Transpapillary nasocystic tube placement to allow gallbladder distention for EUS-guided cholecystoduodenostomy

James_headshot 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.

Read the full article 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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