Cholecystostomy Research Articles

Urgent versus elective laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for high-risk grade II acute cholecystitis

Urgent versus elective laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for high-risk grade II acute cholecystitis

Author commentary on Hae Won Yoo et al.

Hae Won Yoo et al. Peroral cholecystoscopy using a multibending ultraslim endoscope through a lumen-apposing metal stent for endoscopic ultrasound-guided gallbladder drainage: a feasibility study

Effect of Preserving the Percutaneous Gallbladder Drainage Tube Before Laparoscopic Cholecystectomy on Surgical Outcome: Post Hoc Analysis of the CSGO-HBP-017

BackgroundWhen percutaneous transhepatic gallbladder drainage (PTGBD) is followed by laparoscopic cholecystectomy (LC), there is no consensus regarding whether the drainage tube should be preserved or removed before LC. We hypothesized that the surgical results of LC might differ between cases with PTGBD tube preservation versus removal. Here, we investigated how drainage tube preservation or removal affected the surgical outcome of LC. MethodsUsing data from our previous multicenter study, we compared LC outcomes after PTGBD between patients with PTGBD tube preservation versus removal. This study included 208 patients who underwent LC over 12 days after PTGBD. In 83 cases, the PTGBD tube was preserved until LC, and in 125 cases, the tube was removed before LC. The results were verified by propensity score matching with 50 patients in each group. ResultsCases with tube preservation versus removal exhibited significantly longer surgery duration (174 ± 105 min vs 145 ± 61 min, P = .0118) and postoperative hospital stay (14 ± 16 days vs 7 ± 7 days, P < .0001), a significantly higher postoperative complication rate (13.2% vs 3.2%, P = .0061), and a marginally higher incidence of open conversion (12.0% vs 4.8%, P = .0547). Propensity score matching verified the inferior surgical outcomes in cases with tube preservation. ConclusionsThese results imply that when LC is performed > 12 days after PTGBD, the surgical outcome may be inferior when the drainage tube is preserved rather than removed before LC.

Preoperative risk score to predict subtotal cholecystectomy after gallbladder drainage for acute cholecystitis: Secondary analysis of data from a multi-institutional retrospective study (CSGO-HBP-017B).

Subtotal cholecystectomy (STC) has become recognized as a "bailout procedure" to prevent bile duct injury in patients undergoing laparoscopic cholecystectomy (LC). Predictors of conversion to STC have not been identified because LC difficulty varies based on pericholecystic inflammation. We analyzed data from patients enrolled in a previously performed multi-institutional retrospective study of the optimal timing of LC after gallbladder drainage for acute cholecystitis (AC). These patients presumably had a considerable degree of pericholecystic inflammation. In total, 347 patients who underwent LC after gallbladder drainage for AC were analyzed to examine preoperative and perioperative factors predicting conversion to STC. Three hundred patients underwent total cholecystectomy (TC) and 47 underwent conversion to STC. Eastern Cooperative Oncology Group Performance Status (ECOG PS) (P< .01), severity of cholecystitis (P= .04), previous history of treatment for common bile duct stones (CBDS) (P< .01), and surgeon experience (P= .03) were significantly associated with conversion to STC. Logistic regression analyses showed that ECOG PS (odds ratio 0.2; P< .0001) and previous history of treatment for CBDS (odds ratio 0.37; P= .0073) were independent predictors of conversion to STC. Our predictive risk score using these two variables suggested that a score ≥2 could discriminate between TC and STC (P< .0001). Poor ECOG PS and previous history of treatment for CBDS were significantly associated with conversion to STC after gallbladder drainage for AC.

Feasibility of therapeutic endoscopic ultrasound in the bridge-to-surgery scenario: The example of pancreatic adenocarcinoma.

