Outcomes of endoscopic transpapillary gallbladder stenting for symptomatic gallbladder diseases: a multicenter prospective follow-up study[*]

Background and study aims: Endoscopic transpapillary gallbladder drainage for symptomatic gallbladder disease is a safe and effective bridge therapy in patients at high risk for surgery or who have terminal liver disease and are awaiting transplantation. However, there are few reports on long-term results in terms of stent patency and clinical course. Our study was designed to investigate the long-term patency and clinical course after endoscopic transpapillary gallbladder stenting (ETGS) in patients with symptomatic gallbladder disease.

Patients and methods: A total of 29 patients who were unsuitable for cholecystectomy underwent ETGS from June 2006 to March 2010 using a 7-Fr double-pigtail stent between the gallbladder and the duodenum. Their clinical progress, adverse events, and stent patency after ETGS were recorded prospectively in two tertiary referral centers.

Results: Technically, ETGS was successful in 23 (79.3 %) of the 29 patients. The mean procedure time was 22.4 ± 11.5 min. Postprocedure adverse events were mild pancreatitis (8.7 %) and cholestasis (8.7 %), all of which resolved with conservative management. During the follow-up period (median 586 days, range 11 – 1403 days), 20 patients were analyzed as per protocol, and scheduled follow-up was performed. Late adverse events developed in four patients (20 %), including distal migration (n = 2), cholangitis (n = 1), and recurrent biliary pain (n = 1). The remaining 16 patients were followed for more than 12 months (nine patients were followed for more than 24 months). Median stent patency was 760 days, as determined by the Kaplan-Meier method.

Conclusions: As a primary therapy, ETGS is technically feasible and effective in patients who are unsuitable for cholecystectomy. ETGS may also provide long-term stent patency without the need for scheduled stent exchanges.

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1 Part of this study was presented in a topic forum at Digestive Disease Week, 1 – 5 May 2010 (New Orleans, Louisiana, USA).