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DOI: 10.1055/s-0030-1256226
© Georg Thieme Verlag KG Stuttgart · New York
Outcomes of endoscopic transpapillary gallbladder stenting for symptomatic gallbladder diseases: a multicenter prospective follow-up study[*]
Publication History
submitted 24 July 2010
accepted after revision 8 December 2010
Publication Date:
21 March 2011 (online)
![](https://www.thieme-connect.de/media/endoscopy/201108/lookinside/thumbnails/10.1055-s-0030-1256226-1.jpg)
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.
1 Part of this study was presented in a topic forum at Digestive Disease Week, 1 – 5 May 2010 (New Orleans, Louisiana, USA).
References
- 1 Strasberg S M. Clinical practice. Acute calculous cholecystitis. N Engl J Med. 2008; 358 2804-2811
- 2 Lau H, Lo C Y, Patil N G et al. Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surg Endosc. 2006; 20 82-87
- 3 Puggioni A, Wong L L. A metaanalysis of laparoscopic cholecystectomy in patients with cirrhosis. J Am Coll Surg. 2003; 197 921-926
- 4 Lee S S, Park do H, Hwang C Y et al. EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study. Gastrointest Endosc. 2007; 66 1008-1012
- 5 Picus D, Hicks M E, Darcy M D et al. Percutaneous cholecystolithotomy: analysis of results and complications in 58 consecutive patients. Radiology. 1992; 183 779-784
- 6 van Sonnenberg E, D’Agostino H B, Goodacre B W et al. Percutaneous gallbladder puncture and cholecystostomy: results, complications, and caveats for safety. Radiology. 1992; 183 167-170
- 7 Itoi T, Sofuni A, Itokawa F et al. Endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis in whom percutaneous transhepatic approach is contraindicated or anatomically impossible (with video). Gastrointest Endosc. 2008; 68 455-460
- 8 Shrestha R, Trouillot T E, Everson G T. Endoscopic stenting of the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease awaiting orthotopic liver transplantation. Liver Transpl Surg. 1999; 5 275-281
- 9 Schlenker C, Trotter J F, Shah R J et al. Endoscopic gallbladder stent placement for treatment of symptomatic cholelithiasis in patients with end-stage liver disease. Am J Gastroenterol. 2006; 101 278-283
- 10 Kalloo A N, Thuluvath P J, Pasricha P J. Treatment of high-risk patients with symptomatic cholelithiasis by endoscopic gallbladder stenting. Gastrointest Endosc. 1994; 40 608-610
- 11 Conway J D, Russo M W, Shrestha R. Endoscopic stent insertion into the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease. Gastrointest Endosc. 2005; 61 32-36
- 12 Shrestha R, Lasch H. Endoscopic therapy for biliary tract disease before orthotopic liver transplantation. Gastrointest Endosc Clin N Am. 2001; 11 45-64
- 13 Kjaer D W, Kruse A, Funch-Jensen P. Endoscopic gallbladder drainage of patients with acute cholecystitis. Endoscopy. 2007; 39 304-308
- 14 Mutignani M, Iacopini F, Perri V et al. Endoscopic gallbladder drainage for acute cholecystitis: technical and clinical results. Endoscopy. 2009; 41 539-546
- 15 Feretis C, Apostolidis N, Mallas E et al. Endoscopic drainage of acute obstructive cholecystitis in patients with increased operative risk. Endoscopy. 1993; 25 392-395
- 16 Johlin Jr. F C, Neil G A. Drainage of the gallbladder in patients with acute acalculous cholecystitis by transpapillary endoscopic cholecystotomy. Gastrointest Endosc. 1993; 39 645-651
- 17 Dumas R, Caroli-Bosc F X, Demarquay J F et al. Acute inoperable cholecystitis treated by endoscopic naso-vesicular drainage. Study of 15 patients. Gastroenterol Clin Biol. 1997; 21 854-858
- 18 Song T J, Park do H, Eum J B et al. EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent in patients who are unsuitable for cholecystectomy: a pilot study (with video). Gastrointest Endosc. 2010; 71 634-640
- 19 Cotton P B, Lehman G, Vennes J et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991; 37 383-393
- 20 Park do H, Kim M H, Choi J S et al. Covered versus uncovered wallstent for malignant extrahepatic biliary obstruction: a cohort comparative analysis. Clin Gastroenterol Hepatol. 2006; 4 790-796
- 21 Itoi T, Coelho-Prabhu N, Baron T H. Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc. 2010; 71 1038-1045
- 22 Hatzidakis A A, Prassopoulos P, Petinarakis I et al. Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment. Eur Radiol. 2002; 12 1778-1784
- 23 Kozarek R A. Selective cannulation of the cystic duct at time of ERCP. J Clin Gastroenterol. 1984; 6 37-40
- 24 Gaglio P J, Buniak B, Leevy C B. Primary endoscopic retrograde cholecystoendoprosthesis: a nonsurgical modality for symptomatic cholelithiasis in cirrhotic patients. Gastrointest Endosc. 1996; 44 339-342
- 25 Soehendra N. Access to the cystic duct: a new endoscopic therapy for gallbladder diseases?. Endoscopy. 1991; 23 36-37
- 26 Tamada K, Seki H, Sato K et al. Efficacy of endoscopic retrograde cholecystoendoprosthesis (ERCCE) for cholecystitis. Endoscopy. 1991; 23 2-3
- 27 Siegel J H. Stone extraction, lithotripsy, stents and stones.. In: Siegel J H, ed. Endoscopic retrograde cholangiopancreatography.. New York: Raven Press; 1991: 227-271
- 28 Peters R, Macmathuna P, Lombard M et al. Management of common bile duct stones with a biliary endoprosthesis. Report on 40 cases. Gut. 1992; 33 1412-1415
- 29 Park D H, Kim M H, Lee S K et al. Endoscopic sphincterotomy vs. endoscopic papillary balloon dilation for choledocholithiasis in patients with liver cirrhosis and coagulopathy. Gastrointest Endosc. 2004; 60 180-185
- 30 D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006; 44 217-231
- 31 Ferraz-Neto B H, Hidalgo R, Thomé T et al. Analysis of Model for End-Stage Liver Disease (MELD) score in a liver transplantation waiting list. Transplant Proc. 2007; 39 2511-2513
- 32 Kim W R, Therneau T M, Benson J T et al. Deaths on the liver transplant waiting list: an analysis of competing risks. Hepatology. 2006; 43 345-351
- 33 Ahmad J, Downey K K, Akoad M et al. Impact of the MELD score on waiting time and disease severity in liver transplantation in United States veterans. Liver Transpl. 2007; 13 1564-1569
1 Part of this study was presented in a topic forum at Digestive Disease Week, 1 – 5 May 2010 (New Orleans, Louisiana, USA).
D. H. ParkMD
Division of Gastroenterology
Department of Internal Medicine
University of Ulsan College of Medicine
Asan Medical Center
388-1 Pungnap-2dong
Songpagu
Seoul
Republic of Korea
Fax: +82-2-485-5782
Email: dhpark@amc.seoul.krj991008@hanmail.net