Cholecystogastrostomy using novel anastomotic stent

Dr. TybergAmy Tyberg, MD from Weill Cornell Medical College in New York, New York, USA presents this video case, “Conversion of a percutaneous cholecystotomy tube into an internal cholecystogastrostomy by use of a novel anastomotic stent.”

This video describes a case of a patient with chronic cholecystitis who was deemed not a surgical candidate and underwent percutaneous gallbladder drainage, but continued to have significant morbidity from the external drain and thus underwent successful endoscopic-ultrasound (EUS) guided gallbladder drainage with removal of the external drain.

Surgery remains the gold standard therapeutic option for cholecystitis. In patients who are deemed too high-risk for surgical intervention, percutaneous drainage has traditionally been the procedure of choice. But recently, EUS-guided drainage with creation of a cholecystogastrostomy using a lumen-apposing metal stent has emerged as an alternative therapeutic option. This procedure negates the need for an external drain, which can cause significant pain and morbidity for patients. As demonstrated in the video, the procedure is performed by identifying the gallbladder on EUS, accessing the gallbladder from a transgastric or transduodenal approach with an EUS fine needle aspiration needle, and securing the fistulous tract with a large diameter, lumen-apposing metal stent that allows for tight apposition between the 2 lumens and continued bilious drainage into the gastrointestinal tract through the large stent lumen. Several case series validating the safety and efficacy of this procedural option have been published; long-term safety and efficacy data are needed.

cholecystotomy_figFigure 1. Endoscopic vision of the gallstones visualized through the transgastric anastomosis created into the gallbladder.

Find more VideoGIE cases online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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