A 77-year-old woman with multiple co-morbidities was referred for symptomatic chronic
calculous cholecystitis. She was not a surgical candidate for cholecystectomy and
refused percutaneous gallbladder drainage. Endoscopic ultrasound (EUS)-guided transmural
gallbladder drainage with a lumen-apposing metal stent (LAMS) using an electrocautery
enhanced delivery system was performed ([Video 1]).
Endoscopic ultrasound-guided transmural gallbladder drainage with a lumen-apposing
metal stent using an electrocautery enhanced delivery system.
The echoendoscope was advanced to the duodenal bulb. The gallbladder was accessed
with a needle, and contrast injection confirmed the location. A guidewire was coiled
within the gallbladder lumen. A 15-mm LAMS with an electrocautery enhanced delivery
system was used to dissect a transmural tract into the gallbladder. The stent was
deployed with the distal flange in the gallbladder and the proximal flange in the
duodenal bulb. Dilation of the stent to 15 mm was performed using a controlled radial
expansion balloon. Following dilation, pus and dark bile were seen draining from the
gallbladder ([Fig. 1]).
Fig. 1 Fluoroscopic image of a lumen-apposing metal stent (yellow arrow) between the gallbladder
and duodenum for endoscopic management of cholecystitis.
The patient was discharged home the next day without any abdominal pain. She had no
recurrence of abdominal pain at 6-month follow-up.
The use of LAMS with an electrocautery enhanced delivery system minimizes the risks
associated with dilation of the transmural tract prior to stent placement, including
gallbladder decompression, bile leak, and stent migration [1]
[2]. EUS-guided transmural gallbladder drainage using LAMS has also been described for
internal gallbladder drainage in patients with percutaneous cholecystostomy catheters
who are poor candidates for cholecystectomy [3]. EUS-guided transmural gallbladder drainage is safe, feasible, and effective for
decompressing the gallbladder in patients who are poor surgical candidates.
Endoscopy_UCTN_Code_TTT_1AS_2AD
