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

BACKGROUND: Endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an alternative procedure for acute cholecystitis but remains a challenging procedure. AIMS: To elucidate the efficacy of a strategic approach for ETGBD that utilizes a four-step classification system and the opti...

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Autores principales: Yoshida, Michihiro, Naitoh, Itaru, Hayashi, Kazuki, Hori, Yasuki, Kato, Akihisa, Kachi, Kenta, Asano, Go, Sahashi, Hidenori, Toyohara, Tadashi, Kuno, Kayoko, Kito, Yusuke, Kataoka, Hiromi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9910654/
https://www.ncbi.nlm.nih.gov/pubmed/36758010
http://dx.doi.org/10.1371/journal.pone.0281605
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author Yoshida, Michihiro
Naitoh, Itaru
Hayashi, Kazuki
Hori, Yasuki
Kato, Akihisa
Kachi, Kenta
Asano, Go
Sahashi, Hidenori
Toyohara, Tadashi
Kuno, Kayoko
Kito, Yusuke
Kataoka, Hiromi
author_facet Yoshida, Michihiro
Naitoh, Itaru
Hayashi, Kazuki
Hori, Yasuki
Kato, Akihisa
Kachi, Kenta
Asano, Go
Sahashi, Hidenori
Toyohara, Tadashi
Kuno, Kayoko
Kito, Yusuke
Kataoka, Hiromi
author_sort Yoshida, Michihiro
collection PubMed
description BACKGROUND: Endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an alternative procedure for acute cholecystitis but remains a challenging procedure. AIMS: 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). METHODS: 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). RESULTS: 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). CONCLUSIONS: 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.
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spelling pubmed-99106542023-02-10 Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage Yoshida, Michihiro Naitoh, Itaru Hayashi, Kazuki Hori, Yasuki Kato, Akihisa Kachi, Kenta Asano, Go Sahashi, Hidenori Toyohara, Tadashi Kuno, Kayoko Kito, Yusuke Kataoka, Hiromi PLoS One Research Article BACKGROUND: Endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an alternative procedure for acute cholecystitis but remains a challenging procedure. AIMS: 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). METHODS: 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). RESULTS: 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). CONCLUSIONS: 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. Public Library of Science 2023-02-09 /pmc/articles/PMC9910654/ /pubmed/36758010 http://dx.doi.org/10.1371/journal.pone.0281605 Text en © 2023 Yoshida et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Yoshida, Michihiro
Naitoh, Itaru
Hayashi, Kazuki
Hori, Yasuki
Kato, Akihisa
Kachi, Kenta
Asano, Go
Sahashi, Hidenori
Toyohara, Tadashi
Kuno, Kayoko
Kito, Yusuke
Kataoka, Hiromi
Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage
title Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage
title_full Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage
title_fullStr Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage
title_full_unstemmed Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage
title_short Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage
title_sort theoretical step approach with ‘three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9910654/
https://www.ncbi.nlm.nih.gov/pubmed/36758010
http://dx.doi.org/10.1371/journal.pone.0281605
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