Abstract
Purpose of review
Acute cholecystitis is conventionally managed with cholecystectomy; however, when this occurs in the non-operative patient, it requires consideration for alternative means of gallbladder drainage (GBD).
Recent findings
Suitable endoscopic methods for GBD include transpapillary cystic duct stent or endoscopic ultrasound (EUS)-guided transmural stent placement. Importantly, patients who undergo endoscopic GBD have comparable outcomes to those who undergo placement of percutaneous transhepatic catheters by interventional radiology (IR).
Summary
There is evolving evidence to support endoscopic gallbladder drainage by EUS or ERCP with transpapillary stenting for patients who are non-operative candidates. There appear to be advantages over percutaneous drainage in terms of lower rates of recurrent cholecystitis, faster clinical resolution of symptoms, and omission of external drain-related complications. However, careful consideration of individual characteristics is warranted in the care of these complicated patients. The technical and clinical considerations for endoscopic methods of GB drainage are discussed in this review article.
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Abbreviations
- CCY:
-
Cholecystectomy
- CT:
-
Computed tomography
- EUS-GBD:
-
Endoscopic ultrasound-guided gallbladder drainage
- ET-GBD:
-
Endoscopic transpapillary gallbladder drainage
- Fr:
-
French
- LAMS:
-
Lumen-apposing metal stent
- PT-GBD:
-
Percutaneous transhepatic gallbladder drainage
- SEMS:
-
Self-expandable metal stents
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Jennifer T. Higa declares that she has no conflict of interest.
Shayan S. Irani declares that he has no conflict of interest.
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Key points
• Endoscopic gallbladder drainage is a feasible and efficacious alternative to percutaneous drainage in the management of acute cholecystitis for high-risk surgical candidates.
• EUS-guided gallbladder drainage and per-oral cholecystoscopy are facilitated by the use of lumen-apposing metal stents.
• Multidisciplinary collaboration with IR and surgery is paramount in the care of these patients.
• Choosing the optimal drainage method is dependent on individual patient characteristics.
This article is part of the Topical Collection on Pancreas
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Higa, J.T., Irani, S.S. Endoscopic Methods for Gallbladder Drainage. Curr Treat Options Gastro 17, 357–366 (2019). https://doi.org/10.1007/s11938-019-00243-4
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DOI: https://doi.org/10.1007/s11938-019-00243-4