Post written by Ryan Law, DO, from the Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
We present a case of a 34-year-old woman with a history of an incompletely repaired omphalocele with recurrent small bowel obstructions and lung hypoplasia complicated by chronic respiratory failure requiring nocturnal non-invasive ventilation, who presented with concern for cholecystitis. MRCP showed a distended gallbladder with circumferential wall thickening and pericholecystic fluid as well as cystic duct obstruction. After multidisciplinary discussions with interventional radiology and hepatobiliary surgery, she was referred for endoscopic drainage of the gallbladder as alternative interventions were deemed to be risk prohibitive. We performed an EUS-guided cholecystogastrostomy using a 15-mm cautery-enhanced LAMS resulting in drainage of pus. The LAMS was removed 1 month later and two 10F x 3-cm double-pigtail plastic stents were placed to be left indefinitely. She remains clinically well to date.
While this video demonstrates a previously well demonstrated technique of EUS-guided gallbladder drainage, the indication in this case is quite unique. We were able to solve a clinical problem without subjecting the patient to high-risk surgical or radiologic interventions.
I think that this case is a prime example of how far we have come with therapeutic EUS. Historically, endoscopists would have very little to offer to the management of this clinical scenario. With the ongoing progress in therapeutic EUS, highly-skilled endoscopists can often offer an endoscopic solution as long as the pathology of interest is within reach of a linear echoendoscope and endosonographically visible from the gastrointestinal lumen.
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