polidocanol and Gallstones

To demonstrate the feasibility of cystic duct embolization and chemical gallbladder ablation as an alternative to cholecystectomy in high-risk patients with calculous cholecystitis who were not candidates for surgery.. This prospective study included 10 patients with acute cholecystitis (7 males and 3 females) aged 70-91 years (average age, 81.6 years) between 2013 and 2019. A cholecystostomy catheter was inserted during the acute phase, followed by cystic duct coil embolization performed via the existing drainage tube tract. Once asymptomatic, 3% aethoxysklerol was injected into the gallbladder, and the drain was removed upon sonographic confirmation that the gallbladder remained contracted. Each phase of the procedure was performed with an interval of 2-3 weeks. Clinical, cholangiographic, and sonographic data were collected before and after drain removal at 1-month follow-up.. Cystic duct embolization was technically successful in all patients, with no immediate post-procedure complications. Gallbladder ablation performed in 10 patients was technically successful in all of them (median follow-up, 11 months). One patient required repeat ablation at 14 months, and the prolonged biliary excretions of 1 other patient ceased only at 8 months.. Cystic duct embolization with gallbladder ablation is a feasible procedure for patients in whom cholecystectomy is contraindicated.

Topics: Ablation Techniques; Aged; Aged, 80 and over; Cholecystectomy; Cholecystitis, Acute; Contraindications, Procedure; Cystic Duct; Embolization, Therapeutic; Feasibility Studies; Female; Gallstones; Humans; Male; Polidocanol; Prospective Studies; Risk Factors; Time Factors; Treatment Outcome

Endoscopic papillotomy as therapeutic procedure of first choice for common bile duct stones is related with a relatively low complications rate and exhibits a very low method-related mortality. Major complications are cholangitis, pancreatitis, retroduodenal perforation and hemorrhage. In rare cases minor bleedings after papillotomy may lead to coagulation with consecutive obstruction of the papilla. Jaundice without major clinical symptoms will occur. Diagnosis is established by repeated retrograde cholangiography; conservative management is satisfactory and efficient.

Topics: Aged; Aged, 80 and over; Ampulla of Vater; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis, Extrahepatic; Female; Gallstones; Hemorrhage; Humans; Polidocanol; Polyethylene Glycols; Postoperative Complications; Thrombosis

Treatment was required in nine cases (1.7%) of haemorrhage after endoscopic sphincterotomy performed in 508 patients during 1981/82. Infiltrations with adrenalin (1: 10 000) and 1% polidocanol solution resulted in immediate arrest of haemorrhages in all cases. The endoscopic intervention could thus be completed successfully without further delay. The haemostatic effect was, without exception, permanent. There were no specific complications or late reactions.

Topics: Cholangitis; Cholestasis; Endoscopy; Epinephrine; Female; Gallstones; Gastrointestinal Hemorrhage; Hemostatics; Humans; Polidocanol; Polyethylene Glycols; Postoperative Complications; Sphincter of Oddi