Post written by Theodore W. James, MD, from the Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.

We describe a 39-year-old woman with a history of Crohn’s disease and multiple bowel resections who presented with 2.5 months of right upper-quadrant pain and found to have multiple gallstones and cystic duct obstruction. She was a  poor operative candidate for cholecystectomy due to her numerous prior operations, so we elected to perform EUS-guided gallbladder drainage using a lumen-apposing metal stent. The gallbladder was not distended on ultrasound, so we placed a 7F nasobiliary tube via ERCP into the cystic duct. The gallbladder was then distended with fluid instillation, allowing for a sizeable target on EUS.

This technique for distending a gallbladder has not previously been described, but is similar to a method employed by interventional radiologists to assist in PTC drain placement. ERCP-assisted gallbladder distention with use of an irrigation pump is safe and effective to improve the technical success of EUS-guided cholecystoduodenostomy.

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