Endoscopic Nasogallbladder Drainage Versus Gallbladder Stenting Before Cholecystecomy
Endoscopic Nasogallbladder Drainage Versus Gallbladder Stenting Before Cholecystecomy
Early laparoscopic cholecystectomy is the current standard therapy for acute cholecystitis,
 but temporary decompression of the gallbladder (GB) through percutaneous or endoscopic route
 can be required to alleviate inflammatory process and reach an appropriate time for elective
 surgery in patients with high operative risk or marked local inflammation or organ
 dysfunction. Also preoperative endoscopic retrograde cholangiopancreatography (ERCP) is often
 needed because common bile duct (CBD) stone is accompanied in patients with acute
 cholecystitis at reported rate from 7-20%.

 Two-steps approach of percutaneous transhepatic GB drainage (PTGBD) followed by ERCP or vice
 versa has been performed for the treatment of acute cholecystitis with concomitant CBD stone
 who are not suitable for urgent cholecystectomy. However single-step drainage of CBD and GB
 through ERCP and endoscopic transpapillary GB drainage (ETGD) using nasocystic tube or
 plastic stent has alternatively been attempted in patients who have contraindications for
 PTGBD. In clinical practice, many endoscopists have hesitated to perform ETGD because of its
 relatively low technical success rate and specific concern about post-ERCP adverse event but
 it minimizes catheter keeping duration, and provides effective clinical improvement via
 physiologic route.

 Currently there are scarce data on if ETGD using nasocystic tube or plastic stent are
 comparable in terms of clinical efficacy and safety.
Inclusion Criteria:

 -  grade II or III acute cholecystitis met Tokyo 13 diagnostic criteria

 -  a high suspicion of CBD stone based on laboratory and imaging study

 -  informed consent given.

 Exclusion Criteria:

 -  bilo-pancreatic malignancy or surgically altered enteric anatomy

 -  subsequent elective surgery is expected to be impossible even after GB decompression
 based on American Society of Anesthesiologist class