Endoscopic management of food impaction following endoscopic ultrasound-guided gallbladder drainage using lumen-apposing metal stent

A 61-year-old man was referred to our center for severe acute cholecystitis. Given his serious comorbidities (previous dissection of an aortic aneurysm with residual disease awaiting surgical reintervention; stage 3b chronic kidney disease; alcohol-related liver disease), the patient underwent transgastric endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a 10 × 10 mm lumen-apposing metal stent (LAMS) ([Fig. 1]). In the following months the patient experienced two episodes of food impaction of LAMS, which were treated endoscopically with placement of two double-pigtail plastic stents coaxially through the LAMS. Then, 3 months after the procedure, the patient was admitted for a third recurrence of acute cholecystitis. Computed tomography revealed a distended gallbladder, 19 cm in the long axis and completely occupied by food ([Fig. 2]). After a multidisciplinary evaluation, surgery was again excluded, and an endoscopic attempt was performed.

Fig. 1 Lumen-apposing metal stent placement (red arrow) for transantral gallbaldder drainage.

Fig. 2 Computed tomography image of food impaction within the gallbladder (red arrow).

The double-pigtail plastic stents and the obstructed LAMS were removed to gain access to the gallbladder, which was filled with food residue. The EndoRotor system (Micro-Tech Endoscopy, Ann Arbor, Michigan, USA) was used to simultaneously fragment and aspirate the impacted food ([Fig. 3]), resulting in removal of at least 600 mL of fragmented material ([Fig. 4]). The procedure was completed using polypectomy snares and retrieval nets ([Fig. 5]). Two double-pigtail plastic stents were placed through the fistulous tract ([Video 1]). No immediate adverse events occurred, and after 3 months’ follow-up there was no recurrence of acute cholecystitis.

Fig. 3 Endoscopic removal of food content from the gallbladder using the EndoRotor system (Micro-Tech Endoscopy, Ann Arbor, Michigan, USA).

Fig. 4 Material removed using the EndoRotor system (Micro-Tech Endoscopy, Ann Arbor, Michigan, USA).

Fig. 5 Endoscopic removal of food content from the gallbladder with a retrieval net.

Video 1 Endoscopic management using the EndoRotor system (Micro-Tech Endoscopy, Ann Arbor, Michigan, USA) for cholecystic food impaction following endoscopic ultrasound-guided gallbladder drainage.

EUS-GBD using LAMS is an effective treatment option for acute cholecystitis in fragile patients [1]. However, food impaction can lead to recurrence of acute cholecystitis and its management can be challenging [2]. The ability of EndoRotor to fragment and collect solid and semisolid material may therefore be an effective option beyond its use in gastrointestinal neoplastic lesion resection and necrosectomy of walled-off pancreatic necrosis [3] [4] [5].

Endoscopy_UCTN_Code_TTT_1AS_2AG

Publication History

Article published online:
01 March 2023

• References

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