EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent in patients who are unsuitable for cholecystectomy: a pilot study (with video).

BACKGROUND: Although the definitive therapy of acute cholecystitis is cholecystectomy, nonsurgical treatment such as percutaneous cholecystostomy could be indicated in patients who are unsuitable candidates for cholecystectomy. EUS-guided cholecystoenterostomy with a plastic stent and/or nasobiliary drainage has been proposed as an alternative effective treatment for these patients.

OBJECTIVE: We conducted this study to evaluate the technical feasibility, safety, usefulness, and follow-up results of EUS-guided cholecystoenterostomy with single-step placement of a plastic stent for patients with acute cholecystitis who are unsuitable candidates for cholecystectomy.

DESIGN: A prospective feasibility study with a case series.

SETTING: Tertiary teaching hospital.

PATIENTS: Eight consecutive patients diagnosed with acute cholecystitis who were poor candidates for surgery.

INTERVENTIONS: EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent.

MAIN OUTCOME MEASUREMENTS: Technical success, clinical resolution of acute cholecystitis, procedure-related complications, and recurrence of cholecystitis.

RESULTS: Technical success and clinical resolution were achieved in all patients (100% [8/8] as intent to treat). A transduodenal approach was used for 7 patients and a transgastric approach for 1 patient. One patient showed self-limited pneumoperitoneum, and bile peritonitis occurred in 1 patient. One patient showed distal stent migration without bile leakage 3 weeks after stent insertion. During follow-up periods (median 186 days; range 22-300 days), cholecystitis did not recur in any patients.

LIMITATIONS: Small number of patients.

CONCLUSION: EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent may be a feasible and useful alternative in patients with acute cholecystitis who are unsuitable candidates for cholecystectomy.