Theoretical step approach with 'Three-pillar' device assistance for successful endoscopic transpapillary gallbladder drainage

• Published in: PloS one Vol. 18; no. 2; p. e0281605
• Main Authors: Yoshida, Michihiro, Naitoh, Itaru, Hayashi, Kazuki, Hori, Yasuki, Kato, Akihisa, Kachi, Kenta, Asano, Go, Sahashi, Hidenori, Toyohara, Tadashi, Kuno, Kayoko, Kito, Yusuke, Kataoka, Hiromi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 09.02.2023; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Care and treatment; Catheters; Cholecystitis; Cholecystitis, Acute - surgery; Comparative analysis; Drainage - methods; Endoscopy; Engineering and Technology; Evaluation; Failure; Gallbladder; Gallbladder diseases; Humans; Implants; Inflammation; Laparoscopy; Medical equipment; Medical research; Medicine and Health Sciences; Medicine, Experimental; Methods; Orifices; Patient outcomes; Patients; Performance evaluation; Retrospective Studies; Stents; Success; Surgical drains; Wound drainage; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0281605

Endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an alternative procedure for acute cholecystitis but remains a challenging procedure. To elucidate the efficacy of a strategic approach for ETGBD that utilizes a four-step classification system and the optional use of 'Three-pillar' assistance with the following devices: cholangioscopy (SpyGlass DS, SG), a flex-type guidewire (Flex-GW), and a 3-Fr microcatheter (3-Fr Micro). A total of 115 patients undergoing ETGBD were studied retrospectively. Characteristics and technical outcomes were compared between conventional ETGBD technique (Classical ETGBD, N = 50) and strategic ETGBD with optional Three-pillar assistance (Strategic ETGBD, N = 65). SG-assistance (15/65, 23.1%) was as an excellent troubleshooter in Category 1 (failure to identify the cystic duct [CD] orifice) and Category 2 (failure to advance the GW across the CD takeoff due to unfavorable angle). Flex-GW (19/65, 29.2%) worked for Category 3b (failure of GW access to the GB due to multiple tortuosities). 3-Fr Micro (11/65, 16.9%) was effective for Category 3a (failure of GW access to the GB due to CD obstruction) and Category 4 (failure of drainage stent insertion to the GB). The overall technical success rate was significantly higher for Strategic ETGBD (63/65, 96.9%) compared with Classical ETGBD (36/50, 72.0%) (p = 0.0001). Strategic ETGBD, which includes the Three-pillar assistance options of SG in the initial steps, Flex-GW for tortuous CD, and 3-Fr Micro for stenotic CD, achieved a significantly higher success rate than for Classical ETGBD.