Endoscopic Transpapillary Gallbladder Drainage Research Articles

Endoscopic transpapillary gallbladder drainage using a novel cholangioscope.

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Endoscopic transpapillary gallbladder drainage using a novel sphincterotome.

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Endoscopic Transpapillary Gallbladder Drainage With 2 Stents Versus 1 Stent Reduces Reinterventions: A Multicenter Study

Background and AimsEndoscopic transpapillary gallbladder drainage (ETGBD) is a therapeutic option for gallstone-related gallbladder disease in non-surgical candidates. However, the optimal stenting strategy and follow-up has not been established. We aimed to determine whether there was a decreased need for unplanned reintervention in patients undergoing placement of two transpapillary gallbladder stents as compared to one. MethodsWe performed a multicenter retrospective analysis of patients undergoing ETGBD between June 2013 and October 2022. The primary outcome was clinical success as defined by resolution of symptoms without the need for another drainage strategy. Secondary outcomes included the adverse events of post-ERCP pancreatitis, cholangitis, bleeding, perforation, or death. Factors associated with placement of two stents, unplanned reintervention, and adverse events were assessed. ResultsWe included 75 patients undergoing ETGBD, with a median follow-up of 407 days (IQR: 71-1504). Technical and clinical success were 88.2% and 81.3%, respectively. Unplanned reintervention was significantly lower in the double stenting group (0% vs. 25.4%, P=0.02). Use of a 7 French stent (OR: 15.5; 95% CI: 1.9-125; p=0.01) and presence of a percutaneous cholecystostomy tube (OR: 10.8; 95% CI: 2.8-41.3; p=0.001) were associated with placement of two stents. There was no significant difference in adverse events between groups (OR: 0.9; 95% CI: 0.09-8.8; P=0.94). ConclusionsETGBD is safe and effective in non-operative candidates. Single transpapillary gallbladder stenting is associated with more unplanned reinterventions, and 7 French stent diameter and prior percutaneous cholecystostomy tube may be associated with ability to place a second stent. Endoscopists should consider planned exchange of solitary transpapillary gallbladder stents or interval placement of a second stent if placement of two stents was unsuccessful at the index procedure.

Benefits of endoscopic gallbladder stenting following percutaneous transhepatic gallbladder drainage.

Endoscopic transpapillary gallbladder drainage is challenging because of the complexity of the procedure and high incidence of adverse events (AEs). To overcome these problems, endoscopic gallbladder stenting (EGBS) after percutaneous transhepatic gallbladder drainage (PTGBD) can be effective, as it mitigates inflammation and adhesion. To examine the benefits of EGBS after PTGBD to assess its efficacy and impact on AEs. We retrospectively analyzed data from 35 patients who underwent EGBS after PTGBD at a single center between January 2016 and December 2023. The primary outcomes were technical success and AEs, and the rate of recurrent cholecystitis was evaluated. In addition, the reasons for the failure of the procedure were identified. Among the 35 patients, the technical success rate was 77.1% and the final contrast of the cystic duct was successful in 97.1% of patients. The incidence of early AEs was relatively low (11.4%), with no instances of cystic duct perforation. The rate of recurrent cholecystitis was 3.7%, and no other biliary events were observed. EGBS after PTGBD may be significantly beneficial, with a substantial success rate and minimal AEs in both short- and long-term follow-ups.

Interval cholecystectomy following drainage procedures for acute cholecystitis: percutaneous transhepatic vs endoscopic transpapillary gallbladder drainage

