Definitive nonsurgical management of stump cholecystitis with EUS-guided lumen-apposing metal stent placement and electrohydraulic lithotripsy

Post written by Rishi Pawa, MD, from the Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

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A 31-year-old woman presented with right-upper-quadrant pain and imaging findings of acute cholecystitis. She underwent an open subtotal cholecystectomy because of extensive adhesive disease involving the gallbladder. 

Initially, the patient did well postoperatively but started having recurrent symptoms after 1 month. Six months postoperatively, she presented to the hospital with an acute flare of epigastric abdominal pain with CT scan of her abdomen consistent with stump cholecystitis.

Given the prior difficult surgery and extensive inflammation, she underwent an EUS-guided gallbladder drainage (EUS-GBD) using an 8- x 8-mm electrocautery enhanced lumen-apposing metal stent (LAMS) with a flange diameter of 17 mm and a catheter outer diameter of 9F followed by cholecystoscopy and electrohydraulic lithotripsy with removal of the stone.

Off-label use of LAMSs for EUS-GBD has evolved as an accepted management of cholecystitis in patients who are poor surgical candidates. Traditionally, these drainages have been performed using a larger-diameter LAMS of 10 mm with a flange diameter of 21 mm and a catheter outer diameter of 10.8F or 15 mm with a flange diameter of 24 mm and a catheter outer diameter of 10.8F. The large diameter of the LAMS provides a port of entry for cholecystoscopy and performance of advanced endoscopic interventions.

However, placement of such stents may be technically challenging in patients with a remnant gallbladder after subtotal cholecystectomy or when the gallbladder is shriveled and contracted.

In conclusion, the availability of smaller-diameter LAMSs has enabled endoscopic interventions in confined spaces with limited surgical accessibility.

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Endoscopic image showing the stone in the remnant gallbladder on cholecystoscopy.

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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