Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2017; 23(4): 661-667
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.661
Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent
Ken Kamata, Mamoru Takenaka, Masayuki Kitano, Shunsuke Omoto, Takeshi Miyata, Kosuke Minaga, Kentaro Yamao, Hajime Imai, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Masatoshi Kudo
Ken Kamata, Mamoru Takenaka, Masayuki Kitano, Shunsuke Omoto, Takeshi Miyata, Kosuke Minaga, Kentaro Yamao, Hajime Imai, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
Author contributions: All authors helped to perform the research; Kamata K and Takenaka M wrote the manuscript and analyzed the data; Kamata K performed the procedures; Takenaka M drafted the conception and design; Kitano M, Omoto S, Miyata T, Minaga K, Yamao K, Imai H, Sakurai T, Watanabe T, Nishida N and Kudo M contributed to writing the manuscript; Kitano M and Kudo M also contributed to drafting conception and design.
Supported by the Japan Society for the Promotion of Science and the Japanese Foundation for the Research and Promotion of Endoscopy No. 22590764 and No. 25461035.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Kindai University Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mamoru Takenaka, MD, PhD, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. mamoxyo45@gmail.com
Telephone: +81-72-3660221 Fax: +81-72-3672880
Received: October 5, 2016
Peer-review started: October 7, 2016
First decision: November 9, 2016
Revised: November 15, 2016
Accepted: December 2, 2016
Article in press: December 2, 2016
Published online: January 28, 2017
Processing time: 106 Days and 0.4 Hours
Abstract
AIM

To assess the long-term outcomes of this procedure after removal of self-expandable metal stent (SEMS). The efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with SEMS were also assessed.

METHODS

Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUS-GBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. The SEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured.

RESULTS

The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient (8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d (78-1492).

CONCLUSION

EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.

Keywords: Endoscopic ultrasound-guided gallbladder drainage; Cholecystitis; Endoscopic ultrasound-guided biliary drainage

Core tip: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) was recently used to treat acute cholecystitis. The aim of this study was to assess the utility of removal of self-expandable metal stent (SEMS) at 4-wk after EUS-GBD. Twelve patients with acute calculous cholecystitis underwent EUS-GBD with a SEMS. The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. Recurrence was seen in one patient (8.3%). The median follow-up period after EUS-GBD was 304 d. Removal of the SEMS at 4-wk after SEMS placement might avoid migration of the stent and recurrence of cholecystitis due to food impaction.