Chemical ablation of the Gallbladder with Acetic acid(50%)
Although cholecystectomy is a safe operation in most patients with acute gallbladder disease, the morbidity and mortality of this procedure increase considerably in elderly patients who have risk factors such as severe cardiac or pulmonary disease, sepsis, or multiorgan failure. Chemical ablation of the gallbladder might avoid the need for surgery in these patients. But to date, no sclerosant has caused ablation of animal or human gallbladders with 100% reliability. The purpose of this study is to investigate the feasibility of chemical ablation of dog gallbladder using 50% acetic acid. Five beagle dogs(8-10Kg) underwent percutaneous transhepatic cholecystostomy using sonographic guidance after general anesthesia. Cystic duct occlusion was done by using of N-butyl-2-cyanoacrylate and coils percutaneously. After complete occlusion of the cystic duct had been confirmed, sclerotherapy of the isolated gallbladder was performed. An appropriate amount(4-7ml) of 50% acetic acid was infused into the gallbladder through the drainage tube and remained for 20minutes with position change. After sclerotherapy, the sclerosant was removed through the catheter and irrigation was performed with normal saline solution. The drainage catheter was removed immediately after completion of the sclerotherapy. The animals were sacrificed after 8 weeks. The gallbladder and adjacent structures(liver, biliary tree) were removed and fixed en bloc. After histological slides were prepared by standard techniques, one pathologist examined it. Chemical ablation of the gallbladder with 50% acetic acid was technically successful in all animals. Gross specimens of the gallbladder showed shrunken and fibrotic change without retention of bile, mucus, and pus. Histologic appearance of the fundus and body was completely denudated epithelium from coagulative necrosis, but of the neck was presence of residual and regenerating mucosa. This is probably from coils and glue, which prevent effective sclerotherapy, using for cystic duct occlusion. Gallbladder lumen is filled with hemorrhagic necrotic debris. Gallbladder wall showed fibrosis, chronic inflammatory infiltrates, and foreign body giant cell reaction to pinkish amorphous material. Chemical ablation of the gallbladder with 50% acetic acid was effective and safe. If the method of cystic duct occlusion is modified, more complete sclerotherapy of entire gallbladder mucosa can be achieved.
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