Endoscopic Transpapillary Gallbladder Drainage Research Articles

Preoperative Diagnosis and Management of Thick-Walled Gallbladder Based On the Results of Bile Cytology Using an Endoscopic Transpapillary Gallbladder Drainage Tube

Objective: The objective of the present study was to evaluate retrospectively the usefulness of bile cytology to distinguish benign and malignant disease in patients with thickened gallbladder walls using endoscopic transpapillary gallbladder drainage (ETGD) in comparison with computed tomography (CT). Patients and Methods: We reviewed gallbladder diseases in 85 patients visited in our hospital. Twenty-seven cases of gallbladder cancer (GBC) and 58 benign gallbladder diseases were obtained. A pig-tail-type nasobilliary drainage tube was left indwelling in the gallbladder, and washing cytology was performed using this tube. Results: ETGD was performed in 71 of the 85 patients with lesions in thick-walled gallbladders (83.5%) including 22 of the 27 patients with GBC (81.5%) and 49 of the 58 patients with benign gallbladder diseases (84.5%). There were no significant differences in the success rate of ETGD between patients with GBC and those with benign gallbladder diseases CT and cytology using an ETGD tube had 81% and 81% sensitivity, 91% and 83% specificity, and 88% and 82% accuracy, respectively (P > 0.05). Looking only at the 71 successful ETGD cases, CT and ETGD cytology had 82% and 100% sensitivity, 92% and 98% specificity, and 89% and 99% accuracy, respectively. There is statistically significant in the sensitivity and accuracy (P = 0.036 and 0.025, respectively). Four patients with GBC, in whom CT showed benign findings, underwent open cholecystectomy because ETGD cytology revealed malignant findings. In contrast, 4 patients with benign diseases, in whom CT suggested malignant finding, underwent LC because the findings of ETGD cytology suggested benign disease. Positive cytology for GBC in the first, second, third and fourth examination was seen at 50% (11/22), 72% (13/18), 60% (6/10), and 100% (1/1). Accumulative positive rate was 50%, 92%, and 100% in the first, second, and third examination, respectively. Conclusions: ETGD cytology can be conducted following ERC and is useful in differentiating benign and malignant gallbladder diseases. Although success rate of ETGD procedure is limited now, the present study strongly suggests that ETGD cytology is useful in detecting not only lesions that can be discovered by ordinary image diagnosis but also those that are difficult to discover by conventional diagnostic methods.

Endoscopic transpapillary gallbladder drainage for acute cholecystitis

Endoscopic transpapillary gallbladder drainage for acute cholecystitis

Percutaneous transhepatic gallbladder stenting for recurrent acute acalculous cholecystitis after failed endoscopic attempt

Endoscopic gallbladder stenting is useful palliative therapy for acute cholecystitis in high-risk patients. Although the success rate of endoscopic gallbladder stenting is 79%-100%, an alternative method has not been reported. We succeeded in employing a method for percutaneous gallbladder stenting (PTGS) and herein describe this new method. A patient with acute acalculous cholecystitis related to ischemic atherosclerotic vascular disease, cholangitis due to Lemmel syndrome, and severe congestive heart failure underwent PTGS through the cystic duct from the gallbladder to the duodenal papilla, because an endoscopic method failed in the treatment of Lemmel syndrome. Because we were unable to place endoscopic transpapillary gallbladder drainage, percutaneous transhepatic gallbladder drainage (PTGBD) was performed and both the cholecystitis and cholangitis ceased. PTGS was performed as an alternative to endoscopic gallbladder stenting. Access to the cystic duct and gallbladder was obtained by the PTGBD route, using a guidewire (0.035-inch diameter) and seeking catheter (6.5 Fr) under fluoroscopic control. A 7-Fr 12-cm double-pigtail biliary polyethylene stent was placed. The patient remained asymptomatic for 3 months after the PTGS until he died, of an acute recurrent myocardial infarction. This new PTGS placement is an alternative treatment for symptomatic gallbladder disease in patients with increased operative risk when the endoscopic method is unsuccessful.

Efficacy of Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis

Backgrounds: Endoscopic transpapillary gallbladder drainage (ETGBD) is not prevalent for the first line therapy of acute cholecystitis because of its vexatious complications and the lack of its evidence. In this study, we evaluated the clinical efficacy and safety of ETGBD on acute cholecystitis compared with antibiotics alone and percutaneous transhepatic gallbladder drainage (PTGBD). Methods: We studied 53 consecutive patients with acute cholecystitis who had been treated in our institute between January 2003 and October 2004 retrospectively.

