Percutaneous cholecystoscopy and internal rendezvous for ... - IJP

Brief Reports
Figure 2. In this fluoroscopic image, contrast material injected through
the cholecystostomy catheter demonstrates bile duct stones (white
arrow).
Figure 4. Schematic drawing depicting successful transcystic and transpapillary
guidewire placement. This was achieved by advancing the guidewire into the
cystic and bile ducts and finally into the duodenum, where it was then grasped
and withdrawn through the working channel of the duodenoscope.
DISCLOSURE
T. Baron is a consultant for Olympus America. No other
financial relationships relevant to this publication were
disclosed.
Abbreviation: CBD, common bile duct.
REFERENCES
Figure 3. For the internal rendezvous procedure, a 0.035-inch, hydrophilic
biliary guidewire was advanced into the cystic duct. The guidewire
was passed through the valves of Heister, into the bile duct, then finally
into the duodenum.
mature cholecystostomy tract with technical success rates
of 94% to 96%. 5,6 We performed percutaneous endoscopic
cholecystolithotomy to remove difficult, impacted cystic
duct stones with complete gallbladder clearance. Because
retrograde cannulation was not possible even after precut
papillotomy, an internal rendezvous through the gallbladder
allowed successful ERCP with clearance of choledocholithiasis.
We are unaware of prior reports of such an
internal rendezvous technique, which can be useful for
endoscopically accessing the biliary tree to relieve biliary
obstruction of any etiology and/or to treat biliary leaks in
patients with indwelling, mature percutaneous cholecystostomy
tubes.
1. Bakkaloglu H, Yanar H, Guloglu R, et al. Ultrasound guided percutaneous
cholecystostomy in high-risk patients for surgical intervention. World J
Gastroenterol 2006;12:7179-82.
2. Morse BC, Smith JB, Lawdahl RB, et al. Management of acute cholecystitis
in critically ill patients: contemporary role for cholecystostomy and subsequent
cholecystectomy. Am Surg 2010;76:708-12.
3. Coelho JC, Buffara M, Pozzobon CE, et al. Incidence of common bile duct stones
in patients with acute and chronic cholecystitis. Surg Gynecol Obstet 1984;158:
76-80.
4. Chiarugi M, Galatioto C, Lippolis PV, et al. Simultaneous laparoscopic
treatment for common bile duct stones associated with acute cholecystitis:
results of a prospective study [Italian]. Chir Ital 2006;58:709-16.
5. Kim YH, Kim YJ, Shin TB. Fluoroscopy-guided percutaneous gallstone removal
using a 12-fr sheath in high-risk surgical patients with acute cholecystitis.
Korean J Radiol 2011;12:210-5.
6. Ohashi S. Percutaneous transhepatic cholecystoscopic lithotomy in the managementofacutecholecystitiscausedbygallbladderstones.DiagnTherEndosc
1998;5:19-29.
Department of Medicine, Division of Gastroenterology & Hepatology, Mayo
Clinic, Rochester, Minnesota, USA.
Reprint requests: Todd H. Baron, MD, 200 First Street SW, Rochester, MN 55905.
Copyright © 2011 by the American Society for Gastrointestinal Endoscopy
0016-5107/$36.00
doi:10.1016/j.gie.2011.07.074
2 GASTROINTESTINAL ENDOSCOPY Volume xx, No. x : 2011 www.giejournal.org