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

Abstract

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.