Cerrahi için yüksek riskli bir hastada akut kolesistitin endoskopik transpapiller drenajı

Year 2020, Volume: 28 Issue: 2, 67 - 68, 30.08.2020

Sinem İpor Mehmet Çetin Atilla Önmez Alper İpor Serkan Torun

https://doi.org/10.17940/endoskopi.750914

Abstract

Akut kolesistit, safra taşlarının sık görülen komplikasyonlarından birisidir. Akut kolesistit için genellikle kolesistektomi önerilir. En sık tercih edilen yöntem laparoskopik kolesistektomidir. Ancak ameliyatın kontrendike olduğu durumlarda endoskopik transpapiller safra kesesi drenajı alternatif bir yöntem olarak kabul edilir. 86 yaşında kadın hasta, acil servise, sağ üst kadran ağrısı ve ateş yüksekliği yakınmalarıyla başvurduğunda çekilen abdomen tomografisinde taşlı kolesistit saptandı. Hasta kolesistit, kolanjit ve biliyer sepsis ön tanılarıyla yatırılarak acil endoskopik retrograd kolanjiyografi yapıldı. Safra kesesine 10 Fr 10 cm double pigtail plastik stent ve sağ ve sol ana safra kanalına uzanacak şeklide iki adet 10 Fr double pigtail stent yerleştirildi. İşlem sonrası klinik takiplerinde hasta hızlıca düzeldi ve post-operatif 1 hafta sonra taburcu edildi. Safra kesesinin endoskopik drenajı, transpapiller yoldan veya transmural yoldan endoskopik ultrasonografi ile yapılabilir. Prosedür teknik olarak başarılı olduğunda, transpapiller drenaj, akut kolesistitli hastaların %90’ından fazlasında etkili tedavi sağlar. Endoskopik drenaj yöntemleri kolesistektomi riski yüksek olan hastalarda teknik olarak uygulanabilir, güvenli ve etkili tekniklerdir.

Keywords

Kolesistit, kolanjit, ERCP, ETSD

Endoscopic Transpapillary Drainage of Acute Cholecystitis in a High-Risk Patient for Surgery

Abstract

Acute cholecystitis is one of the common complications of gallstones. Cholecystectomy is generally recommended in patients with acute cholecystitis. The most preferred method is laparoscopic cholecystectomy. However, in cases where surgery is contraindicated, endoscopic transpapillary gallbladder drainage is considered an alternative method. An 86-year-old female patient was admitted to the emergency department with right upper quadrant pain and fever. An abdominal computed tomography scan revealed calculus cholecystitis. The patient was hospitalized with a prediagnosis of cholecystitis, cholangitis, and biliary sepsis, and urgent endoscopic retrograde cholangiopancreatography was performed. A 10-Fr 10-cm double-pigtail plastic stent was inserted into the gallbladder, and two 10-Fr double-pigtail stents extended into the right and left main bile ducts. In the clinical follow-up after the procedure, the patient recovered quickly and was discharged one week postoperatively. Endoscopic drainage of the gallbladder can be performed using endoscopic ultrasonography from either the transpapillary pathway or the transmural pathway. When the procedure is technically successful, transpapillary drainage provides effective treatment in more than 90% of patients with acute cholecystitis. Endoscopic drainage is a technically feasible, safe, and effective method used in patients at a high risk of cholecystectomy.

Keywords

Cholecystitis, cholangitis, endoscopic retrograde cholangiopancreatography, endoscopic transpapillary gallbladder drainage

References

• 1. Lee SO, Yim SK. Management of Acute Cholecystitis. Korean J Gastroenterol [Internet]. 2018;71(5):264–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29791985 2. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):41–54. 3. Peñas-Herrero I, De La Serna-Higuera C, Perez-Miranda M. Endoscopic ultrasound-guided gallbladder drainage for the management of acute cholecystitis (with video). J Hepatobiliary Pancreat Sci. 2015;22(1):35–43. 4. Itoi T, Coelho-Prabhu N, Baron TH. Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc [Internet]. 2010 May;71(6):1038–45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20438890 5. Widmer J, Alvarez P, Sharaiha RZ, Gossain S, Kedia P, Sarkaria S, et al. Endoscopic gallbladder drainage for acute cholecystitis. Clin Endosc. 2015;48(5):411–20. 6. Baron TH, Grimm IS, Swanstrom LL. Interventional Approaches to Gallbladder Disease. Campion EW, editor. N Engl J Med [Internet]. 2015 Jul 23;373(4):357–65. Available from: http://www.nejm.org/doi/10.1056/NEJMra1411372