Diagnosis and Patients Management of Gallbladder Disease by Bile Cytology Using Endoscopic Transpapillary Gallbladder Drainage Tube

Objective: It is often difficult to clinically determine if a gallbladder disease is benign or malignant despite progress in image diagnosis in recent years. The objective of the present study was to evaluate the usefulness of bile cytology for gallbladder cancer using endoscopic transpapillary gallbladder drainage (ETGD). Materials and methods: We reviewed gallbladder diseases in 152 patients treated in our hospital, gallbladder cancer in 31 and benign gallbladder diseases in 121. ETGD procedures included ordinary endoscopic retrograde cholangiography followed by insertion of a guide wire into the gallbladder. A pig-tail-type nasobilliary drainage tube was left indwelling in the gallbladder, and washing cytology was performed using this tube. Results: ETGD could be performed in 123 of the 152 patients with lesions in the gallbladder (81%): 24 of the 31 patients with gallbladder cancer (77%) and 99 of the 121 patients with benign gallbladder diseases (81.8%). Malignancy could be determined by cytology in 20 of the 24 patients with gallbladder cancer in whom ETGD could be performed (83%). Among 99 patients with benign diseases in whom ETGD was possible, only one with chronic cholecystitis showed malignancy of Class IIIb in cytology. Cytology using ETGD tube showed sensitivity of 95%, specificity of 99%, accuracy of 96%, positive predictive value of 83%, and negative predictive value of 99%. Conclusion: Cytology using ETGD tube is very useful in determining whether a gallbladder disease is benign or malignant.

Endoscopic transpapillary gallbladder drainage for closure of calculous gallbladder perforation and cholecystoduodenal fistula

VOLUME 56, NO. 5, 2002 GASTROINTESTINAL ENDOSCOPY 753 Current affiliations: Department of Medicine, Division of Gastroenterology and Hepatology, Department of Surgery, Division of Gastroenterologic and General Surgery, and Department of Radiology, Division of Interventional Radiology, Mayo Medical Center, Rochester, Minnesota. Reprint requests: Todd H. Baron, MD, FACP, 13400 E. Shea Blvd., Scottsdale, AZ 85259. Copyright © 2002 by the American Society for Gastrointestinal Endoscopy 0016-5107/2002/$35.00 + 0 37/4/129217 doi:10.1067/mge.2002.129217 noted. A 10F stent was placed across the stricture into the intrahepatic biliary system, after which the jaundice resolved. Abdominal CT was normal. The patient remained well for 4 weeks but then presented with recurrent right upper quadrant pain, fever, and leukocytosis with normal biochemical parameters of liver function, and he was referred to our institution. Abdominal CT revealed new, marked bowel wall thickening of the proximal and mid portions of the duodenum, as well as thickening of gastric antrum and pylorus. Extensive stranding was seen in the mesenteric fat around the proximal duodenum and gallbladder fossa; the gallbladder wall was thickened with a new adjacent fluid collection. There was a suggestion of a small connection between the gallbladder and duodenal lumen. Radiographic study of the upper GI tract with water-soluble contrast revealed an edematous duodenum without evidence of perforation or fistula. ERCP was repeated because of suspected gallbladder perforation. The previously placed biliary stent was Figure 1. Retrograde cholangiogram showing endoscopically placed biliary catheter in gallbladder (GB). Note markedly irregular contour of gallbladder with extravasation of contrast into fluid collection identified on CT. Endoscopic transpapillary gallbladder drainage for closure of calculous gallbladder perforation and cholecystoduodenal fistula

Endoscopic transpapillary gallbladder drainage (ETGBD) for an advanced-age case of relapsing cholecystitis with cirrhotic liver

Endoscopic transpapillary gallbladder drainage (ETGBD) for an advanced-age case of relapsing cholecystitis with cirrhotic liver

Endoscopic transpapillary gallbladder drainage (ETGBD) for the treatment of acute cholecystitis

We performed endoscopic transpapillary gallbladder drainage (ETGBD) in 21 patients with acute cholecystitis, utilizing a guidewire coated with a hydrophilic polymer. Endoscopic sphincterotomy was not performed. The clinical efficacy of ETGBD was evaluated in terms of reduction of white blood cell count (WBC) and C-reactive protein (CRP) level. ETGBD was successful in 17 (81%) of the 21 patients, in terms of early disappearance of clinical symptoms, and significant decrease of both WBC and CRP after ETGBD (P< 0.001). In patients with the Mirizzi syndrome (n=2), accurate diagnosis was made by endoscopic retrograde cholangiography (ERC), facilitating proper drainage (ETGBD) immediately afterward. With ETGBD, emergency operation was avoided even in critically ill patients complicated with disseminated intravascular coagulopathy (n=2). There were no significant complications. ETGBD may be an effective and safe alternative to percutaneous transhepatic gallbladder drainage in the management of acute cholecystitis, and may be more suitable for patients with a strong bleeding tendency.