Endoscopic transpapillary gallbladder stent placement in?the?presence of uncovered biliary metal stents using a through-the-mesh technique

摘要

Percutaneous transhepatic gallbladder drainage (PTGBD) has traditionally been the treatment of choice for acute cholecystitis (AC) after biliary self-expandable metal stent (SEMS) placement. 1 However, PTGBD or EUS-guided drainage cannot be performed on patients with ascites or coagulopathy. For these patients, endo- scopic transpapillary gallbladder drainage (ETGBD) is the treatment of choice. 2-5 Furthermore, ETGBD may have another advantage over PTGBD: Prompt internal drainage can be achieved by endoscopic transpapillary gallbladder stent placement. 2-4 However, ETGBD is technically chal- lenging, and access into the gallbladder through the cystic duct may be difficult, especially when the previously placed SEMS overlaps the orifice of the cystic duct (OCD). Herein, we present what is to the best of our knowledge the first case of a successful ETGBD performed through the mesh of the previously placed double biliary uncovered SEMSs that overlapped the OCD (through- the-mesh technique).