Introduction
Endoscopic transpapillary gallbladder drainage (ETGBD) for acute cholecystitis has been effective for patients with ascites and bleeding tendencies. However, the success rate of ETGBD is lower than that of other endoscopic retrograde cholangiopancreatography-related procedures, and it is often difficult to complete the procedure.
Aims & Methods
This study aimed to investigate the outcomes of ETGBD in the management of acute cholecystitis at our hospital while offering some technical recommendations for the procedure. This was a retrospective study of 41 patients who had undergone ETGBD for acute cholecystitis at our hospital between January 2015 and July 2021.
Results
There were 28 males and 13 females, with a median age of 80 years (range, 58–91). Of these patients, 27 (65.9%) had mild ETGBD, 13 (31.7%) had moderate ETGBD, and one (2.4%) had severe ETGBD. The cases of intra-gallbladder, cholecystic duct, and common bile duct stones were found in 30 (73.2%), 13 (31.7%), and 16 (39.0%) patients, respectively. The types of cystic duct branching were merging of the upper (n = 36) and lower sides (n = 5), toward the head (n = 35) and foot sides (n = 6), and merging of the right (n = 34) and left sides (n = 7). The technical success rate was 95.1% (39 out of 41) (endoscopic nasobiliary stenting [n = 34] and endoscopic nasobiliary gallbladder drainage [n = 5]), and the clinical success rate was 100% (n = 39). The median treatment time was 30 minutes (range, 11–72). In the present study, difficult intubation was defined as failure to intubate the gallbladder using conventional devices. Among the 12 patients who experienced intrabiliary intubation difficulties, seven of them were able to be cannulated into the gallbladder with the SwingTipTM cannula (Olympus, Tokyo, Japan), which features a controllable catheter tip angle. In two patients whose bile duct stenosis was still difficult even with the SwingTipTM cannula, the long-tapered cannula (StarTipVTM, Olympus) was used to break through the stenosis. In one patient whose cholecystogram could not be obtained, a retrieval balloon for the above contrast was used to obtain a cholecystogram, and endoscopic transpapillary balloon sphincteroplasty was finally performed. Regarding factors influencing the difficulty of intubation of the gallbladder, multivariate analysis showed that "dilation of the common bile ducts (>10 mm)" was a significantly difficult factor.
Conclusion
Even though ETGBD is difficult in patients with dilated common bile ducts (≥10 mm), it could be performed relatively safely and effectively by using dedicated devices.