Endoscopic Retrograde Cholangiopancreatography Treatment of Cholecystitis: Possible? Yes; Practical??

Abstract

Classically, until now, the management of cholecystitis has consisted of immediate and judicious clinical assessment of the affected patient, interpolating into the assessment of the physical findings and results from appropriate laboratory, x-ray, and scanning techniques (sonography and scintigraphy) to formulate a clinical impression. Usually, after the diagnosis has been established, the patient is subjected to a cholecystectomy, although the timing of the surgery may vary depending on the clinical condition of the patient. Alternatives to this management (cholecystectomy, medical management) scheme have been suggested, but these are dependent upon the clinical condition ofthe patient and considerations of risks. Percutaneous drainage of the gallbladder or cholecystostomy is sufficient enough to provide drainage, relieve obstruction, and the consequences of infection, i.e., sepsis, and prevent perforation. A contributory role of endoscopic retrograde cholangiopancreatography (ERCP) in this schema has not been a consideration. An ERCP is rarely employed for therapy (or diagnosis) when cholecystitis is suspected but it might assume a more significant role if it is considered an efficacious alternative in specific conditions. We have had the unusual experience of managing 11 patients with cholecystitis employing ERCP and its therapeutic modalities, i.e., sphincterotomy, selective cannulation of the cystic duct, and relieving obstruction of that structure by catheter displacement of an obstructing stone. Endoscopic techniques providing decompression of the gallbladder are described, and the feasibility of utilizing endoscopic procedures for treatment of cholecystitis will be given consideration.