EUS-guided cholecystenterostomy: a new technique (with videos)

Background

The cornerstone of management for acute cholecystitis is cholecystectomy. However, surgical intervention is contraindicated in the occasional patient. EUS-guided transduodenal gallbladder drainage may represent an effective minimally invasive alternative.

Objectives

To describe a new technique, EUS-guided cholecystenterostomy.

Design and Setting

A single-center retrospective case series.

Patients

Three patients with severe acute cholecystitis unresponsive to conservative management who were deemed unfit for cholecystectomy.

Interventions

Under combined EUS and fluoroscopic guidance, cholecystenterostomy was performed via needle puncture, guidewire insertion, cystoenterostome passage, and stent placement.

Main Outcome Measures

Technical success, clinical progress, immediate and long-term complications, and recurrence of cholecystitis.

Limitations

Pilot series.

Results

Cholecystenterostomy was performed successfully in all patients. Rapid improvement in clinical status and inflammatory parameters ensued. A minor intraprocedural bile leak occurred in 1 patient, without significant clinical sequelae. Cholecystitis did not recur in any patient.

Conclusions

EUS-guided cholecystenteric drainage is technically feasible and appears to be a safe and effective procedure. Via this technique, gallbladder drainage and resolution of related sepsis may be achieved in patients with acute cholecystitis who are unfit for surgery.

Abbreviation: CRP, C-reactive protein