1170 ENDOSCOPIC TRANSPAPILLARY GALLBLADDER STENT PLACEMENT TO PREVENT ACUTE CHOLECYSTITIS IN PATIENTS RECEIVING FULLY COVERED SELF EXPANDING METAL STENTS FOR BENIGN BILIARY STRICTURE

Abstract

Treatment of benign biliary strictures (BBS) with fully covered self-expanding metal stents (FCSEMS) has become common practice due to its deceased number of endoscopic sessions and its efficacy in resolution of benign strictures. However, placement of FCSEMS for BBS poses intrinsic risk, including stent migration, pancreatitis and acute cholecystitis at a rate of 2.9% to 12%. Prophylactic endoscopic transpapillary gallbladder stenting (ETPGBS) during the same ERCP session can allow continuous gallbladder drainage and prevent acute cholecystitis from occlusion of cystic duct orifice by the FCSEMS. The aim of this study was to assess the technical feasibility, efficacy, and safety of ETPGBS prior to placement of FCSEMS for BBS for prevention of acute cholecystitis. This is a retrospective analysis of a prospectively collected database at a single tertiary-care referral center of all patients who underwent FCSEMS for BBS with prophylactic endoscopic transpapillary gallbladder stent placement between 12/1/2016 and 11/30/2019. Demographic, endoscopic, imaging, clinical management, and follow-up data was abstracted and analyzed. A total of 46 transpapillary GB stents were placed during the study period. Selective cystic duct and gallbladder wire cannulation was achieved followed by successful placement of ETPGBS in all patients (technical success 100%). 10 patients underwent ETPGBS prior to biliary FCSEMS during the same endoscopic session. (Figure) The mean age was 69 ± 21.83 years, and the majority of patients were male (80%). A 7 Fr by 22 cm low-profile, soft, plastic double-pigtail gallbladder stent with larger inner lumen was used in all cases. In all cases, a 10 mm diameter FCSEMS (length ranging from 40 mm to 100 mm; 60 mm being the most common) was placed in the common bile duct. There was significant improvement in total bilirubin level (pre-procedural 4±3.08 vs post-procedural 1.27±1.1 gm/dL with mean reduction of 2.73±1.27; p=0.04). FCSEMS were left in place (stent dwell time) for a median of 139 (range: 87-291; mean 164±68) days with resolution of BBS and successful removal of ETPGBS and FCSEMS in all patients. No episodes of acute cholecystitis or any other post-procedural complications were noted during the median follow-up of 126 (range: 3-380; mean 169±147) days. Treatment of BBS with FCSEMS has become an increasingly common alternative therapy to plastic biliary stents. However, rates of acute cholecystitis have been documented as high as 12%. Endoscopic transpapillary gallbladder stent placement prior to FCSEMS in our study demonstrated an effective treatment of BBS without an increase in procedural or post-procedural complications. ETPGBS prevented post-procedural acute cholecystitis with continued efficacy of FCSEMS.