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Long-Term Impact of Endoscopic Gallbladder Stenting for Calculous Cholecystitis in Poor Surgical Candidates: A
Tadahisa Inoue1, Yuta Suzuki2, Michihiro Yoshida3
1Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan. tinoue-tag@umin.ac.jp.
Insights
Endoscopic gallbladder stenting (EGBS) helps prevent cholecystitis recurrence in high-risk patients but has a lower success rate. Prolonged stent use increases the risk of other adverse events.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Biliary Tract Interventions
Background:
- Acute calculous cholecystitis poses risks for high-risk surgical candidates.
- Endoscopic gallbladder stenting (EGBS) is an alternative to surgery, but its long-term outcomes are not well-established.
- Percutaneous transhepatic gallbladder drainage (PTGBD) is another drainage option for these patients.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of EGBS compared to PTGBD in patients unfit for cholecystectomy.
- To assess recurrence rates of cholecystitis and the incidence of adverse events associated with each procedure.
Main Methods:
- A comparative study involving 528 high-risk surgical patients with acute calculous cholecystitis.
- Patients were treated with either EGBS or PTGBD.
- Technical success, early adverse events, and long-term outcomes including cholecystitis recurrence and late adverse events were compared.
Main Results:
- EGBS had a significantly lower technical success rate (75.4%) than PTGBD (98.7%).
- Early adverse event rates were similar between EGBS (7.7%) and PTGBD (4.3%).
- EGBS showed significantly lower rates of cholecystitis recurrence (7.2% at 5 years) compared to PTGBD (30.2% at 5 years), but higher rates of other symptomatic late adverse events (31.4% at 5 years vs. 13.1% for PTGBD).
Conclusions:
- Long-term EGBS is effective in preventing cholecystitis recurrence in patients unsuitable for surgery.
- However, EGBS is associated with a lower technical success rate and an increased frequency of other late adverse events with prolonged indwelling times.
Background:
Although long-term stent placement using endoscopic gallbladder stenting (EGBS) reportedly reduces cholecystitis recurrence in patients unfit to undergo cholecystectomy, its efficacy and safety remain uncertain.
Aims:
This study aimed to examine the long-term effect of EGBS in poor surgical candidates of cholecystectomy.
Methods:
A total of 528 high-risk surgical patients with acute calculous cholecystitis met this study's eligibility criteria. The technical success and adverse events (AE) were compared between patients who underwent EGBS and those who underwent percutaneous transhepatic gallbladder drainage (PTGBD). Elective stent exchange and removal were not performed after EGBS. The external tube was removed after improvement of cholecystitis following PTGBD.
Results:
The technical success rate was significantly lower with EGBS compared to PTGBD (75.4% versus 98.7%, P < 0.001), while the early-AE rate did not differ significantly between the two methods (7.7% versus 4.3%, P = 0.146). The 1-, 3-, and 5-year cumulative incidence rates of cholecystitis were 3.8%, 7.2%, and 7.2% with EGBS, and 11.7%, 17.6%, and 30.2% with PTGBD, respectively (P = 0.001). Conversely, those of symptomatic late-AE (except cholecystitis) were 8.2%, 22.7%, and 31.4% with EGBS, and 7.5%, 10.9%, and 13.1% with PTGBD, respectively (P = 0.035). Thus, the 1-, 3-, and 5-year cumulative incidence of overall late-AE was 12.0%, 30.4%, and 40.4% with EGBS, and 19.2%, 28.3%, and 42.5% with PTGBD, respectively (P = 0.649).
Conclusions:
Long-term stent placement via EGBS is useful for preventing the recurrence of cholecystitis, but the success rate is low and the frequency of other late-AE increases with the prolongation of the indwelling period.
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