Endoscopic Transpapillary Gallbladder Stenting Research Articles

Interval cholecystectomy following drainage procedures for acute cholecystitis: percutaneous transhepatic vs endoscopic transpapillary gallbladder drainage

BackgroundGallbladder drainage procedures are often considered for acute cholecystitis (AC) patients with significant peri-operative risks. While percutaneous transhepatic gallbladder drainage (PTGBD) has been evaluated in previous studies, there is scarce data on the feasibility and efficacy of endoscopic transpapillary gallbladder stenting (ETGBS) in patients with AC. This study aimed to compare the characteristics of interval cholecystectomy following ETGBS and PTGBD. MethodsThis retrospective descriptive study included patients who underwent ETGBS and/or PTGBD for AC and subsequently underwent interval cholecystectomy between 2018 and 2023. Demographics, operative technique, and postoperative complications of patients with ETGBS and PTGBD were compared. ResultsA total of 59 patients were included (14 ETGBS and 45 PTGBD). The median days between ETGBS and cholecystectomy were significantly longer than the PTGBD group (64 [45-150] days vs. 16 [10-42] days, p=0.045). The median operation time was significantly longer in the ETGBS group. Among 33 patients who underwent subtotal cholecystectomy, the ERGBS group more frequently required closure of the gallbladder stump due to the difficulty in ligating the cystic duct compared to the PTGBD group (75.0% vs. 28.0%, p=0.035). Similarly, the fundus-first approach was more commonly selected in the ERGBS group (62.5% vs. 28.0%, p=0.01). No significant differences in the incidence of postoperative complications were observed between the two groups. ConclusionsInterval cholecystectomy following ETGBS is more technically demanding compared to PTGBD. Laparoscopic subtotal cholecystectomy following ETGBS could be a potential treatment option for patients who are unfit for early surgery, with the recognition of the difficulty in ligating the cystic duct.

Endoscopic transpapillary gallbladder stenting for acute cholecystitis

Background Cholecystectomy is the treatment of choice for acute cholecystitis. However, the mortality rate of emergency cholecystectomy in high-risk patients with severe comorbidities remains unsatisfactory. Endoscopic transpapillary gallbladder stenting (ETGBS) has emerged as a useful interventional endoscopic technique for the management of acute cholecystitis. Aim The purpose of this research was to assess the safety and effectiveness of ETGBS in the treatment of acute cholecystitis in elderly individuals who were not good candidates for surgery. Patients and methods We studied 35 elderly patients, 60 years of age or older, receiving treatment at Aswan University Hospital’s surgery department for acute cholecystitis. Every patient had ETGBS, involving the insertion of a 7-Fr stent into the gallbladder. If ETGBS was unsuccessful, percutaneous transhepatic gallbladder draining was carried out. The effectiveness of ETGBS was the primary outcome measure in this investigation. Results ETGBS was successful in 30 (85%) individuals with acute cholecystitis. 8.57% (3/35) of the cases had early adverse events (AEs). Three patients had endoscopic sphincterotomy hemorrhage, one had minor pancreatitis, and one patient experienced obstructive jaundice as early AEs. There were 8.57% (3/35) late AEs. Late AEs included cholangitis in one patient and cholecystitis recurrence in two others. Percutaneous transhepatic gallbladder drainage was used for the five individuals in whom ETGBS failed. Conclusion ETGBS appears to be a successful treatment for elderly patients with acute cholecystitis who are unsuitable for surgery.

Rescue technique using a novel device delivery system for difficult endoscopic transpapillary gallbladder stenting.

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Endoscopic Gallbladder Drainage Conversion versus Conservative Treatment Following Percutaneous Gallbladder Drainage in High-Risk Surgical Patients.