Upfront resection is becoming a rarer indication for pancreatic ductal adenocarcinoma, as biologic behavior and natural history of the disease has boosted indications for neoadjuvant treatments. Jaundice, gastric outlet obstruction and acute cholecystitis can frequently complicate this window of opportunity, resulting in potentially deleterious chemotherapy discontinuation, whose resumption relies on effective, prompt and long-lasting management of these complications. Although therapeutic endoscopic ultrasound (t-EUS) can potentially offer some advantages over comparators, its use in potentially resectable patients is primal and has unfairly been restricted for fear of potential technical difficulties during subsequent surgery. This is a narrative review of available evidence regarding EUS-guided choledochoduodenostomy, gastrojejunostomy and gallbladder drainage in the bridge-to-surgery scenario. Proof-of-concept evidence suggests no influence of t-EUS procedures on outcomes of eventual subsequent surgery. Moreover, the very high efficacy-invasiveness ratio over comparators in managing pancreatic cancer-related symptoms or complications can provide a powerful weapon against chemotherapy discontinuation, potentially resulting in higher subsequent resectability. Available evidence is discussed in this short paper, together with technical notes that might be useful for endoscopists and surgeons operating in this scenario. No published evidence supports restricting t-EUS in potential surgical candidates, especially in the setting of pancreatic cancer patients undergoing neoadjuvant chemotherapy. Bridge-to-surgery t-EUS deserves further prospective evaluation.

Gallbladder Cancer with Acute Cholecystitis Diagnosed by Cholecystoscopy via Percutaneous Transhepatic Gallbladder Drainage

Gallbladder Cancer with Acute Cholecystitis Diagnosed by Cholecystoscopy via Percutaneous Transhepatic Gallbladder Drainage

GALLBLADDER PERFORATION: EXPERIENCE OF 35 CASES AT A TERTIARY CARE HOSPITAL

Introduction: Gall bladder stone disease is one of the commonest hepatobiliary disease encountered in any general surgical outdoor worldwide especially in fertile females who are obese and in their 4th or 5th decade of life. One of the complications can be gallbladder perforation, although can be a sequel to acalcular cholecystitis. In India, incidence of Gall bladder perforation is estimated to be around 4%. There has been a marked increase in the incidence of the gallstone in the West during the past century. Material and Methods: The aim of our study was to highlight the Etiopathogenesis, Diagnosis, Management and Complications of gall bladder perforations. Results: In our study 35 patients were studied ageing between 25-80 years of age with a mean age of 54.3+14.53 years. Majority of our study patients i.e. 13 (37.1%) aged &gt;60 years. Type 2 GB perforation was seen in 30 (85.7%) patients, followed by Type 1 in 3 (86% patients while as 2 (5.7%) patients were found to have Type 3 GB perforation. Percutaneous drainage of gall bladder was done in majority 30 (85.7%) patients. Conclusion: Type II gallbladder perforation is the most common type. Contrast- enhanced CT has an important role in diagnosing gallbladder perforation. Early suspicion, diagnosis, and appropriate management are of crucial importance for a better outcome in patients with gall bladder perforation.

Ultimate outcomes of three modalities for non-surgical gallbladder drainage in acute cholecystitis with or without concomitant common bile duct stones.

Backgrounds/AimsIn moderate and high-surgical risk patients with acute cholecystitis, studies comparing percutaneous cholecystostomy (PC) vs. endoscopic transpapillary gallbladder stenting (ETGS) vs. endoscopic ultrasound-guided transmural gallbladder stenting (EUGS) are limited. Thus, the aim of this study was to compare efficacy and recurrence of cholecystitis after PC, ETGS, or EUGS during follow-up.MethodsWe reviewed 143 moderate and high-surgical risk patients with acute cholecystitis with or without concomitant common bile duct stones who underwent PC, ETGS, or EUGS at our hospital. Technical success rate (TSR), clinical success rate (CSR), and recurrence were compared.ResultsTSR in PC or EUGS group was higher than that in the ETGS group for those with concomitant common bile duct stones (100% vs. 100% vs. 73.2%; p = 0.07) and for those without concomitant common bile duct stones (100% vs. 100% vs. 77.3%; p < 0.001). CSR in ETGS or EUGS group was higher than that in the PC group for those with concomitant common bile duct stones (96.2% vs. 100% vs. 87.5%; p = 0.41) and for those without concomitant common bile duct stones (94.1% vs. 100% vs. 63.0%; p = 0.006). Using Kaplan–Meier analysis, the overall recurrent risk was the highest in the PC group (p = 0.004).ConclusionsIn moderate and high-surgical risk patients with acute cholecystitis, EUGS provides significantly higher CSR with comparable TSR to PC. Thus, ETGS should be the first choice in those with concomitant common bile duct stones. Among the three patient groups, those who received PC had the highest rate of recurrence.

