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DOI: 10.1055/a-2132-5258
Simple endoscopic transpapillary gallbladder aspiration/irrigation using a double-pigtail plastic stent system
Endoscopic transpapillary gallbladder drainage (ET-GBD) using a double-pigtail plastic stent (DPPS) is an alternative intervention for patients with operable acute cholecystitis (AC) [1]. ET-GBD with nasobiliary drainage (NB) tube placement enables gallbladder aspiration/irrigation [1]. However, NB tubes can cause patient discomfort, become dislodged, and have short-term acceptability [1]. The clinical success rate of ET-GBD is unfavorable compared to that of percutaneous and endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) [1] [2] [3]. However, what if effective aspiration/irrigation were possible during plastic stent deployment? This study demonstrates simple gallbladder aspiration and irrigation during ET-GBD.
A 51-year-old woman with severe AC underwent an ET-GBD ([Fig. 1]). Balloon-occluded cholangiography demonstrated disruption of the cystic duct, which was compressed by edema. After standard cannula advancement over a 0.025-inch guidewire, viscous bile was never aspirated, even after guidewire withdrawal due to the small single hole on the cannula. We advanced the stent system, which consisted of a DPPS over the inner sheath (Advanix J, 7F, 10 cm; Boston Scientific, Marlborough, Massachusetts, United States) ([Fig. 2]a). Next, the inner sheath was retracted into the DPPS after guidewire removal. We then aspirated 40 mL of gallbladder contents using this stent system halfway through stent deployment. Subsequently, we irrigated and aspirated the gallbladder three times with 20 mL of contrast-containing saline ([Fig. 2]b, [Fig. 2]c). Finally, the inner sheath was completely withdrawn for the DPPS deployment ([Fig. 2]d).
This inner sheath retraction maneuver into the DPPS allowed one-step gallbladder aspiration/irrigation during DPPS deployment ([Video 1]). In addition, multiple side holes on the large-caliber DPPS facilitated replacement of viscous bile with saline, which might have improved the clinical success of ET-GBD. Moreover, these tips can be utilized during EUS-GBD using a DPPS, where a lumen-apposing metal stent (LAMS) is unavailable, although LAMS is recommended for EUS-GBD [4].
Qualität:
Publikationsverlauf
Eingereicht: 22. Mai 2023
Angenommen nach Revision: 11. Juli 2023
Artikel online veröffentlicht:
01. September 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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