KNACKS AND PITFALLS OF ENDOSCOPIC ULTRASOUND-GUIDED GALLBLADDER DRAINAGE

Abstract

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a new method of gallbladder drainage in patients with acute cholecystitis. EUS-GBD has as high a success rate as percutaneous drainage and can be used to perform internal drainage similar to transpapillary drainage. Methods of EUS-GBD procedures have not been well discussed due to its short history and lack of sufficient level of evidence. When cholecystitis occurs, the gallbladder lumen becomes so large that the gallbladder is easily punctured. On the other hand, insertion of devices such as a dilator, stent, or naso-cystic tube into the gallbladder is often difficult compared to other interventional EUS procedures, because the gallbladder is not adhered to the stomach or duodenum unlike walled-off necrosis, and is not fixed in an organ unlike intrahepatic bile ducts and pancreatic ducts. Moreover, the fact that the location and orientation of the gallbladder are not fixed makes the procedure difficult, and many tips and tricks are required to perform EUS-GBD safely and effectively. In this commentary on technical tips of EUS-GBD, we describe our technique of EUS-GBD using a plastic stent and a naso-cystic tube.