Abstract
Background
Cholecystostomy is commonly performed in high-risk patients with acute cholecystitis. However, internal drainage may be more desirable in patients as it is associated with lower complication rates. This paper describes an image-guided, percutaneous technique for internal gallbladder drainage using a covered lumen-apposing metal stent (LAMS) and assesses its feasibility and safety in a porcine model.
Methods
Procedures were performed on 30-kg pigs. Under ultrasound and fluoroscopic guidance, a percutaneous puncture was performed through-and-through the gallbladder into the stomach. A guidewire was placed and a 12Fr sheath was advanced through which a 10-mm LAMS was deployed. Its distal flange was deployed in the gastric lumen, and its proximal flange in the gallbladder. The cholecystoenteric anastomosis was examined by means of endoscopy, laparoscopy, and necropsy.
Results
Technical success was 100% (7/7). Procedure times decreased with experience and improvements in technique (median: 22 min). Contrast injection demonstrated free flow through the stent with no leakage. Necropsy confirmed appropriate stent position with good apposition of gallbladder and stomach, and no intraprocedural complications were detected.
Conclusions
Image-guided, percutaneous, internal gallbladder drainage using a LAMS is safe and feasible in a porcine model. This technique may be an alternative to endoscopic ultrasound-guided stent placement and external cholecystostomy tube drainage.
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References
Gomes CA, Junior CS, Saveiro SD, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Correa LD, Alves CB, Guimaraes SF (2017) Acute calculous cholecystitis: review of current best practices. World J Gastrointest Surg 9:118–126
Papis D, Khalifa E, Bhogal R, Nair A, Khan S, Hamady Z, Ahmed J, Marangoni G (2017) Is percutaneous cholecystostomy a good alternative treatment for acute cholecystitis in high-risk patients? Am Surg 83:623–627
Kim D, Iqbal SI, Ahari HK, Molgaard CP, Flacke S, Davison BD (2017) Expanding role of percutaneous cholecystostomy and interventional radiology for the management of acute cholecystitis: an analysis of 144 patients. Diagn Interv Imaging 99:15
Morse BC, Smith JB, Lawdahl RB, Roettger RH (2010) Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy. Am Surg 76:708–712
Binmoeller KF, Shah J (2011) A novel lumen-apposing stent for transluminal drainage of nonadherent extraintestinal fluid collections. Endoscopy 43:337–342
Patil R, Ona MA, Papafragkakis C, Anand S, Duddempudi S (2016) Endoscopic ultrasound-guided placement of the lumen-apposing self-expandable metallic stent for gallbladder drainage: a promising technique. Ann Gastroenterol 29:162–167
Zener R, Noel-Lamy M, Shlomovitz E (2017) Percutaneous lumen-apposing cholecystoduodenal stent insertion through a pre-existing fistula for internal drainage of the gallbladder in the setting of calculous cholecystitis. J Vasc Interv Radiol 28:1154–1155
Baron TH, Grimm IS, Swanstrom LL (2015) Interventional approaches to gallbladder disease. N Engl J Med 373:357–365
Alvino DML, Fong ZV, McCarthy CJ, Velmahos G, Lillemoe KD, Mueller PR, Fagenholz PJ (2017) Long-term outcomes following percutaneous cholecystostomy tube placement for treatment of acute calculous cholecystitis. J Gastrointest Surg 21:761–769
Lee TH, Park DH, Lee SS, Seo DW, Park SH, Lee SK, Kim MH, Kim SJ (2011) Outcomes of endoscopic transpapillary gallbladder stenting for symptomatic gallbladder diseases: a multicenter prospective follow-up study. Endoscopy 43:702–708
Turner BG, Rotman S, Paddu NU, Trost D, Jamal-Kabani A, Gaidhane M, Kahaleh M (2013) Cholecystoduodenal drainage and gallstone removal in a patient with cholecystitis and unresectable cholangiocarcinoma. Endoscopy 45(Suppl 2):E114–E115
Baron TH, Topazian MD (2007) Endoscopic transduodenal drainage of the gallbladder: implications for endoluminal treatment of gallbladder disease. Gastrointest Endosc 65:735–737
Walter D, Teoh AY, Itoi T, Perez-Miranda M, Larghi A, Sanchez-Yague A, Siersema PD, Vleggaar FP (2016) EUS-guided gall bladder drainage with a lumen-apposing metal stent: a prospective long-term evaluation. Gut 65:6–8
de la Serna-Higuera C, Perez-Miranda M, Gil-Simon P, Ruiz-Zorrilla R, Diez-Redondo P, Alcaide N, Sancho-del Val L, Nunez-Rodriguez H (2013) EUS-guided transenteric gallbladder drainage with a new fistula-forming, lumen-apposing metal stent. Gastrointest Endosc 77:303–308
Wasan SM, Kapadia AS, Adler DG (2005) EUS training and practice patterns among gastroenterologists completing training since 1993. Gastrointest Endosc 62:914–920
Zener R, Swanstrom LL, Shlomovitz E (2018) Anatomic feasibility of percutaneous cholecystoenteric fistula creation and stent insertion in acute cholecystitis. Surg Innov 25:339–345
Funding
Funding was provided through a research grant from Boston Scientific and the Institute of Image Guided Surgery, IHU, Strasbourg, France.
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Drs. M. Kostrzewa and R. Zener have no conflicts of interest or financial ties to disclose. Dr. L. Swanström and E. Shlomovitz are consultants for Boston Scientific.
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Kostrzewa, M., Zener, R., Swanström, L.L. et al. An alternative percutaneous technique for gallbladder drainage using lumen-apposing metal stents. Surg Endosc 34, 2512–2518 (2020). https://doi.org/10.1007/s00464-019-07060-x
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DOI: https://doi.org/10.1007/s00464-019-07060-x