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Endoscopic gallbladder stent placement for treatment of symptomatic cholelithiasis in patients with end-stage liver
Christine Schlenker1, James F Trotter, Raj J Shah
1Division of Gastroenterology/Hepatology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
Insights
Endoscopic gallbladder stenting offers a less invasive treatment for symptomatic gallbladder disease in patients with cirrhosis. This procedure effectively resolves symptoms and complications, serving as a viable option for high-risk individuals awaiting liver transplantation.
Area of Science:
- Gastroenterology
- Hepatology
- Endoscopic Procedures
Background:
- Symptomatic cholelithiasis is prevalent in cirrhosis patients.
- Cholecystectomy poses increased risks for cirrhotic patients.
- Gallbladder disease management in cirrhosis requires safer alternatives.
Purpose of the Study:
- To evaluate endoscopic gallbladder stenting as a treatment for symptomatic gallbladder disease in cirrhosis patients.
- To assess the safety and efficacy of gallbladder stenting in this high-risk population.
Main Methods:
- Retrospective review of 23 cirrhosis patients undergoing endoscopic retrograde cholangiography with gallbladder stent placement.
- Data collected from July 1994 to August 2004.
Main Results:
- Stenting indications included biliary colic, acute cholecystitis, and gallstone pancreatitis.
- 87% of patients achieved symptom resolution post-stenting.
- Three patients experienced late complications, successfully treated with antibiotics.
Conclusions:
- Endoscopic gallbladder stenting is a potential treatment for symptomatic gallbladder disease in cirrhosis patients.
- This less invasive approach is suitable for high-risk patients awaiting liver transplantation.
Objectives:
Symptomatic cholelithiasis is a common disease in the general population with an increased prevalence in patients with cirrhosis. While cholecystectomy is the procedure of choice for the treatment of symptomatic cholelithiasis, cirrhotics have an increased risk of complications associated with this therapy. We have found that placement of an endoscopic gallbladder stent is an alternative, less invasive treatment for cirrhotic patients with symptomatic gallbladder disease and describe our experience here.
Methods:
A retrospective medical record review of 23 patients with cirrhosis who underwent endoscopic retrograde cholangiography with gallbladder stent placement for symptomatic gallbladder disease from July 1994 to August 2004.
Results:
Indications for stent placement included recurrent biliary colic (56.5%), acute calculous cholecystitis (39%), acalculous cholecystitis (8.6%), and gallstone pancreatitis (8.6%). All patients experienced resolution of their symptoms following stent placement. Twenty patients (87%) were asymptomatic from 5 days to 3 years post-procedure until transplantation, death, or end of study period. Nine patients (39%) underwent liver transplantation, 5 days to 34 months after the procedure. Eleven patients are well, with ten patients awaiting liver transplantation. Three patients developed late complications and were treated successfully with antibiotics.
Conclusion:
Endoscopic stenting of the gallbladder may be a potential treatment for symptomatic gallbladder disease in patients with cirrhosis awaiting liver transplantation, considered to be high-risk for cholecystectomy.
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