An 82-year-old male suffered from calculous cholecystitis accompanied by multiple comorbidities such as rheumatoid arthritis, emphysema, and hiatal hernia which rendered cholecystectomy extremely risky. [1] He underwent percutaneous transhepatic gallbladder drainage (PTGBD) initially but experienced recurrent abdominal pain and fever soon after discharge. Preoperative laboratory tests showed white blood cell count of 4.78 × 109/L and C-reactive protein level of 25.61 mg/L indicating persistent inflammation. Endoscopic transpapillary gallbladder drainage (ETGBD) was performed successfully with a 7 Fr × 10 cm double-pigtail stent placed across the cystic duct without any perioperative complications (Fig. 1). On postoperative day 5 his white blood cell count decreased to 4.59 × 109/L and C-reactive protein dropped to 9.54 mg/L. One month later he remained asymptomatic with normal gallbladder size and well-positioned stent. At five-year follow-up, no symptom recurrence was observed and liver function tests were normal. Imaging confirmed the stent was appropriately positioned (Fig. 2). This case demonstrates that ETGBD is an effective and durable alternative for a high-risk patient ineligible for surgery.[2, 3].
Fig. 1.
Endoscopy images of endoscopic transpapillary gallbladder drainage (ETGBD) placement procedure performed via ERCP. a Intraprocedural fluoroscopic cholangiography. The guidewire is advanced through the cystic duct into the gallbladder, with contrast outlining the biliary system and gallbladder to confirm appropriate access prior to stent placement. b Endoscopic view during deployment of the transcystic double-pigtail stent. The stent is advanced over the guidewire, with the distal (duodenal) pigtail partially visible at the papillary orifice. c Post-deployment fluoroscopic check showing the correctly positioned transcystic double-pigtail stent. One pigtail is coiled within the gallbladder lumen, and the other lies in the duodenum, confirming successful placement of the drainage stent
Fig. 2.
Axial non-contrast abdominal CT scan obtained at 5-year follow-up after endoscopic transpapillary gallbladder drainage (ETGBD) placement. The radiopaque transcystic double-pigtail gallbladder stent is well visualized in its intended position within the gallbladder lumen, with no evidence of migration, obstruction, or related long-term complications
Author Contributions
Wang Mingjian wrote the main manuscript text and prepared Figs. 1–2; all authors reviewed the manuscript.
Funding
Science and Technology Program of the Joint Fund of Scientific Research for the Public Hospitals of Inner Mongolia Academy of Medical Sciences,2023GLLH0024,2023GLLH0024,2023GLLH0024
Data Availability
No datasets were generated or analyzed during the current study.
Declarations
Competing interests
The authors declare no competing interests.
Footnotes
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References
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Data Availability Statement
No datasets were generated or analyzed during the current study.