Post written by Jad AbiMansour, MD, from the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

The video highlights best practices, devices, and techniques for endoscopic transpapillary gallbladder drainage through a series of narrated cases ranging from routine to technically challenging.

Endoscopic transpapillary gallbladder drainage is an invaluable tool for palliation of acute cholecystitis in patients who are not candidates for cholecystectomy, particularly if ERCP is indicated for other reasons.

However, selective cannulation of the cystic duct and successful gallbladder stenting can be challenging.  This video highlights a series of maneuvers and devices that endoscopists can use to increase the likelihood of success.

A multidisciplinary discussion should guide selection of the best management strategy for patients with acute cholecystitis. If transpapillary gallbladder drainage is deemed to be in the patient’s best interest, endoscopists should be prepared to use a variety of approaches when standard devices and techniques are unsuccessful.

This includes using a rotatable catheter system, downsizing to a smaller guidewire, occluding the proximal common hepatic duct with an occlusion balloon, and directly intubating the cystic duct using peroral cholangioscopy as outlined in this video.

Guidewire coiled into gallbladder.

Read the full article online.

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