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DOI: 10.1055/a-0929-4645
Successful endoscopic transpapillary gallbladder stenting using a new easily maneuverable guidewire: a report of two cases
Corresponding author
Publication History
Publication Date:
07 June 2019 (online)
Endoscopic transpapillary gallbladder drainage has a poor technical success rate (80 % – 90 %) [1] [2] [3] [4]. The technique is sometimes challenging when the guidewire cannot be advanced through the cystic duct into the gallbladder because of ductal tortuosity or obstruction [5] ([Fig. 1]). This report describes a new, easily maneuverable guidewire (approved by the review board of Nagoya City University Graduate School of Medical Sciences; approval No. 46-18-0012), which was successfully advanced into the gallbladders of two patients in whom a conventional guidewire could not be advanced ([Fig. 2], [Video 1]).
Video 1 Two cases of endoscopic transpapillary gallbladder stenting using a new easy maneuverable guidewire.
Quality:
Case 1: an 83-year-old man developed epigastralgia caused by acute cholecystitis 3 days after percutaneous coronary intervention to treat acute coronary syndrome. As he was at risk of requiring anticoagulation therapy, percutaneous transhepatic gallbladder drainage was performed on the same day, and a choledocholithiasis was detected via cholangiography ([Fig. 3]). Then, 3 months later, after his heart condition had stabilized, we performed endoscopic choledocholithiasis extraction and endoscopic transpapillary gallbladder stenting (ETGS) to remove the percutaneous catheter and prevent future acute cholecystitis.
Case 2: a 65-year-old man was admitted with epigastralgia caused by recurrent acute cholecystitis; he was awaiting preventative cholecystectomy ([Fig. 4]). A new choledocholithiasis originating from the gallbladder was detected on computed tomography; we extracted it and then performed subsequent ETGS as a bridge to cholecystectomy.
In both cases, tortuous cystic ducts hindered the advancement of a regular guidewire, with “popping up” of its flexible tip portion ([Fig. 1]). Therefore, we used the improved M-through guidewire (ASAHI INTECC Corp., Seto, Japan), which was maneuvered easily and was successfully passed through both cystic ducts; we placed plastic stents along the guidewires. The new guidewire has an innovative tip allowing smooth tracking and easy maneuverability. This guidewire was passed rapidly through tortuous cystic ducts, followed by plastic stent placement in the gallbladder ([Fig. 5]).
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Competing interests
None
Acknowledgments
The improved M-through guidewires were gifts from ASAHI INTECC Corp.
* These authors contributed equally to this work.
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References
- 1 Itoi T, Coelho-Prabhu N, Baron TH. Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc 2010; 71: 1038-1045
- 2 Oh D, Song TJ, Cho DH. et al. EUS-guided cholecystostomy versus endoscopic transpapillary cholecystostomy for acute cholecystitis in high-risk surgical patients. Gastrointest Endosc 2018; 10: 33011-33016
- 3 Yang MJ, Yoo BM, Kim JH. et al. Endoscopic naso-gallbladder drainage versus gallbladder stenting before cholecystectomy in patients with acute cholecystitis and a high suspicion of choledocholithiasis: a prospective randomised preliminary study. Scand J Gastroenterol 2016; 51: 472-478
- 4 Itoi T, Kawakami H, Katanuma A. et al. Endoscopic nasogallbladder tube or stent placement in acute cholecystitis: a preliminary prospective randomized trial in Japan (with videos). Gastrointest Endosc 2015; 81: 111-118
- 5 Widmer J, Alvarez P, Sharaiha RZ. et al. Endoscopic gallbladder drainage for acute cholecystitis. Clin Endosc 2015; 48: 411-420
Corresponding author
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References
- 1 Itoi T, Coelho-Prabhu N, Baron TH. Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc 2010; 71: 1038-1045
- 2 Oh D, Song TJ, Cho DH. et al. EUS-guided cholecystostomy versus endoscopic transpapillary cholecystostomy for acute cholecystitis in high-risk surgical patients. Gastrointest Endosc 2018; 10: 33011-33016
- 3 Yang MJ, Yoo BM, Kim JH. et al. Endoscopic naso-gallbladder drainage versus gallbladder stenting before cholecystectomy in patients with acute cholecystitis and a high suspicion of choledocholithiasis: a prospective randomised preliminary study. Scand J Gastroenterol 2016; 51: 472-478
- 4 Itoi T, Kawakami H, Katanuma A. et al. Endoscopic nasogallbladder tube or stent placement in acute cholecystitis: a preliminary prospective randomized trial in Japan (with videos). Gastrointest Endosc 2015; 81: 111-118
- 5 Widmer J, Alvarez P, Sharaiha RZ. et al. Endoscopic gallbladder drainage for acute cholecystitis. Clin Endosc 2015; 48: 411-420