An alternative percutaneous technique for gallbladder drainage using lumen-apposing metal stents.

Surgical Endoscopy
Michael KostrzewaEran Shlomovitz

Abstract

Cholecystostomy is commonly performed in high-risk patients with acute cholecystitis. However, internal drainage may be more desirable in patients as it is associated with lower complication rates. This paper describes an image-guided, percutaneous technique for internal gallbladder drainage using a covered lumen-apposing metal stent (LAMS) and assesses its feasibility and safety in a porcine model. Procedures were performed on 30-kg pigs. Under ultrasound and fluoroscopic guidance, a percutaneous puncture was performed through-and-through the gallbladder into the stomach. A guidewire was placed and a 12Fr sheath was advanced through which a 10-mm LAMS was deployed. Its distal flange was deployed in the gastric lumen, and its proximal flange in the gallbladder. The cholecystoenteric anastomosis was examined by means of endoscopy, laparoscopy, and necropsy. Technical success was 100% (7/7). Procedure times decreased with experience and improvements in technique (median: 22 min). Contrast injection demonstrated free flow through the stent with no leakage. Necropsy confirmed appropriate stent position with good apposition of gallbladder and stomach, and no intraprocedural complications were detected. Image-guided, percutaneous, in...Continue Reading

References

Nov 23, 2005·Gastrointestinal Endoscopy·Sanjeev M WasanDouglas G Adler
Dec 5, 2012·Gastrointestinal Endoscopy·Carlos de la Serna-HigueraHenar Nuñez-Rodriguez
Jul 23, 2015·The New England Journal of Medicine·Todd H BaronLee L Swanstrom
Feb 23, 2017·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Donna Marie L AlvinoPeter J Fagenholz
Jun 13, 2017·World Journal of Gastrointestinal Surgery·Carlos Augusto GomesSamuel de Fádel Guimarães

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