Outcomes of Spiral Versus Conventional Double Pigtail Plastic Stents in Permanent Transpapillary Gallbladder Drainage...

Endoscopic gallbladder stenting is an important definitive treatment option for acute cholecystitis in high-risk patients who are poor surgical candidates. In this study, we aimed to compare the outcomes between a novel 5-Fr spiral-shaped plastic stent (IYO-stent) and conventional 7-Fr double-pigtail stent (C-stent) for permanent transpapillary gallbladder drainage.

This retrospective cohort study included 56 patients with acute cholecystitis who underwent permanent endoscopic gallbladder stenting at 2 Japanese centers between 2019 and 2023 (C-stent, n = 27; IYO-stent, n = 29). The primary endpoint was event-free survival (EFS), defined as the time to recurrent cholecystitis, procedure-related complications, stent dysfunction, complications requiring intervention, or death. The secondary endpoints were cholecystitis recurrence-free survival and technical success.

The median EFS was 10.6 months (95% confidence interval [CI], 2.7- not available) in the C-stent group and was not reached in the IYO-stent group; the 24-month EFS rates were 41.6% (95% CI, 22.2-59.9) and 92.0% (95% CI: 71.1-98.0), respectively. The IYO-stent was associated with a lower risk of events compared to the C-stent (adjusted hazard ratio 0.17, 95% CI 0.05-0.55). Cholecystitis recurrence-free survival rates at 24 months were 58.2% with C-stents and 100% with IYO-stents. The technical success was 100% in both groups.

In high-risk patients undergoing permanent endoscopic transpapillary gallbladder drainage, the novel 5-Fr IYO-stent showed superior long-term efficacy over conventional 7-Fr double-pigtail stents, with markedly improved event-free survival and absence of cholecystitis recurrence during follow-up.