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DOI: 10.1055/s-0038-1637617
EUS-GUIDED CHOLECYSTODUODENOSTOMY FOR THE TREATMENT OF VESICULAR HYDROPS SECONDARY TO CYSTIC NEOPLASTIC INFILTRATION
Publication History
Publication Date:
27 March 2018 (online)
Introduction:
In patients with vesicular hydrops secondary to unresectable malignant biliary stenosis, the placement of a biliary prosthesis using ERCP is the treatment of choice. However, if there is infiltration of the cystic, the biliary prosthesis does not resolve the vesicular hydrops. Percutaneous drainage is associated with a high percentage of inability to withdraw it until the death of the patient, with the significant deterioration of the quality of life that this entails. In these cases, endoscopic drainage of the gallbladder should be the treatment of choice.
Clinical case:
A 84 year old woman is admitted for obstructive jaundice secondary to Klastkin tumor. The CT showed a distended 7 cm diameter gallbladder with diffuse thickening of the wall and signs of cholecystitis, as well as thickening of the common hepatic duct, compatible with cholangiocarcinoma. Given the age and comorbidity of the patient, palliative treatment was decided and ERCP was requested. In the cholangiography there is no contrast passage towards the gallbladder. A 10 × 100 mm uncovered biliary prosthesis is placed that resolves the obstructive jaundice, with pain persisting in the right hypochondrium. The control ultrasound shows a more distended gallbladder (8 cm) with wall edema, which is why EUS-guided cholecystoduodenostomy is performed using Hot Axios 10 × 10 mm prosthesis with “free hand” technique, obtaining abundant output of purulent material.
Conclusions:
Endoscopic drainage of the gallbladder should be the treatment of choice for vesicular hydrops secondary to cystic neoplastic infiltration, given the benefit it provides to the patient compared to percutaneous drainage.