Balloon-assisted percutaneous cholecystoenteric anastomosis creation: updated technique and instructional guide.

Describe the improved technique for balloon assisted percutaneous cholecystoenteric anastomosis creation, including patient selection and indications.

Background: Symptomatic cholelithiasis is a challenging clinical situation for complex or elderly patients that are not surgical candidates for traditional operative management. Cholecystostomy tubes are often inserted in the acute phase for these patients, however without treating the underlying cause, the patients may be left with chronic cholecystostomy tubes or risk recurrent cholecystitis. Percutaneous cholecystoenteric anastomosis creation is a novel technique used to create a fistula between the gallbladder and the duodenum to divert bile directly to the enteric lumen and eventually eliminate the requirement for a cholecystostomy tube.

Clinical Findings/Procedure Details: Percutaneous cholecystoenteric anastomosis is an emerging technique to treat gallstone disease in patients who are not surgical candidates. This educational presentation will use a small series of 5 patients to describe and visually demonstrate the improved balloon-assisted percutaneous cholecystoenteric anastomosis (BA-PCEA) creation procedure.  The novel technique of BA-PCEA may be useful to improve success in fistula creation. The exhibit will describe the necessary steps in BA-PCEA creation, in addition to the equipment and patient selection. Importantly, the BA-PCEA technique overcomes some of the challenges relating to duodenal puncture. In this small series the procedure was safe and effective with 100% clinical and technical success. One late post procedural complication occurred which was a persistent cholecystocutaneous fistula.

Conclusion and/or Teaching Points:

Percutaneous cholecystoenteric anastomosis creation is an evolving technique. This exhibit describes the procedural details for the improved BA-PCEA technique.