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Elective endoscopic gallbladder treatment in patient with recurrent gallbladder colic and high surgical risk
An 80-year-old woman presented with a 1-year history of recurrent right upper quadrant colicky pain. Her medical history included abdominal surgery, ischemic stroke with impaired mobility, and obesity (body mass index > 30.1 kg/cm2).
Transabdominal ultrasound showed distended gallbladder with thickened walls and two large stones (4 cm and 3 cm). Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) followed by intracholecystic lithotripsy was offered as a minimally invasive treatment alternative to surgery and scheduled for 2 weeks later.
EUS examination confirmed gallbladder wall thickening and two large stones ([Video 1]). Transduodenal EUS-GBD using a 15 × 10 mm AXIOS stent (Boston Scientific, Marlborough, Massachusetts, USA) mounted onto a cautery device was successfully performed ([Fig. 1]). After 48 hours, the central stent was dilated up to 15 mm and the gallbladder lumen accessed with a gastroscope. After adequate water irrigation, holmium laser lithotripsy with variable pulse power and frequencies was performed , and fragmented stones were flushed out or removed using a Dormia basket or Roth net until complete gallbladder clearance was achieved ([Fig. 2]). No adverse events occurred and the patient was discharged.
Video 1 Endoscopic view of holmium laser lithotripsy of the central part of one of the stones inside the gallbladder.
Outpatient cholecystoscopy 2 weeks later revealed complete gallbladder clearance. The stent was removed using a grasping forceps ([Fig. 3]) and exchanged for two double-pigtail stents (7 Fr, 4 cm), which were left in place ([Fig. 4]).
Elective endoscopic gallbladder treatment has been described previously in five relatively young patients with a mean age of 50 years and giant gallstones, who rejected surgery and desired gallbladder preservation . With an aging population, the number of elderly frail individuals at high surgical risk and gallstone disease requiring surgical intervention is expected to increase , and elective endoscopic gallbladder treatment may be a valid alternative treatment option in such patients.
Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.
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Article published online:
17 September 2021
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