Active Gallbladder Lavage Using a Double-pigtail Plastic Stent Delivery System During Endoscopic Ultrasound-guided...

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Medical Devices

Background:

• Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with metallic stents is preferred for frail patients with acute cholecystitis but raises concerns about tissue reactions and surgical impact.
• Double-pigtail plastic stents (DPPS) offer an alternative, yet leakage from the anastomosis site remains a challenge.

Purpose of the Study:

• To evaluate the feasibility and safety of an active gallbladder lavage technique using a specific DPPS system during EUS-GBD.
• To assess the efficacy of this technique in patients with acute cholecystitis who may be candidates for subsequent laparoscopic cholecystectomy (Lap-C).

Main Methods:

• A single-arm retrospective study involving patients with acute cholecystitis undergoing EUS-GBD.
• Utilized a DPPS system with an integrated lavage function by retracting the inner sheath to a "halfway back position" for active gallbladder irrigation.
• Patients were assessed for clinical and performance status recovery, with Lap-C considered as a final option.

Main Results:

• High technical success rate of 97.3% (36/37) and a 100% clinical success rate (36/36).
• Median procedure duration was 25 minutes, with 8 minutes dedicated to lavage.
• No adverse events were reported, and 9 out of 9 patients (25.0%) who underwent elective Lap-C did not require conversion to open surgery.

Conclusions:

• The active gallbladder lavage technique using the DPPS system during EUS-GBD is a feasible and acceptable procedure.
• This method offers a safe and effective alternative for managing acute cholecystitis, particularly in patients who may benefit from subsequent surgical intervention.