2026 Volume 40 Issue 1 Pages 126-132
Endoscopic transpapillary gallbladder drainage (ETGBD) is a treatment alternative for acute cholecystitis in patients unsuitable for surgery, but identifying the cystic duct remains technically challenging. Amidotrizoic acid 60% is heavier than bile and preferentially flows along gravity during cholangiography. We examined four cases of acute cholecystitis to evaluate whether strategic patient positioning improves ETGBD success. Although ERCP is typically performed in the prone position, we assessed the cystic duct orientation on pre-procedural contrast-enhanced CT and initiated ERCP in positions that aligned the duct with gravity. All procedures began in the left lateral position; three cases were repositioned toward the supine position during cholangiography. One patient showed contrast leakage, but in all cases, the cystic duct was promptly visualized and ETGBD was successfully completed. Adjusting the initial position to align the cystic duct direction with gravity may facilitate duct visualization and improve the technical success rate of ETGBD.
