Predicting the success of endoscopic transpapillary gallbladder drainage for patients with acute cholecystitis during pretreatment evaluation.

INTRODUCTION: Although endoscopic transpapillary gallbladder drainage (ETGBD) has been reported to be an effective treatment for acute cholecystitis, technical difficulties have precluded more widespread use of this technique. Case evaluations that can predeict the occurrence of such difficulties should increase the acceptance of ETGBD for acute cholecystis treatment. OBJECTIVE: To establish a pretreatment evaluation protocol for patients with acute cholecystitis. METHODS: Eleven patients with acute cholecystitis who received ETGBD in 2003 or 2004 were enrolled in the present rettrospective study. The frequency of success, complications and overall effectiveness of ETGBD success, including clinical and laboratory parameters, and gallbladder ultrasonograms, were also evaluated. RESULTS: ETGBD was successful in seven of 11 patients (success rate 63.6%). All seven patients who underwent ETGBD successfully were afebrilic and asymptomatic within a few days. No clinical or laboratory variables were significantly associated with success of ETGBD. In contrast, ultrasonographic measures of gallbladder minor-axis length and wall thickness in successful cases were significantly shorter (27.4 mm versus 38.0 mm; P=0.008) and thinner (4.2 mm versus 9.0 mm; P=0.041) relative to unsuccessful cases. CONCLUSIONS: Ultrasonographic measures of gall bladder minor-axis length and wall thickness can serve as important evaluation of ETGBD technical difficulties during pretreatment evaluation of patients with acute cholecystitis.