Perc Cholecystostomy prior to ERCP

[iaskdumbquestions]

Recently had a patient with obstructing CBD stone, patient was getting sicker. GI couldn't ERCP for another day but both surgery and GI said to hold off on perc chole unless absolutely necessary as it would effect the ERCP. Neither GI nor surgery were exactly clear on why decompressing the GB would negatively effect the ERCP, so I'm asking here. Thanks!

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[Gastrapathy]

it wouldn’t affect the ercp but it would affect the subsequent management of the GB.

 

[AlteredScale]

The big question here is why couldn't they do the ERCP for another day?

PCT doesn't not affect ERCP but def makes any sort of cholecystogastrostomy or cholecystoduodenostomy with LAMS impossible since the GB is not distended.

 

[iaskdumbquestions]

Yeah their line of reasoning doesn't make sense to me. I would have preferred perc drain to decompress and get some manner of source control, then they could ERCP and take the stone out later.

I appreciate the responses

 

[Acoustic]

Yeah their line of reasoning doesn't make sense to me. I would have preferred perc drain to decompress and get some manner of source control, then they could ERCP and take the stone out later.

I appreciate the responses

You may have preferred that, but the patient wouldn’t have. It sucks having a drain hanging out your side. Its disfiguring, can be painful, get infected, fall out etc.

Often the cystic duct in these cases isn’t COMPLETELY occluded, such that it could also decompress the main bile duct too. That could make it harder to cannulate the bile duct on ERCP so maybe that’s why they phrased it the way they did? That’s never really that big of a deal though. It definitely does increase the difficulty of EUS transmural gallbladder drainage but it’s not impossible. Can instill sterile water via the tube to “plump up” the gallbladder again.

They probably wanted you to wait for patient factors above and because it wasn’t really necessary to get source control right away.