Endoscopic Transpapillary Gallbladder Stent Placement Is Safe and Effective in High-Risk Patients Without Cirrhosis.

Abstract

Endoscopic transpapillary gallbladder stent (ETGS) placement is a proposed minimally invasive alternative to cholecystectomy in high-risk patients with symptomatic gallbladder disease. To describe the safety and efficacy of ETGS placement in 29 consecutive patients without cirrhosis. A retrospective analysis of consecutive ETGS cases from 2005 to 2013 at a referral center was undertaken. The mean age was 70years (range 40-91), and 62% were hospitalized. The most common indication for ETGS was acute calculus cholecystitis (52%). Comorbidities precluding cholecystectomy included advanced cancer (45%), severe cardiopulmonary disease (21%), and advanced age/frailty (17%). Eighty-six percent of the patients had an ASA class of III or IV, and the Charlson comorbidity index was >3 in 55%. An ETGS was successfully placed in 22 patients (76%) with 18 being successful on the first attempt. A percutaneous rendezvous approach was required to obtain cystic duct access in six patients (21%). During a mean follow-up of 376days, a sustained clinical response was noted in 90% of the patients with a stent placed. No peri-procedural complications were noted. However, two patients developed delayed complications of abdominal pain and cholangitis. Six patients were alive with their original stent still in place at a mean follow-up of 2.5years. ETGS is an effective and safe alternative to cholecystectomy in high-risk patients. Technical success can be facilitated by a percutaneous rendezvous technique. Our data and those of others suggest that scheduled stent exchanges may not be required unless a clinical change occurs.