Tips and tricks for endoscopic transpapillary gallbladder drainage

Background and AimsPercutaneous gallbladder drainage has traditionally been the reference standard treatment for cholecystitis in patients deemed unfit surgery. Endoscopic transpapillary emerged as a reliable alternative that offers an internal, incisionless option nonsurgical patients. The aim of this study was to describe techniques successful selective cystic duct cannulation during ERCP.MethodsA series endoscopic procedures is shown, including fluoroscopic video images. Each case highlights best practices, devices, aid with completion challenging cases.ResultsStandard access described using catheter 0.035-inch angled guidewire. Challenges are overcome various approaches, rotatable system, downsizing smaller guidewire, occluding proximal common hepatic occlusion balloon, directly intubating peroral cholangioscopy. Dilation performed devices designed biliary intervention, but smaller, percutaneous angioplasty balloons used small ducts severe strictures. After dilation, plastic, double-pigtail stent deployed across papilla, reobtained similar fashion place second, parallel stent. To eliminate need re-access after initial deployment, cytology brush repurposed obtain dual-wire within before deployment.ConclusionsWhen fundamentals ERCP here used, can be safely effectively treat who not surgical candidates. Percutaneous ERCP. A cases. Standard deployment. When