P0819 (S1867). - EUS-Guided Cholecystogastrostomy With Endoscopic Suction-Assisted Gallstone Removal and Transcystic Cholangiography in a Patient With Acute on Chronic Cholecystitis and Decompensated Cirrhosis
Mitali Agarwal, MD1, Zohair Ahmed, MD2, Brian Boulay, MD, MPH1, Edward C. Villa, MD1; 1University of Illinois at Chicago, Chicago, IL; 2UIC, Chicago, IL
Introduction: EUS guided placement of cholecystogastrostomy is a therapeutic option for patients with acute and/or chronic cholecystitis who cannot undergo laparoscopic cholecystectomy or percutaneous transhepatic gallbladder drainage.
Methods: Our patient is a 58-year-old male with history of HCV and alcohol cirrhosis post TIPS (nonfunctioning) who presented with acute on chronic cholecystitis. He was high risk for surgery (Child-Pugh C) and could not undergo percutaneous gallbladder drain placement due to the presence of ascites. Thus, a decision was made to perform an EUS guided cholecystogastrostomy using a lumen apposing metal stent. In this video, we will demonstrate the techniques of performing an EUS guided cholecystogastrostomy via lumen apposing metal stent, followed by endoscopic removal of gallstones and debris with a standard adult gastroscope and transcystic cholangiography using the existing cholecystogastrostomy. The patient did well after his procedures. Discussion: EUS guided placement of cholecystogastrostomy via lumen apposing metal stent is a minimally invasive technique for gallbladder drainage in patients with acute and/or chronic cholecystitis. It has high success rates with minimal adverse events when performed by an experienced endoscopist. The established cholecystogastrostomy can be used to access the gallbladder (using a standard adult gastroscope) to remove additional gallstones and debris and perform transcystic cholangiogram.
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Disclosures: Mitali Agarwal indicated no relevant financial relationships. Zohair Ahmed indicated no relevant financial relationships. Brian Boulay: Boston Scientific – Consultant, I am only a consultant but this site insists I check every box.. Edward Villa: Olympus Corporation – Consultant.