Anatomic Feasibility of Percutaneous Cholecystoenteric Fistula Creation and Stent Insertion in Acute Cholecystitis

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Objective. To assess the prevalence of patients whose anatomy would be potentially amenable to percutaneous cholecystoenteric lumen-apposing metallic stents (LAMS) insertion from a population of acute cholecystitis patients. Methods. Contrast-enhanced abdominal computed tomography images in 100 consecutive adult patients with acute cholecystitis were reviewed retrospectively. Feasibility of LAMS placement percutaneously or with endoscopic ultrasound guidance was defined as the presence of a straight and unobstructed trajectory from the skin to the gallbladder, and between the gallbladder and the gastric antrum, or the proximal duodenum, measuring ≤2 cm, respectively. Results. The gallbladder was within 2 cm of the gastric antrum or proximal duodenum without intervening structures in 95 of 100 patients (95%). Percutaneous LAMS appeared anatomically feasible in 90 of 100 patients (90%). Mean ± SD shortest inner-inner wall distance between the gallbladder and the adjacent proximal gastrointestinal tract was 1.20 ± 0.43 cm. The closest location for percutaneous LAMS was between the gallbladder and duodenum in 87 of the feasible cases (97%). The percutaneous approach was transhepatic in 89.5%, and extrahepatic in 10.5%. Endoscopic ultrasound-guided LAMS appeared feasible in 95 of 100 patients, including 5 of the 10 percutaneously unfeasible cases. The other 5 patients appeared unfeasible due to colonic interposition or other intervening structures. Conclusions. LAMS appeared anatomically feasible percutaneously in 90% of acute cholecystitis patients. The shortest and most direct path for percutaneous LAMS was transhepatic and cholecystoduodenal. Percutaneously placed LAMS may be an attractive alternative to percutaneous cholecystostomy.

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