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Single-operator peroral cholangioscopy cystic duct cannulation for transpapillary gallbladder stent placement in patients with acute cholecystitis at moderate to high surgical risk (with videos)

  • Author Footnotes
    ∗ Drs Ridtitid and Piyachaturawat contributed equally to this study.
    Wiriyaporn Ridtitid
    Footnotes
    ∗ Drs Ridtitid and Piyachaturawat contributed equally to this study.
    Affiliations
    Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand

    Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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  • Author Footnotes
    ∗ Drs Ridtitid and Piyachaturawat contributed equally to this study.
    Panida Piyachaturawat
    Footnotes
    ∗ Drs Ridtitid and Piyachaturawat contributed equally to this study.
    Affiliations
    Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
    Search for articles by this author
  • Nicha Teeratorn
    Affiliations
    Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand

    Department of Medicine, Buddhachinaraj Hospital, Phitsanulok, Thailand
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  • Phonthep Angsuwatcharakon
    Affiliations
    Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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  • Pradermchai Kongkam
    Affiliations
    Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
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  • Rungsun Rerknimitr
    Correspondence
    Reprint requests: Rungsun Rerknimitr, Professor of Medicine, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Rama 4 Road, Patumwan, Bangkok, 10330, Thailand.
    Affiliations
    Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand

    Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Ridtitid and Piyachaturawat contributed equally to this study.
Published:April 21, 2020DOI:https://doi.org/10.1016/j.gie.2020.03.3866

      Background and Aims

      One of the main reasons for failed endoscopic transpapillary gallbladder stenting (ETGS) under fluoroscopic guidance is the inability to cannulate the cystic duct. Single-operator peroral cholangioscopy (SOC)-assisted ETGS is an adjunct technique to facilitate ETGS. We aimed to demonstrate its efficacy.

      Methods

      Between 2015 and 2019, 104 patients with acute cholecystitis at moderate to high surgical risk underwent ETGS, which involved 3 steps: (1) cystic duct cannulation under fluoroscopic guidance with or without additional SOC guidance; (2) guidewire placement; and (3) stent placement in the gallbladder. The technical success rate was determined when stent placement was confirmed endoscopically and radiographically.

      Results

      Of 104 patients, 55 (53%) patients had successful ETGS under fluoroscopic guidance. Of 49 patients who had failed fluoroscopy-guided ETGS, 41 patients underwent additional SOC-assisted ETGS and 5 patients proceeded to other interventions. Of patients who underwent SOC-assisted ETGS (n = 41), 23 (56%) cystic cannulation followed by stent placement were successful; cystic duct cannulations, guidewire, and stent placement failed in 8, 9, and 1 patients, respectively. The overall technical success rate of ETGS increased from 53% (55 of 104) to 75% (78 of 104) after additional SOC assistance. Adverse events and recurrence were not different between patients who underwent ETGS under fluoroscopic guidance and those who underwent SOC-assisted ETGS.

      Conclusions

      In patients with acute cholecystitis who are not surgical candidates, SOC-assisted ETGS can increase the technical success rate after failed fluoroscopic guidance. SOC can help for the cystic duct cannulation and guidewire placement steps but not for the stent placement step.

      Abbreviations:

      CBD (common bile duct), CCI (Charlson’s comorbidity index), CI (confidence interval), ETGS (endoscopic transpapillary gallbladder stenting), OR (odds ratio), PAE (procedure-related adverse event), SOC (single-operator peroral cholangioscopy)
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