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

par Kwan, Vu;Eisendrath, Pierre ;Antaki, Fadi;Le Moine, Olivier ;Devière, Jacques
Référence Gastrointestinal endoscopy, 66, 3, page (582-586)
Publication Publié, 2007-09

Article révisé par les pairs

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Résumé :

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.