Drainage of Gallbladder Fossa Fluid Collections with Endoprosthesis Placement Under Endoscopic Ultrasound Guidance: A Preliminary Report of Two Cases

Collections of fluid in the gallbladder fossa can be detected by ultrasound in as many as 29 % of patients following cholecystectomy. Traditionally, persistent collections are treated by percutaneous drainage and bile duct decompression. We present two cases of persistent gallbladder fossa fluid collections which were refractory to bile duct decompression but which were successfully drained by endoscopic ultrasound-guided endoprosthesis placement. Under endoscopic ultrasound (EUS) control, a 19-gauge needle was inserted through the duodenal wall into the gallbladder fossa fluid collection. A guide wire was coiled within the collection, and an endoprosthesis was placed over the wire. Endoprosthesis insertion was successful in both cases, resulting in rapid symptomatic and radiographic improvement. EUS-guided drainage offers a minimally invasive alternative to percutaneous treatment of persistent gallbladder fossa fluid collections following cholecystectomy.

References

• 1 Ascher S M, Evans S R, Goldberg J A. et al . Laparoscopic cholecystectomy: postoperative sonographic findings.  Dig Dis Sci. 1993;  38 2212-2219
• 2 Bersani D, Lallemand M. Aspect échographique des collections liquidiènnes de la loge vésiculaire après cholecystectomie: à-propos de 11 observations.  J Radiol. 1986;  67 589-593
• 3 McLindon J P, England R E, Martin D F. Causes, clinical features and nonoperative management of bile leaks.  Eur Radiol. 1998;  8 1602-1607
• 4 van Sonnenberg E, Casola G, Wittich G R. et al . The role of interventional radiology for complications of cholecystectomy.  Surgery. 1990;  107 632-638
• 5 Kozarek R A. Laparoscopic cholecystectomy: who does what, when and to whom?.  Endoscopy. 1992;  24 785-787
• 6 Mergener K, Strobel J C, Suhocki P. et al . The role of ERCP in diagnosis and management of accessory bile duct leaks after cholecystectomy.  Gastrointest Endosc. 1999;  50 527-531
• 7 Quinn S F, Sangster W, Standage B. et al . Biliary complications related to laparoscopic cholecystectomies: radiologic diagnosis and management [see Comment].  Surg Laparosc Endosc. 1992;  2 279-286
• 8 Barton J R, Russell R C, Hatfield A R. Management of bile leaks after laparoscopic cholecystectomy.  Br J Surg. 1995;  82 980-984
• 9 Giovannini M, Monges G, Seitz J F. et al . Distant lymph node metastases in esophageal cancer: impact of endoscopic ultrasound-guided biopsy.  Endoscopy. 1999;  31 536-540
• 10 Ikenberry S, Gress F, Savides T, Hawes R. Fine-needle aspiration of posterior mediastinal lesions guided by radial scanning endosonography.  Gastrointest Endosc. 1996;  43 605-610
• 11 Wiersema M J, Hassig W M, Hawes R H, Wonn M J. Mediastinal lymph node detection with endosonography.  Gastrointest Endosc. 1993;  39 788-793
• 12 Harewood G C, Wiersema M J. Endosonography-guided fine-needle aspiration biopsy in the evaluation of pancreatic masses.  Am J Gastroenterol. 2002;  97 1386-1391
• 13 Grimm H, Binmoeller K F, Soehendra N. Endosonography-guided drainage of a pancreatic pseudocyst.  Gastrointest Endosc. 1992;  38 170-171
• 14 Sanchez C ortes, Maalak A, Le Moine O. et al . Endoscopic cystenterostomy of nonbulging pancreatic fluid collections [see Comment].  Gastrointest Endosc. 2002;  56 380-386
• 15 Vosoghi M, Sial S, Garrett B. et al . EUS-guided pancreatic pseudocyst drainage: review and experience at Harbor-UCLA Medical Center.  Med Gen Med. 2002;  4 2
• 16 Baron T H, Wiersema M J. EUS-guided transesophageal pancreatic pseudocyst drainage.  Gastrointest Endosc. 2000;  52 545-549