Margherita Sandano (Milan / IT), Davide Drigo (Trieste / IT), Clemente Junior Nappi (Trieste / IT), Alan Biloslavo (Trieste / IT), Paola Germani (Trieste / IT), Selene Bogoni (Trieste / IT), Davide Cosola (Trieste / IT), Matteo Rossano Buonocore (Trieste / IT), Fabio Monica (Trieste / IT), Nicolò de Manzini (Trieste / IT)
Abstract text (incl. references and figure legends)
Case history
We present the case of a 94 years old woman with a past medical history of diastolic heart failure and dementia. The patient was in poor general condition with a Frailty Index of 7 and ASA 4.
Clinical findings
The patient was admitted to our Emergency department with right quadrant abdominal pain and fever. Vital parameters were stable.
Investigation/Results
Blood samples showed incremented CRP levels and WBC count. CT scan revealed acute cholecystitis.
Diagnosis
Acute cholecystitis in an elderly and fragile patient.
Therapy and Progressions
The patient underwent at first antibiotic therapy and cholecystostomy placement on the same day of arrival with progressive improvement of the general conditions. The drainage tube was closed after 14 days and later the patient was discharged. Afterwards, the patient was kept under regular clinical and ultrasound follow-up until cholecystoduodenal lumen apposing metal stent (LAMS) was endoscopically placed as definitive treatment. The post-procedural course was uneventful. The patient was discharged the day after the procedure.
Comments
From our small preliminary experience, we believe that using cholecystostomy as bridge therapy to definitive endoscopic stent is a life-saving procedure in patients unfit for surgery. It allows us to stabilize the acute situation and perform LAMS in an elective setting. Bridge cholecystostomy followed by elective cholecystoduodenal stenting may be considered safe also in low-volume LAMS centres. Moreover, it may improve by far the quality of life of patients unfit for surgery with a low complication rate.
Amato, A., Sinagra, E., Celsa, C., Enea, M., Buda, A., Vieceli, F., Scaramella, L., Belletrutti, P., Fugazza, A.,Cammà, C.,Radaelli, F.,Repici, A.,Anderloni, A., 2021. Efficacy of lumen-apposing metal stents or self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy: a systematic review and meta-analysis. Endoscopy 53, 1037–1047.
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