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Updated: Feb 17, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Feasibility of conversion of percutaneous cholecystostomy to internal transmural endoscopic ultrasound-guided
Tanyaporn Chantarojanasiri1, Saburo Matsubara2, Hiroyuki Isayama3
1Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Internal Medicine, Police General Hospital, Bangkok, Thailand.
Insights
Converting percutaneous transhepatic gallbladder drainage (PTGBD) to endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using plastic stents is a feasible option for patients with acute cholecystitis who cannot undergo surgery, preventing recurrence.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Biliary Interventions
Background:
- Percutaneous transhepatic gallbladder drainage (PTGBD) is standard for acute cholecystitis in non-surgical candidates.
- PTGBD removal leads to high recurrence rates (41-46%).
- Alternative drainage methods are needed to prevent recurrence.
Purpose of the Study:
- To assess the feasibility of converting PTGBD to transmural endoscopic ultrasound-guided gallbladder drainage (EUS-GBD).
- To evaluate EUS-GBD using plastic stents as a definitive treatment for acute cholecystitis in high-risk patients.
Main Methods:
- Retrospective review of patients converted from PTGBD to transmural EUS-GBD.
- EUS-GBD involved placement of one or two 7-Fr double pigtail plastic stents.
- Temporary endoscopic naso-gallbladder drainage (ENGBD) was used in some cases.
Main Results:
- Six patients (61-88 years) with acute cholecystitis underwent conversion.
- Technical and clinical success were achieved in all patients, allowing PTGBD removal.
- No recurrence of cholecystitis was observed during 3-26 months follow-up; one case of bile leak was managed conservatively.
Conclusions:
- Transmural EUS-GBD with plastic stents is a feasible and effective method for converting PTGBD in patients unfit for cholecystectomy.
- This technique offers a potential solution to prevent recurrence after initial PTGBD.
- Further studies are required to validate these findings.
Background/Aim:
Percutaneous cholecystostomy [percutaneous transhepatic gallbladder drainage (PTGBD)] is the treatment of choice in surgically unfit patients with acute cholecystitis. However, PTGBD tube removal after symptoms resolution results in 41-46% recurrence. This study aims to demonstrate the feasibility of the conversion of PTGBD to transmural endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using plastic stents in patients unfit for cholecystectomy.
Patients And Methods:
Patients who underwent internal transmural EUS-GBD as a conversion from PTGBD were reviewed. EUS-GBD was performed after the improvement of cholecystitis due to recurrent cholecystitis and PTGBD intolerance. One or two 7-Fr double pigtail plastic stent insertion with or without temporary endoscopic naso-gallbladder drainage (ENGBD) insertion was performed.
Results:
Six patients (age 61-88), with three cases of acute cholecystitis after metallic biliary stenting and three cases of calculus cholecystitis, who underwent PTGBD were included. EUS-GBD was performed 10-63 days after PTGBD, using one plastic stent in five cases, two stents in one case, with temporary ENGBD in two cases. The technical success and clinical success were achieved and the PTGBD tubes were subsequently removed in all patients. All ENGBD tubes were removed within 5 days after insertion. Bile leak with peritonitis was demonstrated in one case, which was treated conservatively. No recurrent cholecystitis was seen during 3-26 months of follow-up.
Conclusion:
The conversion of percutaneous cholecystostomy to internal transmural EUS-GBD with plastic stents is feasible for patients unfit for cholecystectomy. However, more studies are still needed to confirm the results.
