Project description:Background and aimsPercutaneous gallbladder drainage has traditionally been the reference standard treatment for cholecystitis in patients deemed unfit for surgery. Endoscopic transpapillary gallbladder drainage has emerged as a reliable alternative that offers an internal, incisionless option in nonsurgical patients. The aim of this study was to describe techniques for successful selective cystic duct cannulation and gallbladder drainage during ERCP.MethodsA series of endoscopic transpapillary gallbladder procedures is shown, including endoscopic and fluoroscopic video and images. Each case highlights best practices, devices, and techniques to aid with successful completion of challenging cases.ResultsStandard cystic duct cannulation and gallbladder access is described using a standard catheter and a 0.035-inch angled guidewire. Challenges to selective cystic duct cannulation are overcome using various approaches, including using a rotatable catheter system, downsizing to a smaller guidewire, occluding the proximal common hepatic duct with an occlusion balloon, and directly intubating the cystic duct using peroral cholangioscopy. Dilation of the cystic duct is performed using standard devices designed for biliary intervention, but smaller, percutaneous angioplasty balloons are used for small ducts and severe strictures. After dilation, a plastic, double-pigtail stent is deployed across the papilla, and access is reobtained in a similar fashion to place a second, parallel stent. To eliminate the need to re-access the gallbladder after initial stent deployment, a cytology brush catheter is repurposed to obtain dual-wire access within the gallbladder before initial stent deployment.ConclusionsWhen the fundamentals of ERCP and the techniques described here are used, endoscopic transpapillary gallbladder drainage can be performed safely and effectively to treat cholecystitis in patients who are not surgical candidates.

| S-EPMC10665532 | biostudies-literature

Burning and cutting: a unique technique for management of migrated uncovered metal biliary stents.

Project description: Not available

| S-EPMC7649830 | biostudies-literature

Case of endoscopic bilateral stent-in-stent placement using long metallic stents for pancreatic cancer and plexus invasion.

Project description: Not available

| S-EPMC9314804 | biostudies-literature

Stepwise Algorithmic Approach to Endoscopic Removal of Biliary Partially Covered and Uncovered Self-Expanding Metal Stents.

Project description:Self-expanding metal stents play a crucial role in the management of patients with biliary obstruction. Endoscopic extraction of uncovered metal stents (UCMSs) and partially covered metal stents (PCMSs) could be challenging because of tissue ingrowth. No standardized technique can guarantee universal success. We present our technique and experience of endoscopic extraction of biliary stents in two patients with a UCMS and three patients with a PCMS. Three of the five patients had a previous failed attempt of stent extraction at an outside hospital. Overall, our composite success rate was 80% (4/5). The individual success rate was 100% (3/3) for PCMSs and 50% (1/2) for UCMSs. The stent-in-stent technique, in which a fully covered metal stent is placed through an existing UCMS/PCMS, was used in 60% (3/5) of the cases, with a success rate of 66.7% (2/3). We share our algorithmic approach to each case, with detailed emphasis on the technical aspects of the procedure.

| S-EPMC8357580 | biostudies-literature

Transpapillary nasocystic tube placement to allow gallbladder distention for EUS-guided cholecystoduodenostomy.

Project description: Not available

| S-EPMC6893152 | biostudies-literature

Fishing line assisted endoscopic placement of multiple plastic biliary stents for unresectable malignant hilar biliary obstruction: a retrospective study.

Project description:Background and aimsStent migration is one of the most common complications during the placement of multiple plastic biliary stents (MPBS) under endoscopy. This study aims to evaluate the feasibility and efficiency of the fishing line assisted (FLA) method for preventing the complication.MethodsPatients with unresectable malignant hilar biliary obstruction (MHBO) who undergone endoscopic placement of MPBS using the FLA or conventional method from May 2018 to April 2021 in our center were enrolled in the study. The endpoints of this study were the stent migration rate, technical success rates, adverse events rates, times of stent migration, and the procedure time.ResultsFLA group (N = 19) and conventional group (N = 22) had similar baseline characteristics of the patients. The technical success rates (100% vs. 95.5%; P > 0.05), ERCP-related adverse events rates (5.3% vs. 4.5%; P > 0.05), and the stent-related adverse events rates (0% vs. 4.5%; P > 0.05) were no significant differences between the FLA and conventional groups. MPBS inserted using the conventional method consumed more time (median, 33.9 min vs. 15.6 min; P < 0.05) method and increased the times of stent migration (median, 3 times vs. 0 times; P < 0.05) than using the FLA method. Even if no statistical difference was detected in the stent migration rate between groups, this rate was lower in the FLA group than the conventional group (0% vs. 13.6%; P > 0.05).ConclusionsFLA method is an effective technique for MPBS implantation to prevent stent migration during endoscopic retrograde cholangiography (ERCP). The method should be applied to patients with unresectable MHBO who need to place MPBS.

| S-EPMC8603567 | biostudies-literature

Endoscopic transpapillary gallbladder drainage for management of acute cholecystitis with coagulopathy.

Project description:Acute cholecystitis is a common and frequently occurring disease, and laparoscopic cholecystectomy is the preferred treatment method. Percutaneous transhepatic gallbladder drainage is regarded as the first-line palliative procedure for elderly patients with poor cardiopulmonary function who cannot tolerate general anesthesia. However, for patients with acute cholecystitis who are undergoing treatment with oral antithrombotics or who have abnormal coagulation mechanisms, endoscopic transpapillary gallbladder drainage may be a good choice. Endoscopic transpapillary gallbladder drainage is an endoscopic retrograde cholangiopancreatography-based technique that drains the gallbladder by placing a tube into the cavity of the gallbladder though the cystic gall duct. It is the application of the concept of natural orifice transluminal endoscopic surgery in the biliary system. This technique can not only achieve gallbladder drainage but can also minimize the risk of procedure-induced bleeding. In this paper, we describe a representative case to introduce the key points of this procedure and the associated clinical care, hoping to provide useful information for clinicians and nurses.

| S-EPMC8168036 | biostudies-literature

Percutaneous Management of a Coronary Bifurcation Aneurysm with Mesh-Covered Stents and the Simultaneous Kissing Stent Technique.

Project description:A 63-year-old man was admitted with a clinical diagnosis of acute coronary syndrome (non-ST-segment elevation), characterized by regional hypokinesia of the left ventricular posterior and lateral walls and by positive cardiac biomarkers. The coronary angiogram showed a 12.5-mm-diameter aneurysm with a mural thrombus and possible distal embolism to the bifurcation of the left circumflex coronary artery and the 2nd marginal branch. The aneurysm was managed percutaneously by implanting 2 mesh-covered stents in accordance with the "simultaneous kissing stent" technique. Follow-up angiography and optical coherence tomography at 5 postprocedural months documented complete sealing of the aneurysm and diffuse in-stent restenosis. No sign of ischemia occurred during the subsequent follow-up.

| S-EPMC4567121 | biostudies-literature

Novel 7-mm-diameter double bare metal stent for endoscopic side-by-side stent placement in malignant hilar biliary obstruction.

Project description: Not available

| S-EPMC7221250 | biostudies-literature