Endoscopic transpapillary gallbladder drainage (ETGBD) is clinically effective for acute cholecystitis but is technically challenging 1 2 . In addition, the shape and bifurcation of the cystic duct represent a technical limitation and difficulty of this method 2 3 4 . Recently, an ultraslim catheter-type peroral cholangioscope (UC-POCS, DRES Slim Scope; Japan Lifeline Co., Ltd, Tokyo, Japan) has been developed and used clinically 5 . The UC-POCS consists of a catheter-type sheath (outer diameter 2.3 mm) with two independent lumens and a high-resolution digital camera. The device can be used as a catheter for common bile duct (CBD) cannulation ( Fig. 1 ). Herein, we report a case in which UC-POCS-assisted ETGBD was performed for acute cholecystitis.
Fig. 1.
The ultraslim catheter-type peroral cholangioscope device consists of: a a catheter-type sheath (outer diameter 2.3 mm); b two independent lumens and a high-resolution digital camera.
A 61-year-old woman with type 2 diabetes mellitus visited our clinic with chills and right upper quadrant abdominal pain. Abdominal computed tomography showed a prominent enlarged gallbladder with edematous wall thickening and she was diagnosed as having moderate acute cholecystitis ( Fig. 2 ). Urgent cholecystectomy was indicated but had to be abandoned due to concurrent diabetic ketosis. We therefore attempted ETGBD.
Fig. 2.
Abdominal computed tomography showing a prominent enlarged gallbladder with edematous wall thickening.
First, the CBD was successfully cannulated without any difficulty using the novel catheter, but the cystic duct could not be identified on subsequent cholangiography ( Video 1 ). Therefore, the POCS mounted in the catheter was used to look inside the CBD and could identify the bifurcation of the cystic duct. Additional cholangiography showed an impacted stone at this location. The guidewire was manipulated under fluoroscopy and was successfully inserted into the gallbladder. Following the removal of the UC-POCS, ETGBD with a 5-Fr naso-drainage tube was successfully achieved with no adverse events.
Ultraslim catheter-type peroral cholangioscope-assisted endoscopic transpapillary gallbladder drainage for acute cholecystitis.
Video 1
Endoscopy_UCTN_Code_TTT_1AR_2AB
Footnotes
Conflict of Interest The authors declare that they have no conflict of interest.
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References
- 1.Siddiqui A, Kunda R, Tyberg A et al. Three-way comparative study of endoscopic ultrasound-guided transmural gallbladder drainage using lumen-apposing metal stents versus endoscopic transpapillary drainage versus percutaneous cholecystostomy for gallbladder drainage in high-risk surgical patients with acute cholecystitis: clinical outcomes and success in an international, multicenter study. Surg Endosc. 2019;33:1260–1270. doi: 10.1007/s00464-018-6406-7. [DOI] [PubMed] [Google Scholar]
- 2.Khan MA, Atiq O, Kubiliun N et al. Efficacy and safety of endoscopic gallbladder drainage in acute cholecystitis: is it better than percutaneous gallbladder drainage? Gastrointest Endosc. 2017;85:76–87. doi: 10.1016/j.gie.2016.06.032. [DOI] [PubMed] [Google Scholar]
- 3.Maruta A, Iwata K, Iwashita T et al. Factors affecting technical success of endoscopic transpapillary gallbladder drainage for acute cholecystitis. J Hepatobiliary Pancreat Sci. 2020;27:429–436. doi: 10.1002/jhbp.744. [DOI] [PubMed] [Google Scholar]
- 4.Hirakawa N, Yamamoto K, Sofuni A et al. Factors predicting technical failure of endoscopic transpapillary gallbladder drainage for acute cholecystitis. DEN Open. 2023;31:e308. doi: 10.1002/deo2.308. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Tonozuka R, Nagai K, Tsuchiya T et al. Potential versatile uses of a novel ultra-thin peroral cholangioscope. J Hepatobiliary Pancreat Sci. 2024;31:e11–e13. doi: 10.1002/jhbp.1390. [DOI] [PubMed] [Google Scholar]