{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:01:59Z","timestamp":1787022119962,"version":"build-2736575974"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T00:00:00Z","timestamp":1675900800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an alternative procedure for acute cholecystitis but remains a challenging procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To elucidate the efficacy of a strategic approach for ETGBD that utilizes a four-step classification system and the optional use of \u2018Three-pillar\u2019 assistance with the following devices: cholangioscopy (SpyGlass DS, SG), a flex-type guidewire (Flex-GW), and a 3-Fr microcatheter (3-Fr Micro).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 115 patients undergoing ETGBD were studied retrospectively. Characteristics and technical outcomes were compared between conventional ETGBD technique (Classical ETGBD, N = 50) and strategic ETGBD with optional Three-pillar assistance (Strategic ETGBD, N = 65).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>SG-assistance (15\/65, 23.1%) was as an excellent troubleshooter in Category 1 (failure to identify the cystic duct [CD] orifice) and Category 2 (failure to advance the GW across the CD takeoff due to unfavorable angle). Flex-GW (19\/65, 29.2%) worked for Category 3b (failure of GW access to the GB due to multiple tortuosities). 3-Fr Micro (11\/65, 16.9%) was effective for Category 3a (failure of GW access to the GB due to CD obstruction) and Category 4 (failure of drainage stent insertion to the GB). The overall technical success rate was significantly higher for Strategic ETGBD (63\/65, 96.9%) compared with Classical ETGBD (36\/50, 72.0%) (p = 0.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Strategic ETGBD, which includes the Three-pillar assistance options of SG in the initial steps, Flex-GW for tortuous CD, and 3-Fr Micro for stenotic CD, achieved a significantly higher success rate than for Classical ETGBD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0281605","type":"journal-article","created":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T13:37:59Z","timestamp":1675949879000},"page":"e0281605","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Theoretical step approach with \u2018Three-pillar\u2019 device assistance for successful endoscopic transpapillary gallbladder drainage"],"prefix":"10.1371","volume":"18","author":[{"given":"Michihiro","family":"Yoshida","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8342-886X","authenticated-orcid":true,"given":"Itaru","family":"Naitoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Hayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9510-2568","authenticated-orcid":true,"given":"Yasuki","family":"Hori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihisa","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenta","family":"Kachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Go","family":"Asano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidenori","family":"Sahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadashi","family":"Toyohara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayoko","family":"Kuno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Kito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromi","family":"Kataoka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,2,9]]},"reference":[{"issue":"2","key":"pone.0281605.ref001","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1155\/1992\/46529","article-title":"Acute calculous cholecystitis. 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Wakabayashi","year":"2018","journal-title":"Journal of hepato-biliary-pancreatic sciences"},{"issue":"1","key":"pone.0281605.ref005","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1002\/jhbp.504","article-title":"Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos).","volume":"25","author":"Y Mori","year":"2018","journal-title":"Journal of hepato-biliary-pancreatic sciences"},{"issue":"9","key":"pone.0281605.ref006","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1002\/bjs.1800820939","article-title":"Percutaneous cholecystostomy: a valuable technique in high-risk patients with presumed acute cholecystitis.","volume":"82","author":"MM Melin","year":"1995","journal-title":"The British journal of surgery"},{"issue":"7","key":"pone.0281605.ref007","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s00535-007-2061-9","article-title":"Usefulness of single and repetitive percutaneous 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