In the present study, all cystic duct patterns were Type I , The linear type was found in 85 patients and accounted for The gallbladder cannulation was performed in patients with a high risk of PEC according to the cystic duct patterns.
The overall success rate of cystic duct cannulation was Types I and III cystic ducts were easier to cannulate with a high success rate However, no statistically significant difference was found among different types or subtypes of the cystic duct Tables 3 and 4.
All cases with complication recovered after conservative treatment. Because the low incidence of complication rates in different groups, we did not make a comparison between the different groups. One right epigastric pain was suspected to be related to cystic duct cannulation. The endoscopic gallbladder drainage technique is challenging for endoscopists after successful bile duct cannulation. Previous studies reported the technical success rate of gallbladder cannulation as Successful endoscopic transpapillary cannulation of the gallbladder depends on a complete understanding of the anatomy and the possibility of stenosis or obstruction of the cystic duct.
Usually, cystic ducts were divided into three patterns as we described above. The Type I cystic duct was the most common and accounted for The linear type cystic duct accounted for more than half in the three subtypes of the Type I pattern Table 2.
Gallbladder cannulation requires specific skills due to the origin of cystic duct take-off, cystic duct configuration, corkscrew profile of the cystic duct, and presence of valves of Heister. Performing gallbladder cannulation according to the classification of cystic duct patterns is relatively easy and safe. Therefore, the first step in endoscopic transpapillary cannulation of the gallbladder is to accurately define the origin of cystic duct take-off [ 7 ].
During ERCP, the bile duct is selectively cannulated to obtain a direct cholangiogram. The cystic duct can be opacified during a cholangiogram, but if it fails to be opacified owing to cystic duct obstruction, some contrast can be injected under pressure to allow filling of the cystic duct using an occlusion balloon cholangiogram [ 4 ].
Also, a small amount of contrast medium is injected into the common bile duct to avoid filling the gallbladder with a further increase in intraluminal pressure [ 10 ]. Then, a 0. Based on different patterns of the cystic duct, different accessories are selected to cannulate the duct into the gallbladder. The use of a sphincterotome or a catheter with a flexible tip generally helps in cystic duct cannulation because it bows toward the cystic duct in a right-sided take-off Types I and II.
Since Type III is located on the left and angled up, a rotatable sphincterotome is particularly helpful if a standard sphincterotome fails. This prevented the cystic duct from mechanical injury. If tortuous cystic ducts cannot be straightened, it is better to choose a 5-Fr soft catheter so as to prevent the cystic duct from mechanical injury and deeply cannulate into the gallbladder. The close coordination between the catheter and the guidewire should also be given special attention during endoscopic transpapillary cannulation of the gallbladder.
In the present study, cystic duct cannulation was performed in patients with an overall success rate of No statistically significant difference was observed among different types or subtypes of the cystic ducts.
The results suggested that more patients should be examined to elucidate further which type of cystic duct is easier to cannulate. Several factors accounted for the technical failure of endoscopic transpapillary gallbladder cannulation Fig. These factors might block the advancement of the guidewire or make it difficult to traverse with the guidewire. Occasionally, although the guidewire passed through the narrow cystic duct, the catheter could not pass through it owing to its narrow caliber.
Representative cases of failure of endoscopic transpapillary gallbladder cannulation. If impacted stones in the cystic duct or the neck of the gallbladder were confirmed under fluoroscopic control, it was better to choose a dilation balloon catheter for cystic duct cannulation. If a guidewire was passed beyond the obstruction with several attempts and inserted into the gallbladder, the catheter was sometimes bypassed, impacting the stone into the gallbladder [ 9 ] Fig.
If the catheter or guidewire could not be inserted into the gallbladder, the cystic duct was cannulated into a gallbladder by pushing forward or pulling backward the inflated dilation balloon Fig. The impacted stone was either dislodged into the gallbladder or simply bypassed by pushing forward or pulling backward the inflated dilation balloon [ 4 ]. If cystic duct stenosis is severe, a hydrophilic guidewire through the valves of Heister is sometimes advanced into the cystic duct, but it is difficult to introduce even a 5-Fr catheter into the gallbladder through the cystic duct with stenosis.
Performing cannulation in the cystic duct with a sharp angle using the balloon occlusion technique is usually not difficult. Sometimes, deep cannulation is very difficult because a sharply angled cystic duct cannot be straightened and the guidewire cannot be passed easily using the balloon occlusion technique. Moreover, the markedly dilated cystic duct resulting from the take-off obstruction due to an impacted stone or stenosis looks like a corkscrew duct owing to the tortuous, edematous valves of Heister.
Cannulation cannot be performed because the guidewire also becomes a spiral one in the dilated cystic duct with swollen valves of Heister. Cystic duct cannulation when a stone impacted in the neck of the gallbladder. B1 Access to the cystic duct using the dilation catheter with a guidewire. B2—3 The impacted stones ST were dislodged into the gallbladder using the dilation inflated cathete.
The cystic duct perforation or hemorrhage may occur with guidewire or catheter manipulation. However, no perforation or severe hemorrhage related to cystic duct cannulation occurred in the present study. A major complication was right epigastric pain. Therefore, cystic duct cannulation was a relatively safe procedure. With the increase in endoscopic gallbladder drainage for elderly patients with multiple comorbidities at a high risk of cholecystectomy, it has become essential to understand the classification of cystic duct patterns.
Successfully and safely performing endoscopic transpapillary cannulation of the gallbladder according to the classification of cystic duct patterns is extremely helpful. However, data are available from the author upon reasonable request. Complications of endoscopic biliary sphincterotomy. N Engl J Med. Risk factors of acute cholecystitis after endoscopic common bile duct stone removal. World J Gastroenterol. Risk factors for post-ERCP cholecystitis: a single-center retrospective study.
Should this happen, bile will become trapped within the gallbladder. The bile will build up to the point where the gallbladder will swell. In the worst case scenario, the gallbladder will rupture, leading to a surgical emergency.
The gallbladder is a pear-shaped, hollow structure located under the liver and on the right side of the abdomen. Its primary function is to store and…. The common bile duct is a small, tube-like structure formed where the common hepatic duct and the cystic duct join. Its physiological role is to carry…. The jejunum is one of three sections that make up the small intestine.
Learn about its function and anatomy, as well as the conditions that can affect…. The vagus nerve is the longest of the 12 cranial nerves.
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