Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage
<h4>Background</h4> Endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an alternative procedure for acute cholecystitis but remains a challenging procedure. <h4>Aims</h4> To elucidate the efficacy of a strategic approach for ETGBD that utilizes a four...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9910654/?tool=EBI |
| _version_ | 1811166134995517440 |
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| author | Michihiro Yoshida Itaru Naitoh Kazuki Hayashi Yasuki Hori Akihisa Kato Kenta Kachi Go Asano Hidenori Sahashi Tadashi Toyohara Kayoko Kuno Yusuke Kito Hiromi Kataoka |
| author_facet | Michihiro Yoshida Itaru Naitoh Kazuki Hayashi Yasuki Hori Akihisa Kato Kenta Kachi Go Asano Hidenori Sahashi Tadashi Toyohara Kayoko Kuno Yusuke Kito Hiromi Kataoka |
| author_sort | Michihiro Yoshida |
| collection | DOAJ |
| description | <h4>Background</h4> Endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an alternative procedure for acute cholecystitis but remains a challenging procedure. <h4>Aims</h4> To elucidate the efficacy of a strategic approach for ETGBD that utilizes a four-step classification system and the optional use of ‘Three-pillar’ assistance with the following devices: cholangioscopy (SpyGlass DS, SG), a flex-type guidewire (Flex-GW), and a 3-Fr microcatheter (3-Fr Micro). <h4>Methods</h4> A total of 115 patients undergoing ETGBD were studied retrospectively. Characteristics and technical outcomes were compared between conventional ETGBD technique (Classical ETGBD, N = 50) and strategic ETGBD with optional Three-pillar assistance (Strategic ETGBD, N = 65). <h4>Results</h4> SG-assistance (15/65, 23.1%) was as an excellent troubleshooter in Category 1 (failure to identify the cystic duct [CD] orifice) and Category 2 (failure to advance the GW across the CD takeoff due to unfavorable angle). Flex-GW (19/65, 29.2%) worked for Category 3b (failure of GW access to the GB due to multiple tortuosities). 3-Fr Micro (11/65, 16.9%) was effective for Category 3a (failure of GW access to the GB due to CD obstruction) and Category 4 (failure of drainage stent insertion to the GB). The overall technical success rate was significantly higher for Strategic ETGBD (63/65, 96.9%) compared with Classical ETGBD (36/50, 72.0%) (p = 0.0001). <h4>Conclusions</h4> Strategic ETGBD, which includes the Three-pillar assistance options of SG in the initial steps, Flex-GW for tortuous CD, and 3-Fr Micro for stenotic CD, achieved a significantly higher success rate than for Classical ETGBD. |
| first_indexed | 2024-04-10T15:47:38Z |
| format | Article |
| id | doaj.art-9796c639c1eb45cba7cc026a9f3bd80e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-10T15:47:38Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-9796c639c1eb45cba7cc026a9f3bd80e2023-02-12T05:31:17ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01182Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainageMichihiro YoshidaItaru NaitohKazuki HayashiYasuki HoriAkihisa KatoKenta KachiGo AsanoHidenori SahashiTadashi ToyoharaKayoko KunoYusuke KitoHiromi Kataoka<h4>Background</h4> Endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an alternative procedure for acute cholecystitis but remains a challenging procedure. <h4>Aims</h4> To elucidate the efficacy of a strategic approach for ETGBD that utilizes a four-step classification system and the optional use of ‘Three-pillar’ assistance with the following devices: cholangioscopy (SpyGlass DS, SG), a flex-type guidewire (Flex-GW), and a 3-Fr microcatheter (3-Fr Micro). <h4>Methods</h4> A total of 115 patients undergoing ETGBD were studied retrospectively. Characteristics and technical outcomes were compared between conventional ETGBD technique (Classical ETGBD, N = 50) and strategic ETGBD with optional Three-pillar assistance (Strategic ETGBD, N = 65). <h4>Results</h4> SG-assistance (15/65, 23.1%) was as an excellent troubleshooter in Category 1 (failure to identify the cystic duct [CD] orifice) and Category 2 (failure to advance the GW across the CD takeoff due to unfavorable angle). Flex-GW (19/65, 29.2%) worked for Category 3b (failure of GW access to the GB due to multiple tortuosities). 3-Fr Micro (11/65, 16.9%) was effective for Category 3a (failure of GW access to the GB due to CD obstruction) and Category 4 (failure of drainage stent insertion to the GB). The overall technical success rate was significantly higher for Strategic ETGBD (63/65, 96.9%) compared with Classical ETGBD (36/50, 72.0%) (p = 0.0001). <h4>Conclusions</h4> Strategic ETGBD, which includes the Three-pillar assistance options of SG in the initial steps, Flex-GW for tortuous CD, and 3-Fr Micro for stenotic CD, achieved a significantly higher success rate than for Classical ETGBD.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9910654/?tool=EBI |
| spellingShingle | Michihiro Yoshida Itaru Naitoh Kazuki Hayashi Yasuki Hori Akihisa Kato Kenta Kachi Go Asano Hidenori Sahashi Tadashi Toyohara Kayoko Kuno Yusuke Kito Hiromi Kataoka Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage PLoS ONE |
| title | Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage |
| title_full | Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage |
| title_fullStr | Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage |
| title_full_unstemmed | Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage |
| title_short | Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage |
| title_sort | theoretical step approach with three pillar device assistance for successful endoscopic transpapillary gallbladder drainage |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9910654/?tool=EBI |
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