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Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older.

Maekawa S, Nomura R, Murase T, Ann Y, Oeholm M, Harada M - BMC Gastroenterol (2013)

Bottom Line: The main outcome measure of this study was the efficacy of EGS.Permanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis.The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gastroenterological Medicine, Japan Labour Health and Welfare Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata 942-8502, Japan. s5083m@niirou.jp

ABSTRACT

Background: Endoscopic transpapillary pernasal gallbladder drainage and endoscopic gallbladder stenting (EGS) have recently been reported to be useful in patients with acute cholecystitis for whom a percutaneous approach is contraindicated. The aim of this study was to evaluate the efficacy of permanent EGS for management of acute cholecystitis in elderly patients who were poor surgical candidates.

Methods: We retrospectively studied 46 elderly patients aged 65 years or older with acute cholecystitis who were treated at Japan Labour Health and Welfare Organization Niigata Rosai Hospital. In 40 patients, acute cholecystitis was diagnosed by transabdominal ultrasonography and computed tomography, while 6 patients were transferred from other hospitals after primary management of acute cholecystitis. All patients underwent EGS, with a 7Fr double pig-tail stent being inserted into the gallbladder. If EGS failed, percutaneous transhepatic gallbladder drainage or percutaneous transhepatic gallbladder aspiration was subsequently performed. The main outcome measure of this study was the efficacy of EGS.

Results: Permanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis. The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13). In 30 of these 31 patients (96.7%), there was no recurrence of cholecystitis and 29 patients (93.5%) remained asymptomatic until death or the end of the study period (after 1 month to 5 years).

Conclusions: EGS can be effective for elderly patients with acute cholecystitis who are poor surgical candidates and can provide a solution for several years.

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Related in: MedlinePlus

A guidewire has been passed antegradely into the duodenum via the PTGBDroute (A), and EGS was performed by using the guidewire retrogradely(B).
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Figure 3: A guidewire has been passed antegradely into the duodenum via the PTGBDroute (A), and EGS was performed by using the guidewire retrogradely(B).

Mentions: We also performed elective EGS for the purpose of permanent placement in 6 patients(5 after PTGBD and 1 after conservative treatment) who were transferred from otherhospitals within 1 week after the onset of acute cholecystitis, and the procedurewassuccessful in all 6 patients. In 5 patients, EGS was done by passing the guidewireantegradely into the duodenum via the PTGBD route and then the guidewire was usedretrogradely (Figure 3). In 1 patient, EGS was done viaperoral cholangioscopy (POCS) with a GIF-XP260 (Olympus) because the cystic ductbranched caudally from the common bile duct and this was considered to be a verydifficult case for EGS. The procedure was started by inserting the GIF-XP260 intothe common bile duct after endoscopic sphincterotomy. We endoscopically explored thecystic duct and then easily inserted the guidewire and the cannula into the duct.Then the guidewire was advanced retrogradely through the cannula and coiled withinthe gallbladder. Afterwards, we exchanged the GIF-XP260 for the GIF-Q260, and adouble pigtail stent was advanced into the gallbladder over the wire (Additionalfile 3).


Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older.

Maekawa S, Nomura R, Murase T, Ann Y, Oeholm M, Harada M - BMC Gastroenterol (2013)

A guidewire has been passed antegradely into the duodenum via the PTGBDroute (A), and EGS was performed by using the guidewire retrogradely(B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3675408&req=5

Figure 3: A guidewire has been passed antegradely into the duodenum via the PTGBDroute (A), and EGS was performed by using the guidewire retrogradely(B).
Mentions: We also performed elective EGS for the purpose of permanent placement in 6 patients(5 after PTGBD and 1 after conservative treatment) who were transferred from otherhospitals within 1 week after the onset of acute cholecystitis, and the procedurewassuccessful in all 6 patients. In 5 patients, EGS was done by passing the guidewireantegradely into the duodenum via the PTGBD route and then the guidewire was usedretrogradely (Figure 3). In 1 patient, EGS was done viaperoral cholangioscopy (POCS) with a GIF-XP260 (Olympus) because the cystic ductbranched caudally from the common bile duct and this was considered to be a verydifficult case for EGS. The procedure was started by inserting the GIF-XP260 intothe common bile duct after endoscopic sphincterotomy. We endoscopically explored thecystic duct and then easily inserted the guidewire and the cannula into the duct.Then the guidewire was advanced retrogradely through the cannula and coiled withinthe gallbladder. Afterwards, we exchanged the GIF-XP260 for the GIF-Q260, and adouble pigtail stent was advanced into the gallbladder over the wire (Additionalfile 3).

Bottom Line: The main outcome measure of this study was the efficacy of EGS.Permanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis.The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gastroenterological Medicine, Japan Labour Health and Welfare Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata 942-8502, Japan. s5083m@niirou.jp

ABSTRACT

Background: Endoscopic transpapillary pernasal gallbladder drainage and endoscopic gallbladder stenting (EGS) have recently been reported to be useful in patients with acute cholecystitis for whom a percutaneous approach is contraindicated. The aim of this study was to evaluate the efficacy of permanent EGS for management of acute cholecystitis in elderly patients who were poor surgical candidates.

Methods: We retrospectively studied 46 elderly patients aged 65 years or older with acute cholecystitis who were treated at Japan Labour Health and Welfare Organization Niigata Rosai Hospital. In 40 patients, acute cholecystitis was diagnosed by transabdominal ultrasonography and computed tomography, while 6 patients were transferred from other hospitals after primary management of acute cholecystitis. All patients underwent EGS, with a 7Fr double pig-tail stent being inserted into the gallbladder. If EGS failed, percutaneous transhepatic gallbladder drainage or percutaneous transhepatic gallbladder aspiration was subsequently performed. The main outcome measure of this study was the efficacy of EGS.

Results: Permanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis. The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13). In 30 of these 31 patients (96.7%), there was no recurrence of cholecystitis and 29 patients (93.5%) remained asymptomatic until death or the end of the study period (after 1 month to 5 years).

Conclusions: EGS can be effective for elderly patients with acute cholecystitis who are poor surgical candidates and can provide a solution for several years.

Show MeSH
Related in: MedlinePlus