# Active Gallbladder Lavage Using a Double‐pigtail Plastic Stent Delivery System During Endoscopic Ultrasound‐guided Gallbladder Drainage (With Video)

## TL;DR

A new technique using a double-pigtail plastic stent during gallbladder drainage helps clean the gallbladder safely and effectively, avoiding complications and allowing future surgery if needed.

## Contribution

Introduces an active gallbladder lavage technique using a modified DPPS system during EUS-GBD to prevent bile leakage and improve clinical outcomes.

## Key findings

- The technique achieved a 97.3% technical success rate and 100% clinical success rate.
- No adverse events like bile leakage or pneumoperitoneum were reported.
- Nine patients were later scheduled for elective laparoscopic cholecystectomy without needing open surgery.

## Abstract

Endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) with a lumen‐apposing metallic stent is advised for frail patients with acute cholecystitis. However, concerns remain about severe tissue reactions and potential negative impacts on subsequent surgery. EUS‐GBD using a double‐pigtail plastic stent (DPPS) is an alternative for these patients. However, multiple steps harbor bile or air leaking from the anastomosis site. Some DPPS systems comprise an inner sheath that mounts a DPPS and a delivery pusher catheter. This DPPS system gains a lavage function, similar to a long plastic irrigation tube, when the inner sheath is retracted to the “halfway back position” within the DPPS. This single‐arm retrospective study reviewed the active gallbladder lavage technique using this “halfway back position” of the DPPS system during EUS‐GBD for patients with acute cholecystitis who left the option of laparoscopic cholecystectomy (Lap‐C) as a final option, depending on clinical and performance status recovery. The technical success rate was 97.3% (36/37). The clinical success rate among those with technical success was 100% (36/36). The median total duration was 25 min 7 s, which included a lavage duration of 8 min 18 s. The volume of lavage was 40 mL, and the number of attempts was two. The length of the anastomosis measured using computed tomography was 11.6 mm. No adverse events were reported. Nine patients (25.0%) were scheduled for elective Lap‐C, and none required conversion to open surgery. The active gallbladder lavage technique using the DPPS system during EUS‐GBD was both feasible and acceptable.

Endoscopic ultrasound‐guided gallbladder drainage using a double‐pigtail plastic stent (DPPS) harbors the risk of bile leakage and pneumoperitoneum through the anastomosis site. When the inner sheath of the DPPS system is retracted halfway back into the stent, multiple side holes emerge on the stent end, which accelerates the active gallbladder lavage. This active and straightforward gallbladder lavage using the DPPS system resulted in a high technical and clinical success rate, and developed neither bile leakage nor pneumoperitoneum.