Editorial
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Dec 5, 2018; 9(6): 47-54
Published online Dec 5, 2018. doi: 10.4292/wjgpt.v9.i6.47
Endoscopic ultrasound guided gallbladder drainage - is it ready for prime time?
Umesha Boregowda, Chandraprakash Umapathy, Arpitha Nanjappa, Helen Wong, Madhav Desai, Marina Roytman, Thimmaiah Theethira, Shreyas Saligram
Umesha Boregowda, Chandraprakash Umapathy, Arpitha Nanjappa, Marina Roytman, Thimmaiah Theethira, Shreyas Saligram, Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93721, United States
Helen Wong, Shreyas Saligram, Department of Gastroenterology and Hepatology, VA Central California Healthcare System, Fresno, CA 93703, United States
Madhav Desai, Department of Gastroenterology and Hepatology, Kansas University Medical Center, Kansas City, Kansas 66160, United States
Author contributions: Boregowda U and Saligram S designed the article, acquisition and interpretation of data; Boregowda U, Umapathy C, Nanjappa A, Desai M drafted the article; Wong H, Theethira T, Roytman M made critical revisions related to important intellectual content of the manuscript; Saligram S made critical revisions related to important intellectual content of the manuscript; and final approved the version of the article to be published.
Conflict-of-interest statement: None of the authors have any conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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 to: Shreyas Saligram, MD, MRCP, Assistant Professor, Department of Gastroenterology and Hepatology, University of California San Francisco, 2823 Fresno Street, Endoscopy Suite, 1st Floor, Fresno, CA 93721, United States. ssaligram@fresno.ucsf.edu
Telephone: +1-559-4593821 Fax: +1-559-4593887
Received: October 9, 2018
Peer-review started: October 9, 2018
First decision: October 22, 2018
Revised: October 28, 2018
Accepted: November 15, 2018
Article in press: November 15, 2018
Published online: December 5, 2018
Abstract

Management of acute cholecystitis includes initial stabilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the severity of cholecystitis or comorbidities will require a temporary measure as a bridge to surgery or permanent nonoperative management to decrease the mortality and morbidity. Most of these patients who require conservative management were managed with percutaneous transhepatic cholecystostomy or trans-papillary drainage of gallbladder drainage with cystic duct stenting through endoscopic retrograde cholangiopancreaticography (ERCP). Although, these conservative measures are effective, they can cause significant discomfort to the patients especially if used as a long-term measure. In view of this, there is a need for further minimally invasive procedures, which is safe, effective and comfortable to patients. Endoscopic ultrasound (EUS) guided gallbladder drainage is a novel method of gallbladder drainage first described in 2007[1]. Over the last decade, EUS guided gallbladder drainage has evolved as an effective alternative to percutaneous cholecystostomy and trans-papillary gallbladder drainage. Our goal is to review available literature regarding the scope of EUS guided gallbladder drainage as a viable alternative to percutaneous cholecystostomy or cystic duct stenting through ERCP among patients who are not suitable for cholecystectomy.

Keywords: Acute cholecystitis, Acute acalculous cholecystitis, Endoscopic ultrasound guided gallbladder drainage, Percutaneous cholecystostomy, Trans-papillary gallbladder drainage

Core tip: Acute cholecystitis can be a medical emergency if not treated. The definitive treatment for it is cholecystectomy. However, some patients are not surgically fit and will need to be managed conservatively. Endoscopic ultrasound guided gall bladder drainage is a novel technique and is a means to manage these patients conservatively either as a bridge to surgery until they become surgically fit or a long term management. We discuss the advantages and disadvantages of this technique as an alternative to other known conservative measures.