Endoscopic transpapillary gallbladder drainage in acute cholecystitis patients

Background and Aims Patients who have acute cholecystitis with co-morbid conditions because the morbidity and mortality of cholecystectomy is high, bile duct drainage may be preferred. This procedure is traditionally done as percutaneous. Because of the percutaneous drainage is a temporary procedure and complications endoscopic bile duct drainage methods have been described. The aim of this study is to share our experience with endoscopic transpapillary gallbladder drainage (ETGBD). Materials and Method 23 patients (10 males, 13 females, mean age 68.4 years) with an indication for biliary drainage were tested to the patient for ETGBD procedure. 19 patients also had a problem that required ERCP to be known as biliary too. In 14 of these patients (mean age 80.1 years), the surgeon was thought to be at risk for advanced age. At the same time, patients (in some cases more than one) were at risk for the following surgical conditions: 2 patients had sepsis, 4 patients had severe pancreatitis which would delay biliary surgery, 1 patient had cerebrovascular disease, 3 patients had Alzheimer's disease, 1 patient had malignancy (endometrium adenocarcinoma), 7 patients had uncontrolled DM, 6 patients had cardiac problems. After biliary cannulation and sphincterotomy were performed, the stones in the biliary tract were removed first. The guidewire was then advanced into the gallbladder via the cystic duct. 7 fr double pigtail stent fitted to gallbladder. Patients who received clinical response and became eligible for surgery were given to surgery. Patients who were not to be operated were seen with a stent in the gall bladder. Bile or pancreatic problems were assessed in the patients during the follow-up period with clinical response rate up to the follow-up period of the study completed. Results Two patients could not have a stent in the bile duct because no cystic duct was found. In one of these patients, a cystic duct was seated and perforation developed and urgent cholecystectomy was needed when passing by the stone. In 21 patients the procedure was successfully performed (technical success rate: 91.3%). Clinical response was obtained in all patients. Eight patients underwent cholecystectomy after being available surgery (median 108 (12-448) days). The stents of these patients were withdrawn during surgery. Thirteen patients who did not underwent surgery due to comorbid diseases were observed median 335 (15 - 680) days. During this period, 3 patients died for non-biliary reasons (pneumonia, heart failure and infarction). Conclusion ETGBD appears to be an effective and safe method for obtaining long-term biliary or pancreatic problems in patients with cholecystitis who are not eligible for surgery, or for saving time in patients who may be at risk for early surgery.