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Endoscopic Methods for Gallbladder Drainage

  • Pancreas (V Chandrasekhara, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

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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Correspondence to Shayan S. Irani MD.

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Conflict of interest

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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This article does not contain any studies with human or animal subjects performed by any of the authors.

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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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