ENDOSCOPIC APPROACHES TO ACUTE CHOLECYSTITIS

Abstract

Endoscopic gallbladder drainage includes transpapillary and transmural drainage. Although endoscopic transpapillary gallbladder drainage (ETGBD) has a relatively low success rate owing to the difficulty of passage through the cystic duct, it is an established method as an alternative to percutaneous transhepatic gallbladder drainage (PTGBD). Moreover, ETGBD is believed to prevent the recurrence of cholecystitis. A greater number of clinical studies have been conducted in patients who underwent endoscopic ultrasound-guided transmural gallbladder drainage (EUS-GBD) than in those who underwent ETGBD, since a brand-new method of EUS-GBD was introduced in 2007. The technical and clinical success rates of EUS-GBD are excellent ; furthermore, stone removal via the fistula with cholecystoscopy can be performed. EUS-GBD is potentially the first-line drainage method in patients with acute cholecystitis who are not eligible for surgery. In this review, the indications for endoscopic gallbladder drainage, methods of endoscopic gallbladder drainage, short-term and long-term outcomes, adverse events, and comparison with PTGBD are discussed based on the latest evidences.