Niigata Rosai Hospital
Satoshi Maekawa graduated University of Occupational and Environmental Health and acquired MD at the age of 25 years. Now he is the director of Department of Gastroenterological Medicine, Japan Labour Health and Welfare Organization Niigata Rosai Hospital. He published more than 4 papers in reputed journals.
Background: Early cholecystectomy is the standard therapy for acute cholecystitis. In critically ill elderly patients, however, the mortality rate of emergency cholecystectomy can reach 30%. Several reports have described the usefulness of percutaneous transhepatic gallbladder drainage (PTGBD) or percutaneous transhepatic gallbladder aspiration (PTGBA) for such poor surgical candidates. Recently, endoscopic transpapillary naso-gallbladder drainage (ETGBD) and endoscopic gallbladder stenting (EGS) have been reported to be useful in patients with acute cholecystitis for whom a percutaneous approach is contraindicated. Objective: To evaluate the efficacy of permanent EGS for management of acute cholecystitis in elderly patients who are poor surgical candidates. Design: Retrospective study. Setting: Japan Labour Health and Welfare Organization Niigata Rosai Hospital. Patients: Forty-six elderly patients with acute cholecystitis who were 65 years of age or older. Interventions: All patients underwent EGS. A 7Fr double pig-tail stent was inserted into the gallbladder. If EGS failed, PTGBD or PTGBA was performed subsequently. Main outcome measurements: The efficacy of EGS. Results: EGS was successful in 37 patients (80.4%) without immediate postprocedural complications, and performed permanent EGS was applied in 31 patients. In 30 of these 31 patients (96.7%), there was no recurrent cholecystitis and 29 patients (93.5%) remained asymptomatic for the duration of their survival (from 1 month to 5 years). Limitations: Difficulty of the EGS procedure. Conclusions: EGS can be effective for elderly patients with acute cholecystitis who are poor surgical candidates and can maintain them for up to several years.