The Evolution of Cholecystitis: A Global Productivity and Publication Trends: Bibliometric Analysis of Cholecystitis

Objective: There is still no bibliometric study on Cholecystitis, although the literature has an increasing number of global studies. This study aims to analyse the scientific articles published on Cholecystitis between 1980 and 2020 using statistical methods. Material and Methods: Articles on Cholecystitis published between 1980 and 2020 were downloaded using the Web of Science (WoS) database and analysed using statistical and bibliometric methods. Spearman correlation coefficient was used for correlation analyses. Non-linear (exponential model) regression analysis was used to predict the number of publications in the coming years. Keyword network visualisation maps were used to identify trend topics. Results: A total of 5052 publications were found. 3174 (62.8%) of these publications, were articles. The top 2 countries that contributed most to the literature were the USA (788, 24.8%) and Japan (303, 9.5%). The most active top 3 institutions were Teikyo University (n=35), Washington University (35), and Seoul National University (27). The top 3 journals with the highest number of publications were Khirurgiya (n=124), American Surgeon (71), and Vestnik Khirurgii Imeni II Grekova (69). According to the average number of citations per article, the most influential journals were Annals of Surgery (Citation: 87), Radiology (61.6), and Journal of Hepato-Biliary-Pancreatic Surgery (56.9), respectively. Conclusion: This comprehensive study on Cholecystitis, which has increased the number of articles in recent years, presented summary information of 3174 articles. Results can be said that the trend topics in cholecystitis studies in recent years are Tokyo guidelines, C-reactive protein, gallbladder drainage, emergency surgery, emergency cholecystectomy, cystic duct, choledocholithiasis, inflammation, acute cholecystitis, delayed laparoscopic cholecystectomy, and percutaneous transhepatic gallbladder drainage/aspiration. This article may be a useful resource for clinicians and scientists on global outputs of cholecystitis.

What makes acute cholecystitis recur after removing the percutaneous cholecystostomy tube?

Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative treatment option for acute cholecystitis. However, the disease may recur after PTGBD catheter removal. This study aimed to evaluate the role of endoscopic sphincterotomy and other risk factors in reducing the recurrence of cholecystitis.We retrospectively analyzed data from 1088 patients who underwent PTGBD for cholecystitis at Kyungpook National University Hospital, Republic of Korea, between January 2011 and April 2018.A total of 115 patients were enrolled in the study. The recurrence rate of cholecystitis was 17.4% (n = 20) during a median follow-up period of 1159 (range, 369–2774) days. Endoscopic biliary sphincterotomy did not significantly affect the recurrence rate of cholecystitis (P = .561). In multivariable analysis, cystic duct stones (P = .013) and PTGBD catheter migration before the prescheduled removal time (P = .002) were identified as independent risk factors for cholecystitis recurrence after PTGBD.To reduce post-PTGBD recurrence in cholecystitis, caution must be exercised to avoid inadvertent dislodging of the PTGBD catheter. In cases of cholecystitis with cystic duct stones, cholecystectomy should be considered only after careful assessment of postoperative risks. Instead, transluminal endoscopic gallbladder drainage could represent a promising option for the prevention of recurrent cholecystitis.

Change in quality of life between primary laparoscopic cholecystectomy and laparoscopic cholecystectomy after percutaneous transhepatic gall bladder drainage.

One of the most important reasons for avoiding percutaneous transhepatic gall bladder drainage (PTGBD) is the deterioration of quality of life (QOL). However, there is no study comparing the QOL between primary laparoscopic cholecystectomy (LC) and LC following PTGBD.Among the LC patients, 69 non-PTGBD patients and 21 PTGBD patients were included after excluding the patients with malignant disease or who needed additional common bile duct procedures. Clinicopathologic characteristics and surgical outcomes were compared. QOL was evaluated with questionnaire EORCT-C30 before and after surgery.The included patients comprised 69 non-PTGBD and 21 PTGBD patients. The PTGBD group include older and higher morbid patients. PTGBD group needed longer operation times than the non-PTGBD group (72.4±34.7 minute vs 52.8±22.0 minute, P = .022) Regarding the overall incidence of complication, the PTGBD group had a significantly higher complication rate than the non-PTGBD group (38.1% vs 10.1%, P = .003) However, there was no significant difference in severe complication). Regarding the QOL, both the functional and global health scales were improved following surgery compared to the preoperative evaluation. Comparative analysis of the 2 groups showed no significant difference in global heath scale either preoperative or postoperatively, while the functional scale and emotional scale were better in the PTGBD group compared to the non-PTGBD group. Regarding the symptom scale, postoperative dyspnea and perioperative diarrhea were better in the PTGBD group.LC following an interval from earlier PTGBD that targets acute cholecystitis or complicated GB had little to no impact on QOL when compared to standard LC.

