The gallbladder is a small organ that helps during the digestive process. It is essentially a small storage sack for bile and communicates with the bile ducts that drain the liver. However, it can be subject to a number of diseases. For instance, gallstones are perhaps the most common condition associated with the gallbladder. These stones can sometimes cause significant abdominal pain and require surgical removal of the gallbladder (cholecystectomy) for treatment. Other conditions that can affect the gallbladder include gallbladder cancer and cholecystitis.
The traditional treatment for recurrent cholecystitis and many other conditions affecting the gallbladder is to perform a cholecystectomy. This is the term used to describe the surgical removal of the gallbladder itself, and is considered a common treatment.
Cholecystectomy is performed in the case of symptomatic gallstones or inflammation of the gallbladder, and even in cases where the pancreas is inflamed due to passage of gallstones. However, it is an invasive treatment, requires the removal of an organ, and requires at some recovery time. Transpapillary gallbladder stenting is an alternative endoscopic treatment of the gallbladder that does not require surgery.
While gallbladder removal is generally a short procedure and sometimes does not even require an overnight stay in the hospital or clinic, it is still an invasive procedure. Thus some patients may not good surgical candidates or some patients may refuse surgery in general. EUS-guided gallbladder is a minimally invasive alternative that offers a completely endoscopic procedure with less recovery time, coupled with reduced discomfort and pain. Of course, one of the primary benefits here is that this treatment method actually alleviates the cause of the symptoms without removing the gallbladder. However, it is generally reserved for high-risk patients that are not good surgical candidates or those who refuse surgery.
Endoscopic (EUS-guided) Gallbladder Drainage is a completely endoscopic procedure performed via EUS. Traditionally, EUS has been mainly used to visualize and sample tumors in and around the GI tract. However new technologies and techniques allow endoscopists to use EUS to access the gallbladder directly from stomach or duodenum with a needle. This direct access from inside the body allows for placement of a lumen-apposing metal stent to make a new connection between the gallbladder and the stomach or duodenum. Placement of this internal stent into the gallbladder allows for drainage of liquid and solid contents of the gallbladder, thereby alleviating inflammation, infection, and pain. This stent that is placed in the gallbladder can be removed if needed, or stay in place indefinitely to treat the gallbladder.
As mentioned, only certain patients are considered candidates for transpapillary gallbladder stenting. Patients with liver disease or other medical conditions who are not able to go through conventional surgery are the primary candidates for this treatment. However, there are others who might be considered candidates, as well, including any patients who would prefer an endoscopic approach over surgery. Endoscopy can be performed safely on elderly patients as well.
Understand that all procedures, whether surgical or endoscopy include inherent risks. However, EUS-guided gallbladder drainage appears to be both effective overall, and safe for patients in the early trials that have been reported around the world. Few adverse events have been reported with this technique, however a detailed discussion with your endoscopist is important prior to undergoing this procedure.
Are you interested in learning more about endoscopic (EUS-guided) gallbladder drainage, or other treatment options? We invite you to contact us to learn more. Dr. Prashant Kedia is a renowned gastroenterologist serving patients in the Dallas-Fort Worth area and beyond. Call today to schedule an appointment at (214) 941-6891.