de Siqueira Neto J, de Moura DTH, Ribeiro IB, Barrichello SA, Harthorn KE, Thompson CC. Gallbladder perforation due to endoscopic sleeve gastroplasty: A case report and review of literature. World J Gastrointest Endosc 2020; 12(3): 111-118 [PMID: 32218890 DOI: 10.4253/wjge.v12.i3.111]
Corresponding Author of This Article
Christopher C Thompson, FASGE, MD, MSc, PhD, Professor, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Thorn 1404, Boston, MA 02115, United States. cthompson@hms.harvard.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Mar 16, 2020; 12(3): 111-118 Published online Mar 16, 2020. doi: 10.4253/wjge.v12.i3.111
Gallbladder perforation due to endoscopic sleeve gastroplasty: A case report and review of literature
João de Siqueira Neto, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Sérgio Alexandre Barrichello, Kelly E Harthorn, Christopher C Thompson
João de Siqueira Neto, Department of Surgery, Federal University of Espirito Santo, Vitoria 29075-910, Espirito Santo, Brazil
Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Sérgio Alexandre Barrichello, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, São Paulo, Brazil
Diogo Turiani Hourneaux de Moura, Kelly E Harthorn, Christopher C Thompson, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Author contributions: de Moura DTH and Barrichello SA conceived and designed the study; de Siqueira Neto J performed the procedure; Ribeiro IB carried out the literature search; Harthorn KE and Thompson CC reviewed the case and edited the manuscript; all authors contributed to finalizing the present version of the paper and approved the manuscript for publication.
Informed consent statement: Written informed consent was obtained from the patient.
Conflict-of-interest statement: Thompson CC reports personal fees from Boston Scientific, personal fees from Olympus, outside the submitted work.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Christopher C Thompson, FASGE, MD, MSc, PhD, Professor, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Thorn 1404, Boston, MA 02115, United States. cthompson@hms.harvard.edu
Received: November 6, 2019 Peer-review started: November 6, 2019 First decision: November 20, 2019 Revised: November 29, 2019 Accepted: December 23, 2019 Article in press: December 23, 2019 Published online: March 16, 2020 Processing time: 127 Days and 2.8 Hours
Abstract
BACKGROUND
The healthcare impact of obesity is enormous, and there have been calls for new approaches to containing the epidemic worldwide. Minimally invasive procedures have become more popular, with one of the most widely used being endoscopic sleeve gastroplasty (ESG). Although major adverse events after ESG are rare, some can cause considerable mortality. To our knowledge, there has been no previous report of biliary ascites after ESG.
CASE SUMMARY
A 48-year-old female with obesity refractory to lifestyle changes and prior gastric balloon placement underwent uncomplicated ESG and was discharged on the following day. On postoperative day 3, she developed abdominal pain, which led to an emergency department visit the following day. She was readmitted to the hospital, with poor general health status and signs of peritoneal irritation. Computed tomography imaging showed fluid in the abdominal cavity. Laparoscopy revealed biliary ascites and showed that the gallbladder was sutured to the gastric wall. The patient underwent cholecystectomy and lavage of the abdominal cavity and was admitted to the intensive care unit post-operatively. After 7 d of antibiotic therapy and 20 d of hospitalization, she was discharged. Fortunately, 6 mo later, she presented in excellent general condition and with a 20.2% weight loss.
CONCLUSION
ESG is a safe procedure. However, adverse events can still occur, and precautions should be taken by the endoscopist. In general, patient position, depth of tissue acquisition, location of stitch placement, and endoscopist experience are all important factors to consider to mitigate procedural risk.
Core tip: Despite broader acceptance of endoscopic sleeve gastroplasty for weight loss management, the procedure can still present challenges for endoscopists. Although the inadvertent puncture of organs adjacent to the stomach is a rare occurrence, it can lead to catastrophic outcomes. Early identification of possible unintended events and an assertive approach to case management can be life-saving. Patient selection and optimal technique remain under debate. With broader adoption of endoscopic sleeve gastroplasty worldwide, risk mitigation strategies must be emphasized to optimize procedural safety.