The Diagnosis and Treatment of Acute Cholecystitis

Acute cholecystitis (AC), defined as inflammation of the gallbladder, is mainly caused by gallstones. Over 90% of AC results from obstruction of the cystic duct by stones or sludge, which subsequently increases the intraluminal pressure within the gallbladder and, in conjunction with the presence of bile supersaturated with cholesterol, activates an acute inflammatory cascade. Clinical features play an important role in the diagnosis of AC. The Tokyo Guidelines 2018 for acute cholecystitis designates the presence of local inflammatory signs and systemic inflammatory signs for a suspected diagnosis. It requires confirmation by radiological imaging along with these two factors for a definitive diagnosis. Thanks to less invasiveness, easy availability, ease of use, and cost-effectiveness, ultrasound (US) is usually accepted as the first choice in suspicious AC patients. A meta-analysis comparing methods of diagnosis for AC reported that the US has 81% of sensitivity and 83% of specificity. Abdominal computed tomography is recommended for diagnosing emphysematous or gangrenous cholecystitis. Meanwhile, acute acalculous cholecystitis (AAC) is a life-threatening disease mainly in severely ill patients. It usually affects the patients hospitalized for multiple trauma, burns, cardiopulmonary bypass surgery, long-term total parenteral nutrition or sepsis. The diagnosis of AAC is quite challenging and requires a high index of suspicion. Currently, cholecystectomy is the treatment of choice for AC, although the optimal time for surgery is still controversial. Due to high morbidity and mortality in high surgical risk groups, percutaneous gallbladder drainage can be a safe and feasible alternative to cholecystectomy, particularly for patients unfit for the surgery.

Effectiveness of Short-Course Antibacterial Therapy on Acute Cholecystitis after Successful Percutaneous Transhepatic Gallbladder Drainage: A Retrospective Study.

Background: The aim of this study was to evaluate the outcome of short- and long-course antibacterial therapy after successful percutaneous transhepatic gallbladder drainage in patients with mild to moderate acute cholecystitis. Patients and Methods: We compared the effect of short-course antibacterial therapy retrospectively (SCT; ≤3 days) and long-course antibacterial therapy (LCT; ≥4 days) after successful drainage of acute cholecystitis. The study outcomes involved three-month recurrence and 30-day mortality rates, as well as hospital stay length. Results: We included 132 patients with acute cholecystitis who underwent successful percutaneous transhepatic gallbladder drainage (PTGBD) and excluded 174 patients. We then grouped these patients (78 males and 54 females), according to the duration of antibacterial therapy. Short- and long-course antibacterial therapy groups comprised 54 (40.9%) and 78 (59.1%) patients, respectively. We did not observe significant differences in the three-month recurrence (p = 0.761) and 30-day mortality (p = 0.151) rates between these groups and observed only two deaths in the LCT group. The median hospital stay for the SCT group was six days (interquartile range [IQR], 5-7 days), compared with nine days (IQR, 8-10 days) for the LCT group (p < 0.001). Conclusions: A duration of three days or less of antibacterial therapy may be adequate for patients with mild to moderate acute cholecystitis after successful PTGBD.

Optimal timing of percutaneous transhepatic gallbladder drainage and subsequent laparoscopic cholecystectomy according to the severity of acute cholecystitis.

