ETGBD in Surgically Unfit Patients With Both Choledocholithiasis and Cholecystolithiasis

For transpapillary gallbladder drainage, biliary cannulation was performed with a duodenoscope (JF-260V or TJF-260V; Olympus Optical). After successful deep cannulation of the CBD, we checked the cholangiogram, performed endoscopic sphincterotomy, and removed the CBD stone using a memory basket and/or retrieval balloon. Cholangiography was then performed again to locate the cystic duct orifice, and a guide wire (Jagwire; Boston Scientific, Marlborough, Massachusetts, USA or Visiglide; Olympus, Tokyo, Japan) was inserted into the gallbladder with different types of catheters (standard catheter, pull-sphincterotome, or rotating sphincterotome) under fluoroscopic guidance. After placement of the guide wire into the gallbladder, contrast dye was injected to confirm good entry into the gallbladder. Once the gallbladder was selected and the guidewire was coiled in the GB, a 7Fr 12-15cm double pigtail plastic stent (Zimmon; Wilson-Cook Medical, Winston-Salem, NC) was inserted into the GB.