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Case Reports
. 2019 Sep-Oct;32(5):522-524.
doi: 10.20524/aog.2019.0384. Epub 2019 May 9.

Endoscopic ultrasound-guided gallbladder drainage by transduodenal lumen-apposing metal stent in a patient with Roux-en-Y reconstruction

Andrea Anderloni  1 , Alessandro Fugazza  1 , Luca Maroni  1   2 , Edoardo Troncone  1   3 , Olivia Milani  4 , Annalisa Cappello  1 , Asma Alkandari  5 , Alessandro Repici  1   6
Affiliations
Case Reports

Endoscopic ultrasound-guided gallbladder drainage by transduodenal lumen-apposing metal stent in a patient with Roux-en-Y reconstruction

Andrea Anderloni et al. Ann Gastroenterol. 2019 Sep-Oct.

Abstract

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is increasingly recognized as an effective and safe treatment option in patients with acute cholecystitis (AC) who are deemed unfit for cholecystectomy. Recent studies suggest that an endoscopic approach to biliary decompression may reduce patient discomfort and procedure-related costs compared with the standard percutaneous transhepatic GBD, while maintaining high rates of technical and clinical success. Here we present a case of a EUS-GBD in an elderly patient with AC and with altered anatomy due to a previous partial gastrectomy with Roux-en-Y reconstruction for gastric cancer. The linear array echoendoscope was carefully advanced within the afferent limb until EUS gallbladder visualization was achieved. Transmural GBD was then performed by placement of an electrocautery-enhanced lumen-apposing metal stent. If alternative treatments are precluded, EUS-GBD in patients with AC and altered anatomy is a feasible and effective therapeutic option when performed by experienced endoscopists.

Keywords: Endoscopic gallbladder drainage; altered anatomy; endoscopic ultrasound; lumen-apposing metal stent.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
(A) Electrocautery-enhanced advancement of the lumen apposing metal stent (EC-LAMS) under radiological guidance before deployment of the first flange. (B) Trans-duodenal endoscopic ultrasound view of the first flange deployment of the EC-LAMS in the gallbladder lumen
Figure 2
Figure 2
Final endoscopic view of the second flange of the electrocautery-enhanced lumen apposing metal stent in the duodenum after complete release of the stent
Figure 3
Figure 3
Control computed tomography scan documenting the correct positioning of the electrocautery-enhanced lumen apposing metal stent between the duodenal and the gallbladder lumen, partially filled with air and previously injected contrast agent
Figure 4
Figure 4
Graphical representation of trans-duodenal endoscopic ultrasound-guided gallbladder drainage in a patient with a Roux-en-Y reconstruction after partial gastrectomy
See this image and copyright information in PMC

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