Endoluminal transgastric endoscopic anastomosis of the gallbladder using an anchoring self-expanding metal stent

Abstract

An 86-year-old woman with a history of diabetes mellitus type 2, hypertension, and coronary artery disease was admitted for acute cholecystitis. On presentation she had abdominal pain and fever. Physical examination was remarkable for epigastric and right upper quadrant tenderness. Laboratory data showed leukocytosis (16 000 cells/µL with left shift; normal range 4500 – 10 000 cells/µL). An abdominal ultrasound confirmed acute cholecystitis because of gallstone disease. The patient was started on intravenous ceftriaxone and metronidazole and she refused surgery repeatedly. Due to the risks of gallbladder hydrops or rupture, we drained the gallbladder endoscopically using a self-expandable metal prosthesis with two flanged ends (Axios, Xlumena, Mountain View, California, USA) ([Fig. 1]). This novel lumen-apposing stent has been previously used to drain pseudocysts and has provided excellent results when used for draining nonadherent extraintestinal fluid collections [1]. The patient underwent the procedure after five days of antibiotic therapy.