Backgrounds/AimsThe optimal timing of percutaneous transhepatic gallbladder drainage (PTGBD) and subsequent laparoscopic cholecystectomy (LC) according to the severity of acute cholecystitis (AC) has not been established yet.MethodsThis single-center, retrospective study included 695 patients with grade I or II AC without common bile duct stones who underwent PTGBD and subsequent LC between January 2010 and December 2019. Difficult surgery (DS) (open conversion, subtotal cholecystectomy, adjacent organ injury, transfusion, operation time ≥ 90 minutes, or estimated blood loss ≥ 100 mL) and poor postoperative outcome (PPO) (postoperative hospital stay ≥ 7 days or Clavien-Dindo grade ≥ II postoperative complication) were defined to comprehensively evaluate intraoperative and postoperative outcomes, respectively.ResultsOf 695 patients, 403 had grade I AC and 292 had grade II AC. According to the receiver operating characteristic curve and multivariate logistic regression analyses, an interval from symptom onset to PTGBD of > 3.5 days and an interval from PTGBD to LC of > 7.5 days were significant predictors of DS and PPO, respectively, in grade I AC. In grade II AC, the timing of PTGBD and subsequent LC were not statistically related to DS or PPO.ConclusionsIn grade I AC, performing PTGBD within 3.5 days after symptom onset can reduce surgical difficulties and subsequently performing LC within 7.5 days after PTGBD can improve postoperative outcomes. In grade II AC, early PTGBD cannot improve the surgical difficulty. In addition, the timing of subsequent LC is not correlated with surgical difficulties or postoperative outcomes.

Experimental study of a physician-controlled electrocautery-enhanced delivery system incorporating a newly developed lumen-apposing metal stent for interventional endoscopic ultrasound (with videos).

Although the lumen-apposing metal stent (LAMS) is useful for interventional endoscopic ultrasound (EUS) procedures, there has been some concern about the potential for stent-induced adverse events because of the high lumen-apposing force. A newly designed LAMS with less lumen-apposing force has been developed for use with a physician-controlled electrocautery-enhanced delivery system. The aim of this animal study was to evaluate the feasibility of performing interventional EUS using this newly designed LAMS system. Endoscopic ultrasound-guided cystogastrostomy was performed using the novel LAMS three times in a wet simulation model. EUS-guided gastroenterostomy and EUS-guided gallbladder drainage were then performed using the system in four pigs. The LAMS was successfully placed in all three EUS-guided cystogastrostomy procedures using the wet simulation model and in all four EUS-guided gastroenterostomy and gallbladder drainage procedures in the animal model. In the 3weeks following the procedure, eating behavior was normal in all animals and there were no adverse events. The stents remained patent during this time and were removed without difficulty. The fistula was mature in all cases and a standard upper gastrointestinal endoscope was easily advanced via the fistula to observe the afferent and efferent loops or the lumen of the gallbladder. Necropsy confirmed complete adhesion between the stomach and the wall of the jejunum or gallbladder. Our study findings demonstrate the feasibility of this new LAMS system and its potential clinical value for interventional EUS.

Safety assessment of dextrin hydrogel adhesion barrier (AdSpray®) for elective laparoscopic cholecystectomy

ObjectiveAdhesion barriers have not traditionally been used during laparoscopic cholecystectomy (lap-chole), and so there are no data confirming the safety of the dextrin hydrogel adhesion barrier (AdSpray®) for the use during lap-chole. The aim of this prospective study is to investigate the safety of AdSpray® for elective lap-chole. MethodsBetween July 2019 and March 2021, we conducted a prospective study at Saiseikai Kumamoto Hospital to assess the safety of applying AdSpray® around the hepatoduodenal ligament, liver surface, and port area after extraction of the gallbladder during elective lap-chole. We assessed patient morbidity, mortality, and laboratory data on postoperative day 1 and at the outpatient follow-up visit. ResultsA total of 100 patients (43 men, 57 women) received AdSpray® application during elective lap-chole at our institution. The mean patient age was 56.5 ± 14.8 y, and the mean body mass index was 25.1 ± 4.8 kg/m2. Preoperative gallbladder drainage was performed in 3 (3.0%) patients as conservative treatment for acute cholecystitis. The mean operative time was 91.7 ± 35.1 min, and the median blood loss was 5 mL (range, 5–120 mL). Intraoperative gallbladder perforation was observed in 4.0% of patients (n = 4). There was no intraoperative bile duct injury. One (1.0%) patient had a postoperative subhepatic fluid collection without bacterial infection. The mean white blood cell count and C-reactive protein level was significantly elevated on postoperative day 1 but returned to preoperative levels by the time of the follow-up visit. All patients were successfully discharged after surgery, and the median postoperative hospital stay was 2 d (range, 2–9 d). ConclusionApplying AdSpray® during elective lap-chole is safe, with an acceptable rate of postoperative complications.