BackgroundGallbladder drainage procedures are often considered for acute cholecystitis (AC) patients with significant peri-operative risks. While percutaneous transhepatic gallbladder drainage (PTGBD) has been evaluated in previous studies, there is scarce data on the feasibility and efficacy of endoscopic transpapillary gallbladder stenting (ETGBS) in patients with AC. This study aimed to compare the characteristics of interval cholecystectomy following ETGBS and PTGBD. MethodsThis retrospective descriptive study included patients who underwent ETGBS and/or PTGBD for AC and subsequently underwent interval cholecystectomy between 2018 and 2023. Demographics, operative technique, and postoperative complications of patients with ETGBS and PTGBD were compared. ResultsA total of 59 patients were included (14 ETGBS and 45 PTGBD). The median days between ETGBS and cholecystectomy were significantly longer than the PTGBD group (64 [45-150] days vs. 16 [10-42] days, p=0.045). The median operation time was significantly longer in the ETGBS group. Among 33 patients who underwent subtotal cholecystectomy, the ERGBS group more frequently required closure of the gallbladder stump due to the difficulty in ligating the cystic duct compared to the PTGBD group (75.0% vs. 28.0%, p=0.035). Similarly, the fundus-first approach was more commonly selected in the ERGBS group (62.5% vs. 28.0%, p=0.01). No significant differences in the incidence of postoperative complications were observed between the two groups. ConclusionsInterval cholecystectomy following ETGBS is more technically demanding compared to PTGBD. Laparoscopic subtotal cholecystectomy following ETGBS could be a potential treatment option for patients who are unfit for early surgery, with the recognition of the difficulty in ligating the cystic duct.

The Success Rate Is Lower but Completion Rate of Laparoscopic Cholecystectomy Is higher in Endoscopic Transpapillary Gallbladder Drainage than Percutaneous Gallbladder Drainage for Acute Cholecystitis.

We investigated the success and complication rates of endoscopic transpapillary gallbladder drainage (ETGBD) and percutaneous transhepatic gallbladder drainage (PTGBD) and the outcomes of subsequent cholecystectomy for acute cholecystitis. Patients (N=178) who underwent cholecystectomy after ETGBD or PTGBD were retrospectively assessed. ETGBD was successful in 47 (85.5%) of 55 procedures, whereas PTGBD was successful in 123 (100%) of 123 sessions ( P <0.001). Complications related to ETGBD and PTGBD occurred in 6 (12.8%) of 47 and 16 (13.0%) of 123 patients, respectively ( P =0.97). After propensity matching, 43 patients from each group were selected. Median time from drainage to cholecystectomy was 48 (14 to 560) days with ETGBD and 35 (1 to 90) days with PTGBD ( P =0.004). Laparoscopy was selected more often in the ETGBD group (97.7%) than in the PTGBD group (79.1%) ( P =0.007), and conversion from laparoscopy to open cholecystectomy was more common with PTGBD (41.2%) than with ETGBD (7.1%) ( P <0.001). Mean operation time was significantly shorter with ETGBD (135.8±66.7min) than with PTGBD (195.8±62.2min) ( P <0.001). The incidence of Clavien-Dindo grade ≥III postoperative complications was 9.3% with ETGBD and 11.6% with PTGBD ( P =0.99). The success rate is lower but completion of laparoscopic cholecystectomy is more in endoscopic gallbladder drainage than percutaneous gallbladder drainage for acute cholecystitis.

The Successful Treatment of Percutaneous Transhepatic Gallbladder Drainage Related Pleurobiliary Fistula via Endoscopic Transpapillary Gallbladder Drainage

The pleurobiliary fistula was not common but sometimes it could occur after percutaneous transhepatic gallbladder drainage. This report describes the case of an 83-year-old Korean male diagnosed with a pleurobiliary fistula after percutaneous transhepatic gallbladder drainage. The patient was treated with endoscopic transpapillary gallbladder drainage under the guidance of the peroral cholangioscopy with SpyGlass DS system. It can decompress pressure within the gallbladder. Leakage from the gallbladder into the pleura was reduced. Finally, his condition got better and he recovered.

Endoscopic transpapillary gallbladder drainage using a novel drill dilator.

Endoscopic transpapillary gallbladder drainage using a novel drill dilator.

Endoscopic Gallbladder Drainage: A Comprehensive Review on Indications, Techniques, and Future Perspectives.

