Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Sep 23:14:164.
doi: 10.1186/1471-230X-14-164.

EUS assisted transmural cholecystogastrostomy fistula creation as a bridge for endoscopic internal gallbladder therapy using a novel fully covered metal stent

Nan Ge, Zhiguo Wang, Siyu Sun  1 , Sheng Wang, Guoxin Wang, Shiwei Sun, Linlin Feng, Fei Yang, Wenzhuang Ma, Shupeng Wang, Xiang Liu, Jintao Guo, Wen Liu
Affiliations

EUS assisted transmural cholecystogastrostomy fistula creation as a bridge for endoscopic internal gallbladder therapy using a novel fully covered metal stent

Nan Ge et al. BMC Gastroenterol. .

Abstract

Background: Laparoscopic cholecystectomy (LC) has become the "gold standard" for treating symptomatic gallstones. Innovative methods, such as a scarless therapeutic procedure through a natural orifice are being introduced, and include transgastric or transcolonic endoscopic cholecystectomy. However, before clinical implementation, instruments still need modification, and a more convenient treatment is still needed. The aim of this study was to evaluate the feasibility of endoscopic internal gallbladder therapy such as cholecystolithotomy in an animal survival model.

Methods: Four pigs underwent endoscopic-ultrasound (EUS)-guided cholecystogastrostomy and the placement of a novel covered mental stent. Four weeks later the stents were removed and an endoscope was advanced into the gallbladder via the fistula, and cholecystolithotomy was performed. Two weeks later the pigs were sacrificed, and the healing of the fistulas was assessed.

Results: EUS-guided cholecystogastrostomy with mental stent deployment was successfully performed in all the animals. Four weeks after the procedure, the fistulas had formed and all the stents were removed. Endoscopic cholecystolithotomy was performed through each fistula. All the animals survived until they were sacrificed 2 weeks later. The fistulas were found to be completely healed.

Conclusions: This study reports the first endoscopic transmural cholecystolithotomy after placement of a novel mental stent in an animal survival model.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The covered mental stent.
Figure 2
Figure 2
Cholecystogastrostomy. a. Endoscopy needle piercing the gallbladder. b. Dilation of the needle path using the cystotome, with a large amount of bile leakage. c. Endoscopic view of the deployed stent. d. Endoscopic ultrasound image of the deployed stent.
Figure 3
Figure 3
Gastric transmural cholecystolithotomy. a. Endoscopic view of the deployed stent. b. A fistula was formed after stent removal. c. Endoscopic view of the gallbladder cavity. d. After the gallbladder was emptied of contents, the neck was clearly viewed by endoscope.
Figure 4
Figure 4
Necropsy. a. The stoma in the stomach was well healed 2 weeks after stent removal. b. The stoma in the gallbladder was well healed 2 weeks after stent removal. c. After the fistula was healed, the gastric and gallbladder walls were attached to each other by a short band of connective tissue.
See this image and copyright information in PMC

References

    1. Begos DG, Modlin IM. Laparoscopic cholecystectomy: from gimmick to gold standard. J Clin Gastroenterol. 1994;19(4):325–330. doi: 10.1097/00004836-199412000-00015. - DOI - PubMed
    1. Sain AH. Laparoscopic cholecystectomy is the current “gold standard” for the treatment of gallstone disease. Ann Surg. 1996;224(5):689–690. doi: 10.1097/00000658-199611000-00019. - DOI - PMC - PubMed
    1. Voermans RP, van Berge Henegouwen MI, Bemelman WA, Fockens P. Feasibility of transgastric and transcolonic natural orifice transluminal endoscopic surgery peritoneoscopy combined with intraperitoneal EUS. Gastrointest Endosc. 2009;69(7):e61–e67. doi: 10.1016/j.gie.2009.01.043. - DOI - PubMed
    1. Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, Thompson CC. Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video) Gastrointest Endosc. 2006;64(3):428–434. doi: 10.1016/j.gie.2006.06.079. - DOI - PubMed
    1. Luo H, Pan Y, Min L, Zhao L, Li J, Leung J, Xue L, Yin Z, Liu X, Liu Z, Liu Z, Sun A, Li C, Wu K, Guo X, Fan D. Transgastric endoscopic gastroenterostomy using a partially covered occluder: a canine feasibility study. Endoscopy. 2012;44(5):493–498. doi: 10.1055/s-0031-1291689. - DOI - PubMed
Pre-publication history
    1. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-230X/14/164/prepub

Publication types

LinkOut - more resources