Design and validation of a therapeutic EUS training program using a live animal model: Taking training to the next level

Background and Objectives: EUS has evolved into a therapeutic modality for gastrointestinal disorders. Simulators, ex vivo models, and phantoms are the current teaching methods for therapeutic EUS (TEUS). We create and evaluate a high-fidelity simulated live animal model (HiFi SAM) for teaching endoscopists TEUS. Materials and Methods: Designing a curriculum that uses HiFi SAM and enables trainees to perform realistic procedures with expert mentors. Results: Twenty-seven trainees participated in a 3-day program with 6 h of theoretical and 14 h of hands using life HiFi SAM. Eighteen experts participated. Twenty-two (20–25) TEUS were defined for each HiFi SAM, and 616 were performed in all. Of 616/264 (43%) were evaluated with a mean of 88 per course (ranging between 80 and 95). Ninety-one percent (240/264) of the procedures were completed successfully. In 24, success was not achieved due to technical and/or model problems. Student rating of HiFi SAM was: 71% excellent rating (scale 8–10) and 95% excellent/good. The HiFi SAM procedure evaluation was (scale 1–5): fine-needle biopsy: 4.79, radiofrequency: 4.76, common bile duct and gallbladder drainage: 4.75, cystic drainages: 4.72, neurolysis: 4.55, microbiopsy: 4.50, and hepatogastric drainage: 4.04, with an overall satisfaction rate of 4.56 (91%). A short survey showed: 83% would recommend absolutely (17% most likely), 33% think that ITEC training was sufficient for their practice, and 66% would like additional training, especially more practice in specific techniques rather than more clinical case discussion. Regarding impact on their practice, 66% of the trainees started a new procedure and/or noted improvement in previous ones. Conclusion: HiFi SAM is a complex model; however, experts and trainees are satisfied with the training this new curriculum provided.

Design and validation of a therapeutic EUS training program using a live animal model: Taking training to the next level.

ABSTRACTBackground and Objectives:EUS has evolved into a therapeutic modality for gastrointestinal disorders. Simulators, ex vivo models, and phantoms are the current teaching methods for therapeutic EUS (TEUS). We create and evaluate a high-fidelity simulated live animal model (HiFi SAM) for teaching endoscopists TEUS.Materials and Methods:Designing a curriculum that uses HiFi SAM and enables trainees to perform realistic procedures with expert mentors.Results:Twenty-seven trainees participated in a 3-day program with 6 h of theoretical and 14 h of hands using life HiFi SAM. Eighteen experts participated. Twenty-two (20–25) TEUS were defined for each HiFi SAM, and 616 were performed in all. Of 616/264 (43%) were evaluated with a mean of 88 per course (ranging between 80 and 95). Ninety-one percent (240/264) of the procedures were completed successfully. In 24, success was not achieved due to technical and/or model problems. Student rating of HiFi SAM was: 71% excellent rating (scale 8–10) and 95% excellent/good. The HiFi SAM procedure evaluation was (scale 1–5): fine-needle biopsy: 4.79, radiofrequency: 4.76, common bile duct and gallbladder drainage: 4.75, cystic drainages: 4.72, neurolysis: 4.55, microbiopsy: 4.50, and hepatogastric drainage: 4.04, with an overall satisfaction rate of 4.56 (91%). A short survey showed: 83% would recommend absolutely (17% most likely), 33% think that ITEC training was sufficient for their practice, and 66% would like additional training, especially more practice in specific techniques rather than more clinical case discussion. Regarding impact on their practice, 66% of the trainees started a new procedure and/or noted improvement in previous ones.Conclusion:HiFi SAM is a complex model; however, experts and trainees are satisfied with the training this new curriculum provided.

EUS-guided gallbladder drainage as a treatment for acute perforated cholecystitis.

Acute perforated cholecystitis is a rare but severe complication of acute cholecystitis. Currently, EUS-GBD using LAMS is the preferred choice for gallbladder drainage in high-risk surgical patients with acute cholecystitis unfit for cholecystectomy. However, it has been suggested to avoid this procedure when there is suspicion of gallbladder perforation or necrosis. The evidence of EUS-GBD in this setting is scarce. Our case demonstrates that EUS-GBD with LAMS can be effective in the management of type II perforation of the gallbladder.

Endoscopic transpapillary gallbladder drainage using a novel, 5-Fr plastic stent with a spiral-shaped tip

Endoscopic transpapillary gallbladder drainage using a novel, 5-Fr plastic stent with a spiral-shaped tip