In recent years, therapeutic endoscopy has become a fundamental tool in the management of gallbladder diseases in light of its minimal invasiveness, high clinical efficacy, and good safety profile. Both endoscopic transpapillary gallbladder drainage (TGBD) and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) provide effective internal drainage in patients with acute cholecystitis unfit for cholecystectomy, avoiding the drawbacks of external percutaneous gallbladder drainage (PGBD). The availability of dedicated lumen-apposing metal stents (LAMS) for EUS-guided transluminal interventions contributed to the expansion of endoscopic therapies for acute cholecystitis, making endoscopic gallbladder drainage easier, faster, and hence more widely available. Moreover, EUS-GBD with LAMS opened the possibility of several cholecystoscopy-guided interventions, such as gallstone lithotripsy and clearance. Finally, EUS-GBD has also been proposed as a rescue drainage modality in malignant biliary obstruction after failure of standard techniques, with encouraging results. In this review, we will describe the TBGD and EUS-GBD techniques, and we will discuss the available data on clinical efficacy in different settings in comparison with PGBD. Finally, we will comment on the future perspectives of EUS-GBD, discussing the areas of uncertainty in which new data are more strongly awaited.

Evaluation of the Validity of Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis Based on the Tokyo Guidelines 2018.

We evaluated the validity of endoscopic transpapillary gallbladder drainage (ETGBD) as a bridging therapy prior to elective Lap-C for the patients with acute cholecystitis (AC). The Tokyo Guidelines 2018 recommend early laparoscopic cholecystectomy (Lap-C) for patients with AC, however, some patients require the preoperative drainage because of inadequate for early Lap-C du to background and comorbidities. We performed a retrospective cohort analysis using data from our hospital records from 2018-2021. In total, 71 cases of 61 patients with AC underwent ETGBD. The technical success rate was 85.9%. Patients in the failure group had more complicated branching of the cystic duct. The length of time until feeding was started and until WBC levels normalized, and the length of hospital stay were significantly shorter in the success group. The median waiting period for surgery was 39 days in the ETGBD success cases. The median operating time, amount of bleeding, and length of postoperative hospital stay were 134 min, 83.2g, and 4 days, respectively. In patients who underwent Lap-C, the waiting period for surgery and the operating time were similar between the ETGBD success and failure groups. However, the temporary discharge period after drainage and the length of postoperative hospital stay were significantly longer in the patients with ETGBD failure. Our study revealed that ETGBD has equivalent efficacy prior to elective Lap-C despite some challenges that lower its success rate. Preoperativ ETGBD can improve patient quality of life by eliminating the need for a drainage tube.

Risk factors and treatment strategies for cholecystitis after metallic stent placement for malignant biliary obstruction: a multicenter retrospective study

Background and study aimsCholecystitis can occur after self-expandable metallic stent (SEMS) placement for malignant biliary obstructions (MBO). Furthermore, the best treatment option for cholecystitis has not been determined. Here, we aimed to identify the risk factors of cholecystitis after SEMS placement and determine the best treatment option. Patients and MethodsIncidence, treatments, and predictive factors of cholecystitis were retrospectively evaluated in 1,084 patients with distal MBO (DMBO) and 353 patients with hilar MBO (HMBO) who underwent SEMS placement at the 12 institutions from January 2012 to March 2021. ResultsCholecystitis occurred in 7.5% of patients with DMBO and 5.9% of patients with HMBO. The recurrence rate was significantly lower (p=0.043), and the recurrence-free period was significantly longer (p=0.039) in endoscopic procedures than in percutaneous procedures for cholecystitis treatment. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) was better in terms of technical success, procedure time, and recurrence-free period than endoscopic transpapillary gallbladder drainage. The cases with obstruction across the cystic duct orifice by tumor (p=0.015) and those with obstruction by stent (p=0.037) were the independent risk factors for cholecystitis in DMBO. The cases with multiple SEMS placements (OR 11, 95% CI 0.68–190, p=0.091) and those with gallbladder stones (OR 2.3, 95% CI 0.92–5.6, p=0.075) had a higher risk for cholecystitis in HMBO. ConclusionsThe incidences of cholecystitis after SEMS placement for DMBO and HMBO were comparable. EUS-GBD is the optimal treatment option for patients with cholecystitis after SEMS placement for MBO.

Role of advanced endoscopy in the management of inflammatory digestive diseases (pancreas and biliary tract).

