Abstract
Laparoscopic cholecystectomy is the standard and fundamental treatment of choice for acute cholecystitis; however, there are cases in which patients may be poor surgical candidates due to advanced age, comorbidities, and/or general condition. The rate of recurrent cholecystitis is high in patients who are not surgically treated; therefore, the prevention of recurrence in this patient population is an important subject of investigation in the management of cholecystitis. Although it has recently been reported that long-term stent placement by endoscopic gallbladder stenting or endoscopic ultrasound-guided gallbladder drainage may reduce the recurrence rate, its efficacy and safety remain controversial. Additionally, details surrounding the long-term stent management of these treatment methods should be further investigated. In this review, we summarize the updated evidence regarding the usefulness of long-term stent placement with endoscopic gallbladder stenting or endoscopic ultrasound-guided gallbladder drainage as a preventive measure for recurrence of cholecystitis and discuss issues that should be addressed in future studies.
Highlights
Acute cholecystitis is a very common condition wherein approximately 90% of cases are caused by gallbladder stones [1,2]
Cholecystectomy is the standard and definitive treatment of choice for acute cholecystitis, but patients who are unsuitable for emergency cholecystectomy are initially managed with gallbladder decompression [3,4]
There is no clear consensus yet, and no detailed review article to date has explored the current state of knowledge pertaining to this subject. In this comprehensive narrative review, we provide an updated summary of the current evidence found on the PubMed database while discussing existing controversies and future prospects of the use of endoscopic gallbladder stenting (EGBS) or endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) as a preventive measure for recurrent cholecystitis in poor surgical candidates
Summary
Acute cholecystitis is a very common condition wherein approximately 90% of cases are caused by gallbladder stones [1,2]. Maruta et al [32] compared the outcomes of patients with the removal of the gallbladder drainage tube after PTGBD or ENGBD and those with long-term stent placement by EGBS. Both the cumulative cholecystitis recurrence rate (16.0% vs 5.0%, p = 0.024) and the cumulative late adverse event rate Based on the results of the three studies, long-term stent placement with EGBS is expected to have a preventive effect on the recurrence of cholecystitis, but the results were inconclusive regarding the overall adverse event rate such as cholangitis. Given that there are only three retrospective studies to date, which were limited by selection and publication bias, further randomized controlled trials (RCT) are necessary
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