Post written by Andrew C. Storm, MD, from the Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

Acute cholecystitis (AC) is a common disease, and while gallbladder removal surgery is one of the most commonly performed operations, some patients are not candidates for surgery. Left untreated, patients with AC can develop gangrene and gallbladder perforation, both of which can be life-threatening. Endoscopic options for cholecystitis include ERCP approaches to place stents into the gallbladder and EUS-guided approaches to drainage.

We have experience treating nonoperative cholecystitis through both ERCP and EUS routes. EUS approaches are not appropriate for all patients, and therapeutic EUS skills are not yet as widely available to patients as ERCP techniques. This study was important to demonstrate the long-term success of ERCP bile duct stenting for palliation of cholecystitis.

Our study demonstrated high technical and clinical success rates for ERCP-directed therapy of cholecystitis. 95.9% of patients achieved long-term success. In a subset of patients who received 2 side-by-side pigtail stents to the gallbladder, the long-term success was 100%. The adverse event rate was 5.9%. We concluded that transpapillary ERCP-directed gallbladder drainage is a safe and effective long-term therapy for patients with acute cholecystitis who are poor candidates for surgery.

Figure: Illustration of ERCP directed gallbladder drainage for long term treatment of cholecystitis.

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