The progress of endoscopic diagnosis and treatment for inflammatory diseases of the biliary tract and pancreas have been remarkable. Endoscopic ultrasonography (EUS) and EUS-elastography are used for the diagnosis of early chronic pancreatitis and evaluation of endocrine and exocrine function in chronic pancreatitis. Notably, extracorporeal shock wave lithotripsy and electrohydraulic shock wave lithotripsy have improved the endoscopic stone removal rate in patients for whom pancreatic stone removal is difficult. Studies have reported the use of self-expanding metal stents for stent placement for pancreatic duct stenosis and EUS-guided pancreatic drainage for refractory pancreatic duct strictures. Furthermore, EUS-guided drainage using a double-pigtailed plastic stent has been performed for the management of symptomatic pancreatic fluid collection after acute pancreatitis. Recently, lumen-apposing metal stents have led to advances in the treatment of walled-off necrosis after acute pancreatitis. EUS-guided biliary drainage is an alternative to refractory endoscopic biliary drainage and percutaneous transhepatic biliary drainage for the treatment of acute cholangitis. The placement of an inside stent followed by switching to uncovered self-expanding metal stents in difficult-to-treat cases has been proposed for acute cholangitis by malignant biliary obstruction. Endoscopic transpapillary gallbladder drainage is an alternative to percutaneous transhepatic gallbladder drainage for severe and some cases of moderate acute cholecystitis. EUS-guided gallbladder drainage has been reported as an alternative to percutaneous transhepatic gallbladder drainage and endoscopic transpapillary gallbladder drainage. However, it is important to understand the advantages and disadvantages of each drainage method and select the optimal drainage method for each case.

A Review on Endoscopic Management of Acute Cholecystitis: Endoscopic Ultrasound-Guided Gallbladder Drainage and Endoscopic Transpapillary Gallbladder Drainage.

A percutaneous cholecystostomy tube (PCT) is the conventionally favored nonoperative intervention for treating acute cholecystitis. However, PCT is beset by high adverse event rates, need for scheduled reintervention, and inadvertent dislodgement, as well as patient dissatisfaction with a percutaneous drain. Recent advances in endoscopic therapy involve the implementation of endoscopic transpapillary drainage (ETP-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), which are increasingly preferred over PCT due to their favorable technical and clinical success combined with lower complication rates. In this article, we provide a comprehensive review of the literature on EUS-GBD and ETP-GBD, delineating instances when clinicians should opt for endoscopic management and highlighting potential risks associated with each approach.

Assessment of Gallbladder Drainage Methods in the Treatment of Acute Cholecystitis: A Literature Review.

Gallbladder drainage is a treatment option in high-risk surgical patients with moderate or severe acute cholecystitis. It may be applied as a bridge to cholecystectomy or a definitive treatment option. Apart from the simple and widely accessible percutaneous cholecystostomy, new attractive techniques have emerged in the previous decade, including endoscopic transpapillary gallbladder drainage and endoscopic ultrasound-guided gallbladder drainage. The aim of this paper is to present currently available drainage techniques in the treatment of AC; evaluate their technical and clinical effectiveness, advantages, possible adverse events, and patient outcomes; and illuminate the decision-making path when choosing among various treatment modalities for each patient, depending on their clinical characteristics and the accessibility of methods.

Strategy Comparison of Endoscopic Ultrasound-Guided Gallbladder Drainage to Percutaneous Transhepatic Gallbladder Drainage, Following Failed Emergent Endoscopic Transpapillary Gallbladder Drainage.

