Su1526 ENDOSCOPIC TRANSPAPILLARY GALLBLADDER DRAINAGE FOR ACUTE CHOLECYSTITIS USING TWO GALLBLADDER STENTS (DUAL GB STENTING)

Abstract

The mainstay of management of acute cholecystitis has been surgical. Management of acute cholecystitis in patients deemed a high risk for surgical intervention includes endoscopic (transpapillary or transmural stenting) or percutaneous drainage of the gallbladder (GB). One of the major long-term advantages of endoscopic transpapillary GB drainage (ETPGBD) is the absence of anatomic distortion; if the patient’s overall condition improves the patient can undergo surgery without additional challenges. Solitary transpapillary GB stents can get obstructed resulting in recurrence, with studies recommending protocolized replacement. Alternatively, dual GB stenting with 2 transpapillary stents has been described with an additional advantage of having a second stent as well as enhanced capillary action between and along the outer surface of the stents (“wicking effect”) allowing for adequate long-term drainage. This study aims to evaluate the technical feasibility, efficacy, and safety of ETPGBD using dual stents for acute cholecystitis. A retrospective analysis of all patients undergoing ETPGBD using dual stents for acute cholecystitis at our institution between 12/1/2016 and 11/1/2019 was conducted. We abstracted and analyzed patient demographics, endoscopic, imaging, clinical management, and follow-up data to evaluate technical and clinical success, adverse events, and long-term outcomes. The patients underwent endoscopic retrograde cholangiopancreatography (ERCP) with ETPGBD. Two stents were placed either during the index ERCP or a 2nd stent was placed on repeat ERCP typically performed 4-6 weeks after the index stent placement. A total of 46 patients underwent ETPGBD of which 16 patients underwent dual stent placement for long-term GB drainage. (Figure 1) The patients were predominantly male (62.5%) with a mean age of 63.75±15.39 years. A total of 32 stents were placed in these patients; of which 72% (23/32) were 7 Fr in size while the remaining 28% (9/32) were 6 Fr in size. All stents were soft, low-profile, 22 cm long double-pigtail plastic stents. The median interval between the placement of first and second GB stent was 41 days (range 21-224; mean 59.75±51.94). Technical and clinical success was 100% with no evidence of recurrent cholecystitis or biliary obstruction during the median follow-up of 8.7 months (range: 1.4-24.2; mean 9.51±7.58). There were no procedure-related adverse events. ETPGBD with dual GB stents is an effective and safe technique for long-term GB drainage in non-surgical candidates with acute cholecystitis. Larger controlled studies are needed to further validate our findings for widespread implementation of this technique.