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Transpapillary gallbladder stent placement for long-term therapy of acute cholecystitis
Andrew C Storm1, Eric J Vargas1, Jerry Y Chin1
1Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) offers a safe and effective long-term solution for acute cholecystitis in patients unsuitable for surgery. Double-stent placement may reduce recurrence rates compared to single-stent therapy.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Biliary Interventions
Background:
- Acute cholecystitis (AC) poses management challenges for patients who are poor surgical candidates.
- Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) is an alternative nonoperative approach.
- Evaluating the long-term efficacy of ERGD is crucial for this patient population.
Purpose of the Study:
- To assess the long-term success of ERGD for acute cholecystitis in non-surgical candidates.
- To determine technical and clinical success rates, adverse events, and recurrence risk factors.
Main Methods:
- A retrospective review of consecutive patients with AC undergoing ERGD between January 2008 and December 2019.
- ERGD involved transpapillary plastic double-pigtail stent placement into the gallbladder.
- Long-term success defined as absence of AC recurrence until 6 months, death, or reintervention.
Main Results:
- High rates of long-term success (95.9%), technical success (96%), and clinical success (100%) were observed.
- Mild adverse events occurred in 5.9% of patients.
- A trend towards longer recurrence-free survival with double-stent placement was noted, with single-stent therapy linked to more repeat procedures.
Conclusions:
- ERGD with transpapillary gallbladder stenting is a safe and effective long-term therapy for AC in high-risk surgical patients.
- Risk factors for AC recurrence include stent removal and single-stent placement.
- Double-stent therapy, though not always feasible, may be preferred for managing recurrence or failed single-stent therapy.
Background And Aims:
Select patients with acute cholecystitis (AC) are poor candidates for cholecystectomy. ERCP-guided transpapillary gallbladder (GB) drainage (ERGD) is one modality for nonoperative management of AC in these patients. Our primary aim was to evaluate long-term success of destination ERGD. Secondary aims were the rate of technical and clinical success, number of repeat procedures, rate of adverse events, and risk factors for recurrent AC.
Methods:
Consecutive patients with AC who were not candidates for cholecystectomy underwent ERGD with attempted transpapillary GB plastic double-pigtail stent placement at a tertiary hospital from January 2008 to December 2019. Long-term success was defined as no AC after ERGD until 6 months, death, or reintervention. Technical success was defined as placement of at least 1 transpapillary stent into the GB and clinical success as resolution of AC symptoms with discharge from the hospital.
Results:
Long-term success was achieved in 95.9% of patients (47/49), technical success in 96% (49/51), and clinical success 100% in those with technical success. Mild adverse events occurred in 5.9% (n = 3). Mean follow-up was 453 days after ERGD (range, 18-1879). A trend toward longer time to recurrence of AC was seen in patients with 2 rather than 1 GB stent placed (P = .13), and more repeat procedures were performed when a single stent was placed (P = .045).
Conclusions:
ERGD with transpapillary GB double-pigtail stent placement is a safe and effective long-term therapy for poor surgical candidates with AC. Risk factors for recurrence include stent removal and single-stent therapy. Double-stent therapy is not always technically feasible but may salvage failed single-stent therapy or recurrence after elective stent removal and may therefore be the preferred treatment modality.
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