Endoscopic transpapillary gallbladder drainage (ETGBD) is recommended for patients with acute cholecystitis at high risk for surgery/percutaneous transhepatic gallbladder drainage (PTGBD). Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has higher success and mortality rates than ETGBD. Optimal endoscopic drainage remains controversial. Patients with moderate/severe acute cholecystitis and high risk for surgery/PTGBD who underwent ETGBD were enrolled. In the new-ETGBD (N-ETGBD)/traditional-ETGBD (T-ETGBD) strategy, patients in whom the initial ETGBD failed underwent rescue-EUS-GBD in the same endoscopic session/rescue-PTGBD, respectively. Therapeutic outcomes were compared. Patients who could not undergo rescue-EUS-GBD/PTGBD owing to poor general conditions received conservative treatment. Technical success was defined as successful ETGBD or successful rescue-EUS-GBD/PTGBD. Forty-one/forty patients were enrolled in the N-ETGBD/T-ETGBD groups, respectively. The N-ETGBD group had a higher, though non-significant, technical success rate compared to the T-ETGBD group (97.6 vs. 90.0%, p = 0.157). The endoscopic technical success rate was significantly higher in the N-ETGBD than in the T-ETGBD group (97.6 vs. 82.5%, p = 0.023). The clinical success/adverse event rates were similar between both groups. The hospitalization duration was significantly shorter in the N-ETGBD than in the T-ETGBD group (6.6 ± 3.9 vs. 10.1 ± 6.4 days, p < 0.001). ETGBD with EUS-GBD as a rescue backup may be an ideal hybrid drainage for emergency endoscopic gallbladder drainage in high-risk surgical patients.

Factors predicting technical failure of endoscopic transpapillary gallbladder drainage for acute cholecystitis.

Endoscopic transpapillary gallbladder drainage (ETGBD) is a highly technical procedure, but few studies have evaluated factors that predict its technical success. Therefore, in this study, we sought to identify predictors of technically successful ETGBD. One hundred and eighty-two patients who underwent ETGBD for acute cholecystitis at our hospital were retrospectively investigated. Factors associated with technical failure were identified by focusing on clinical characteristics, anatomical features (direction of the cystic duct branch and course of the cystic duct), and procedural factors (cystic duct and gallbladder with or without contrast and cystic duct injury). The technical success rate was 84.6% (154/182) and the clinical success rate was 96.1% (148/154). The adverse event rate was 11.0% (20/182; cystic duct injury in 13 patients, pancreatitis in six, and liver abscess in one. Univariate and multivariate analyses identified the right cranial direction and spiral-type course of the cystic duct to be significant anatomical features and cystic duct injury to be a significant procedural feature contributing to the technical failure of ETGBD. ETGBD is a highly practical procedure for patients with acute cholecystitis. However, difficulty is encountered in some cases because of anatomical and procedural factors. Our results suggest that ETGBD may be difficult and thus should not be performed in cases with the right cranial direction or spiral-type course of the cystic duct or those with cystic duct injury.

S54 Endoscopic Transpapillary Gallbladder Drainage With Two Stents Reduces the Need for Re-Intervention Compared to Single Stent

S54 Endoscopic Transpapillary Gallbladder Drainage With Two Stents Reduces the Need for Re-Intervention Compared to Single Stent

S2629 Cholangioscopy-Assisted Endoscopic Transpapillary Gallbladder Drainage in a Decompensated Cirrhotic Patient With Chronic Cholecystitis

S2629 Cholangioscopy-Assisted Endoscopic Transpapillary Gallbladder Drainage in a Decompensated Cirrhotic Patient With Chronic Cholecystitis

Acute cholecystitis: Which flow-chart for the most appropriate management?

Acute cholecystitis (AC) is a very common disease in clinical practice. Laparoscopic cholecystectomy remains the gold standard treatment for AC, however due to aging population, the increased prevalence of multiple comorbidities and the extensive use of anticoagulants, surgical procedures may be too risky when dealing with patients in emergency settings. In these subsets of patients, a mini-invasive management may be an effective option, both as a definitive treatment or as bridge-to-surgery. In this paper, several non-operative treatments are described and their benefits and drawbacks are highlighted. Percutaneous gallbladder drainage (PT-GBD) is one of the most common and widespread techniques. It is easy to perform and has a good cost/benefit ratio. Endoscopic transpapillary gallbladder drainage (ETGBD) is a challenging procedure that is usually performed in high volume centers by expert endoscopists, and it has a specific indication for selected cases. EUS-guided drainage (EUS-GBD) is still not widely available, but it is an effective procedure that could have several advantages, especially in rate of reinterventions. All these treatment options should be considered together in a stepwise approach and addressed to patients after an accurate case-by-case evaluation in a multidisciplinary discussion. In this review, we provide a possible flowchart in order to optimize treatments, resource and provide to patients a tailored approach.

Endoscopic transpapillary gallbladder drainage using a tapered endoscopic sheath.

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