Novel Use of Long, Large-Caliber, Fenestrated Stents for Endoscopic Transpapillary Gallbladder Stenting for Therapy of Symptomatic Gallbladder Disease.

Abstract

Symptomatic gallbladder disease (SGBD) has a high prevalence in the general population, and early cholecystectomy is considered definitive therapy for patients with symptomatic cholelithiasis [1, 2]. Conservative therapy is recommended for those patients in whom surgery is contraindicated or considered high risk [3–5]. Nonsurgical gallbladder drainage methods include percutaneous and endoscopic drainage techniques [5]. While percutaneous transhepatic gallbladder catheter drainage (PCD) is efficacious, it has risks of puncture-related adverse events and tube dislodgement and results in significant patient discomfort [5, 6]. PCD is usually a temporary step until the patient is fit for surgery, symptoms resolve or drainage can be internalized by endoscopic transpapillary gallbladder stenting (ETGS) which involves placement of an internal transpapillary stent. ETGS has technical and clinical success rates comparable to PCD with the advantage of internal drainage; however, its limitations include the potential for stent migration or occlusion requiring stent exchange, cystic duct or gallbladder perforation, and recurrence of symptomatic biliary disease [5–10]. ETGS has been previously described mainly using rigid, double-pigtail polyethylene plastic stents of diameter 5–7 Fr and length 10–15 cm, with inherent limitations in drainage, flexibility, and patency [5–10]. Johlin pancreatic wedge stents (JS) (Wilson-Cook Medical, Winston-Salem, NC, USA) are made of Sof-Flex material, which is a softer polyurethane and polyethylene blend. They are fenestrated with large, multi-side holes along the length of the stent and are available in 8.5 and 10 Fr diameters and variable lengths up to 22 cm (Fig. 1). JS for ETGS have theoretical advantages over conventional stents, including soft material with conformability to tortuous cystic ducts, the presence of side holes, and large caliber allowing potentially longer patency. We report our initial experience using JS for ETGS.