Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Saturday, 04 / 21 / 2018

Articles

EUS-guided Gall Bladder Drainage in Severe Liver Disease: A Single-center Experience in Critically Ill Cirrhotics

ORIGINAL ARTICLE

EUS-guided Gall Bladder Drainage in Severe Liver Disease: A Single-center Experience in Critically Ill Cirrhotics

Kapil Dev Jamwal*, Manoj Kumar Sharma*, Rakhi Maiwall, Barjesh Kumar Sharma and Shiv Kumar Sarin

Department of Hepatology, Institute of Liver and Biliary Sciences, D1, Vasant Kunj, New Delhi, India

*Correspondence to: Kapil Dev Jamwal and Manoj Kumar Sharma, Department of Hepatology, Institute of Liver and Biliary Sciences, D1, near Heritage School, Vasant Kunj, New Delhi 110070, India. Tel: +91-11-46300000, Fax: +91-11-4600025, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. (KDJ), This email address is being protected from spambots. You need JavaScript enabled to view it. (MKS)

Journal of Clinical and Translational Hepatology 2018;6(1):35-39 DOI: 10.14218/JCTH.2017.00018
Received: March 10, 2017 Accepted: August 22, 2017 Published online: October 24, 2017

Abstract

Background and Aims: Acute calculous cholecystitis with impending gall bladder perforation in severe liver diseases including decompensated cirrhosis and acute-on-chronic liver failure (ACLF) is difficult to manage, due to the procedures such as cholecystectomy and per cutaneous cholecystostomy being associated with high risk and complications in these patients.

Methods: Four cases of severe liver disease with acute calculous cholecystitis who presented to the Institute of Liver and Biliary Sciences (New Delhi, India) for further management were included in the study if they underwent endoscopic ultrasound-guided gall bladder drainage (EUS-GBD). The patients were followed up for a minimum of 3 months and outcomes were recorded.

Results: Four cases of severe liver disease (three ACLF and one decompensated cirrhosis), with model for end-stage liver disease scores of 24, 26, 23 and 25 respectively, presented with acute calculous cholecystitis (Tokyo grade III) and systemic sepsis (high total leukocyte counts). Their international normalized ratios were 2.3, 2.6, 2.2 and 2.9 respectively, and two were in shock, requiring inotropes at presentation. Ultrasonography of the abdomen confirmed hugely distended gall bladder with stone impacted at the neck and moderate ascites. All these cases underwent EUS-GBD by linear echo endoscope, and had the gastric wall punctured in the antrum using a 19G access needle followed by dilatation of the tract using controlled radial expansion balloon and Sohendra dilator. In three cases, the plastic stents were placed. In the fourth case, a Nagi stent was placed. All the patients recovered and were discharged within a week.

Conclusions: EUS-GBD is challenging in severe liver disease but represents a life-saving procedure, and hence can be attempted in such critically ill patients with utmost care and precaution.

Keywords
ACLF, Acute-on-chronic liver failure, Cholecystitis, Ascites

 

 

Journal of Clinical and Translational Hepatology 2018 vol. 6, 35-39  [ Html ] [ PDF Full-text ]

© The Authors 2018. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

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