Clinical study of endoscopic transpapillary gallbladder drainage for cystic duct obstruction by impacted gallstones

Between December 1993 and September 1994, endoscopic transpapillary gallbladder drainage (ETGBD) was performed on 13 patients with cholecystitis caused by cystic duct obstruction by impacted gallstones, 11 acute and 2 chronic cases. In 10 of the 13 cases (76.9%) a catheter could be cannulated into the cystic duct. In 7 of the 13 cases (53.8 %) a drainage tube was placed in the gallbladder by removal of impacted stones and ETGBD was successful. Moreover, in 3 of 7 ETGBD successful cases gallstones could be treated by external shock wave lithotripsy (ESWL) utilizing drainage tubes. Suitable conditions for ETGBD application for cystic duct obstruction by impacted stones were as follows. 1) acute cholecystitis, 2) under 15 mm impacted stone size, 3) no gallbladder swelling and no severe wall thickening on ultrasonography, 4) over 4 mm cystic duct diameter. We conclude that ETGBD is a useful method for treatment of acute cholecystitis caused by cystic duct obstruction by impacted stones.