Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
ABSTRACT
Cholecystectomy is the treatment of choice for acute cholecystitis. However, decompression of the gallbladder by percutaneous transhepatic gallbladder drainage or endoscopic transpapillary gallbladder drainage can be performed as an alternative treatment method in surgically high risk patients. Endoscopic transpapillary gallbladder drainage has been used in patients in whom the percutaneous approach is contraindicated because of severe coagulopathy, thrombocytopenia or anatomically inaccessible location. However, endoscopic gallbladder drainage has failed in some patients because of nonvisualization of cystic duct on the cholangiogram or failure of guidewire passage through the cystic duct into the gallbladder. The authors report the successful endoscopic naso-gallbladder drainage tube insertion by using direct cholangioscopic visualization of the cystic duct with the SpyGlass cholangiopancreatography system in a patient with acute calculous cholecystitis and cholangitis.
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