swelling of gallbladder and debris in the gallbladder, therefore, the authors strongly suspected Mirizzi’s syndrome. He had past history of acute myocardial infarction and treated with anticoagulation therapy. Then, the authors couldn’t perform surgical removal or percutaneous transhepatic drainage, and tried endoscopic transpapillary drainage. Endoscopic retrograde cholangiopancreatography revealed smooth stricture in the superior portion of common bile duct and occlusion of the cystic duct, and ENGBD was then performed. After ENGBD, his complaints, laboratory data, swelling of gallbladder and stricture of common bile duct were all remarkably improved.

ENDOSCOPIC NASOBILIARY GALLBLADDER DRAINAGE AFTER ENDOSCOPIC SPHINCTEROTOMY IN PATIENTS WITH ACUTE CHOLECYSTITIS AND CHOLEDOCHOLITHIASIS

A 77‐year‐old man was admitted for the treatment of obstructive jaundice and right hypochondralgia with high fever. An abdominal computed tomography revealed common bile duct stones and acute cholecystitis with gallstones. Magnetic resonance cholangiopancreatography revealed stones in the common bile duct. Endoscopic retrograde cholangiopancreatography also revealed stones in the common bile duct, and immediately endoscopic sphincterotomy was performed. After lithotripsy of the bile duct, continuous endoscopic nasogallbladder drainage was performed successfully. There was severe pus in the gallbladder. Next day, the patient was doing well; there was no pain and fever was down.

Endoscopic naso-gallbladder drainage in the treatment of acute cholecystitis: alleviates inflammation and fixes operator's aim during early laparoscopic cholecystectomy

In 1984, Kozarek first reported the use of endoscopic retrograde cholangiopancreatography (ERCP) to perform selective cannulation of the cystic duct, and since then this procedure has also been reported by others. With this procedure, disorders in the gallbladder can be examined in detail, using, for example, selective cytology, and drainage for acute cholecytitis can also be performed. With this procedure, we were able to successfully perform early laparoscopic cholecystectomy (LC). Although surgery is often problematic in patients with acute cholecystitis because of inflammation, making Callot's triangle difficult to distinguish, the use of endoscopic naso-gallbladder drainage (ENGBD) during surgery enables us to identify the cystic duct for catheter cannulation. We performed early LC for acute cholecystitis in 18 of 22 patients, while 18 other patients underwent open cholecystectomy during the same period (retrospective study). These two groups were then compared. The LC group had shorter pre- and postoperative periods and shorter hospitalization (P < 0.05). ENGBD resulted in very little bleeding. None of the ENGBD patients required conversion to open surgery, whereas 11.1% of the non-ENGBD patients were converted. ENGBD was successfully employed in 18 of the initial 22 (81.8%) patients. The favorable points in using ENGBD with LC were that (i) the gallbladder inflammation was alleviated even if patients had ascites, and (ii) use of ENGBD normally improved visualization and made cystic duct identification easier. However, if ERCP cannot be carried out, the performance of ENGBD must also be ruled out.