Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2020; 12(11): 488-492
Published online Nov 16, 2020. doi: 10.4253/wjge.v12.i11.488
Endoscopic ultrasound-guided gallbladder drainage in pancreatic cancer and cholangitis: A case report
Germana de Nucci, Nicola Imperatore, Desiree Picascia, Enzo Domenico Mandelli, Cristina Bezzio, Ilaria Arena, Barbara Omazzi, Alberto Larghi, Gianpiero Manes
Germana de Nucci, Enzo Domenico Mandelli, Cristina Bezzio, Ilaria Arena, Barbara Omazzi, Gianpiero Manes, Department of Gastroenterology, Garbagnate Milanese Hospital, ASST Rhodense, Milan 20024, Italy
Nicola Imperatore, Department of Gastroenterology, Cardarelli Hospital, Naples 80131, Italy
Desiree Picascia, Department of Gastroenterology, Federico II University, Naples 80100, Italy
Alberto Larghi, Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma 00168, Italy
Author contributions: de Nucci G was responsible for the conception of the paper, execution of the procedures, drafting of the article, interpretation of the data, approval of the article and is the guarantor of the article; Imperatore N was responsible for conception of the paper, drafting of the article and final approval of the article; Picascia D was responsible for drafting of the article, interpretation of data and final approval of the article; Bezzio C was responsible for final approval of the article; Mandelli ED, Omazzi B and Arena I were responsible for drafting of the article and final approval of the article; Larghi A was responsible for drafting of the article, interpretation of data and final approval of the article; Manes G was responsible for the analysis and interpretation of data and final approval of the article; All authors approved the final version of the article, including the authorship list.
Informed consent statement: The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published, and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Germana de Nucci, MD, Doctor, Department of Gastroenterology, Garbagnate Milanese Hospital, ASST Rhodense, Viale Forlanini, No. 95 Garbagnate Milanese, Milan 20024, Italy. germanadenucci1@gmail.com
Received: June 19, 2020
Peer-review started: June 19, 2020
First decision: August 22, 2020
Revised: September 15, 2020
Accepted: October 9, 2020
Article in press: October 9, 2020
Published online: November 16, 2020
Abstract
BACKGROUND

Head pancreatic cancers often present with clinical challenges requiring biliary drainage for chemotherapy or palliative scope. If usual endoscopic modalities fail or if percutaneous approach is not feasible, endoscopic ultrasound (EUS) guided biliary drainage can be considered. Here we describe and discuss an interesting clinical case in which EUS-guided gallbladder drainage (EUS-GBD) was chosen to treat acute severe cholangitis in a patient with advanced pancreatic cancer.

CASE SUMMARY

An 84-year-old female with a previous EUS-biopsy proven diagnosis of head pancreatic cancer presented with clinical signs of acute cholangitis. In September 2018 she had positioned a biliary and duodenal stent to relieve jaundice and an initial duodenal substenosis. In the emergency ward, an abdominal computed tomography scan showed proximal biliary stent occlusion due to neoplastic progression, but endoscopic retrograde cholangiopancreatography was impossible because of worsening duodenal stenosis and the absence of a chance to reach the Vater’s papilla area. EUS-guided choledocoduodenostomy was not technically feasible but because the cystic duct was free of neoplastic infiltration, an EUS-GBD using an Axios™ stent was successfully performed. The patient started to feed after 48 h and was discharged 1 wk later. No other hospitalizations due to cholangitis or symptoms of Axios™ stent occlusion/dysfunction were observed up until her death 6 mo later due to underlying disease.

CONCLUSION

This case demonstrated how different EUS therapeutic approaches could have a key role to treat critical and seemingly unsolvable situations and that they could play a more fundamental role in the next future.

Keywords: Gallbladder drainage, Endoscopy ultrasound, Pancreatic cancer, Cholangitis, Case report, Axios stent

Core Tip: The present case explored the feasibility, safety and efficacy of an endoscopic ultrasound-guided gallbladder drainage to decompress the biliary tree and treat severe cholangitis in a patient with advanced pancreatic cancer. Endoscopic ultrasound-guided gallbladder drainage could be effective to drain the biliary tree if the cystic duct is free from neoplastic tissue. Using the new lumen-apposing self-expandable metallic stent, the procedure could be technically and clinically feasible, safe and an effective alternative to conventional endoscopic retrograde cholangiopancreatography or percutaneous drainage.