Endoscopic treatment of a giant stone in a patient with acute cholecystitis at a high surgical risk: breaking the paradigm (with videos).

Abstract

An 84-year-old man with chronic renal failure on dialysis, chronic heart failure, and obesity presented to the emergency room with right upper quadrant pain and fever. Laboratory tests revealed elevated white blood cells (19.5 (cid:1) 10 9 /L) and serum C-reactive protein (175 mg/dL). Abdominal ultrasound showed gallbladder (GB) wall thickening and a 7.4-cm stone occupying most of the GB lumen. A diagnosis of acute cholecystitis was made. Because of the increased surgical risk, EUS – guided GB drainage (EUS-GBD) with intracholecystic lithotripsy was offered to the patient, who signed informed consent. EUS examination showed presence of a giant stone, producing a shadow covering almost all the GB field