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Endoscopic transpapillary gallbladder drainage for acute cholecystitis is feasible for patients receiving

Ryota Sagami1, Kenji Hayasaka1, Tetsuro Ujihara1

  • 1Departments of, Department of, Gastroenterology, New Tokyo Hospital, Chiba, Japan.

Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society
|February 14, 2020
PubMed

Insights

Endoscopic transpapillary gallbladder drainage (ETGBD) is safe for patients with acute cholecystitis on antithrombotic therapy (ATT). This study found no increased bleeding risk with ETGBD in patients continuing ATT, suggesting it

Area of Science:

  • Gastroenterology and Hepatology
  • Interventional Endoscopy
  • Surgical Risk Management

Background:

  • Patients with acute cholecystitis on antithrombotic therapy (ATT) face elevated bleeding risks during surgical or percutaneous interventions.
  • Endoscopic transpapillary gallbladder drainage (ETGBD) is a recommended alternative, but robust evidence regarding its safety in ATT patients is limited.

Purpose of the Study:

  • To evaluate the safety and efficacy of ETGBD in patients with acute cholecystitis who are undergoing antithrombotic therapy.
  • To compare bleeding complication rates between patients continuing ATT and those discontinuing or not using ATT during ETGBD.

Main Methods:

  • A retrospective multicenter study enrolled 130 patients with acute cholecystitis who underwent ETGBD.
  • Patients were stratified into an ATT group (continued ATT) and a Non-ATT group (discontinued or no ATT).
  • Primary outcome was bleeding complications; secondary outcomes included technical success, clinical success, and overall complication rates.

Main Results:

  • No bleeding complications were observed in either the ATT group (n=83) or the Non-ATT group (n=47).
  • Technical success rates (84.3% vs 89.4%) and clinical success rates (97.1% vs 100%) showed no significant differences between groups.
  • Overall early complications were low (3.1%), including mild pancreatitis and cholangitis; 12-month stent patency was 69.0%.

Conclusions:

  • ETGBD can be performed without an increased risk of bleeding complications in patients with acute cholecystitis receiving ATT.
  • ETGBD emerges as a potentially ideal and safe drainage method for this high-risk patient population.
Abstract

Keywords:
acute cholecystitisantithrombotic therapyendoscopic retrograde cholangiopancreatographyendoscopic transpapillary gallbladder drainagepercutaneous transhepatic gallbladder drainage

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