Endoscopic Internalization by Cutting the Endoscopic Transpapillary Nasogallbladder Drainage Tube in Management of Acute Cholecystitis: A Retrospective Multicenter Cohort Study

Abstract

Background: Both endoscopic nasogallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS) are effective management for acute cholecystitis, although ENGBD can cause discomfort due to its nature of external drainage. Converting ENGBD to EGBS after improvement of cholecystitis might be one treatment strategy. The drainage tube of ENGBD could be endoscopically cut inside the stomach to convert to internal drainage without additional endoscopic retrograde cholangiography (ERCP). Aims: To evaluate the feasibility, efficacy and safety of endoscopic internalization by cutting an ENGBD tube for acute cholecystitis. Methods: Twenty-one patients who underwent endoscopic internalization by cutting the ENGBD tube were enrolled in this study. We initially placed an ENGBD tube for gallbladder lavage and continuous drainage. After improvement of cholecystitis, the tube was cut in the stomach by esophagogastroduodenoscopy (EGD) and placed as EGBS until surgery. Results: The technical success rate of this procedure was 90.5% (19/21), and the clinical success rate was 100% (19/19). The median procedural time was 5 min (range: 2–14 min). Procedural-related adverse events (AEs) were observed in two patients where the tip of the ENGBD tube migrated into the common bile duct from the gallbladder during the procedure in both. During the waiting period for elective surgery, no AEs were identified, except for stent migration without symptoms in one patient (4.7%). Conclusion: Endoscopic internalization by cutting the ENGBD tube after improvement of cholecystitis could be an effective and safe treatment option for preventing recurrent cholecystitis in the waiting period until cholecystectomy.