There are no consensus guidelines for patients with acute cholecystitis undergoing percutaneous cholecystostomy who are unfit for interval cholecystectomy. The current study aimed to compare the clinical outcomes of endoscopic gallbladder drainage, i.e. conversion from percutaneous cholecystostomy (including endoscopic transpapillary gallbladder stenting and endoscopic ultrasound-guided gallbladder drainage), and conservative treatment after percutaneous cholecystostomy tube removal. This retrospective review included patients who underwent percutaneous cholecystostomy for acute cholecystitis between January 2017 and December 2020. Consecutive patients who underwent endoscopic gallbladder drainage or percutaneous cholecystostomy tube removal without interval cholecystectomy were included. Outcome measures included recurrent acute cholecystitis and unplanned readmission due to gallstone-related diseases. During the study period, 238 patients were selected (63 underwent endoscopic gallbladder drainage conversion and 175 underwent conservative treatment). Patients who underwent endoscopic gallbladder drainage conversion had lower rates of recurrent acute cholecystitis (3 [4.76%] vs 31 [17.71%], p=0.012) and unplanned readmission due to gallstone-related diseases (6 [9.52%] vs 40 [22.86%], p=0.022) than those who underwent conservative treatment following percutaneous cholecystostomy tube removal. In the univariate and multivariate analyses, calculus cholecystitis (odds ratio, 13.75; 95% confidence interval, 1.83 to 102.83; p=0.011) and conversion of endoscopic gallbladder drainage (odds ratio, 0.23; 95% confidence interval, 0.06 to 0.78; p=0.019) were significant predictive factors for recurrent acute cholecystitis. Endoscopic gallbladder drainage conversion led to more favorable outcomes than conservative treatment after percutaneous cholecystostomy tube removal. Therefore, endoscopic gallbladder drainage conversion may be considered a promising treatment option for patients undergoing percutaneous cholecystostomy who are at a high surgical risk.

Endoscopic internalization by cutting versus removal of the endoscopic transpapillary naso-gallbladder drainage tube in preoperative management of acute cholecystitis: A retrospective multicenter cohort study.

Endoscopic transpapillary naso-gallbladder drainage (ENGBD) has been reported to be an effective treatment option for acute cholecystitis. At our institution, ENGBD was first placed for external fistula management, and endoscopic internalization by cutting was performed, shifting to endoscopic transpapillary gallbladder stenting (EGBS) after improvement of cholecystitis. However, there has been no comparative study to define which preoperative management is better: converting ENGBD to EGBS or removing ENGBD. The study aimed to compare the incidence rate of the late adverse events (AEs) related to biliary system between shifting from ENGBD to EGBS and removal of ENGBD. We retrospectively studied 122 patients who underwent ENGBD for acute cholecystitis between January 2010 and October 2022. The patients were divided into two groups: the cutting group (converting ENGBD to EGBS) and the removal group (removal of ENGBD). The short and late clinical outcomes were compared between groups. Endoscopic transpapillary naso-gallbladder drainage was successfully placed in 78.6% (96/122), and elective cholecystectomy was performed in 31 and 36 patients in the cutting and removal groups, respectively. The cumulative late-AE rates were 6.4% and 33.3% (p = .007), with a median waiting period for elective cholecystectomy of 58 and 33 days (p = .390) in the cutting and removal groups, respectively. In the multivariate analysis, only endoscopic internalization by cutting was an independent factor affecting late AEs. Endoscopic internalization by cutting ENGBD after the resolution of acute cholecystitis was considered effective in reducing the risk of late AEs during the waiting period for an elective cholecystectomy.

Author commentary on Wiriyaporn Ridtitid et al.

Wiriyaporn Ridtitid et al. Intermediate- to long-term outcomes of endoscopic transpapillary gallbladder stenting in patients with gallstone-related disease: a 10-year single-center experience

Intermediate- to long-term outcomes of endoscopic transpapillary gallbladder stenting in patients with gallstone-related disease: a 10-year single-center experience.

Endoscopic transpapillary gallbladder stenting (ETGS) can be a bridging therapy to elective cholecystectomy or a permanent gallbladder drainage method in patients with symptomatic gallbladder disease who are awaiting cholecystectomy or are unfit for surgery, respectively. We evaluated the intermediate- to long-term outcomes of ETGS in these groups. We retrospectively reviewed 234 patients (acute cholecystitis = 147), who were unfit for surgery (n = 50) or had deferred cholecystectomy (n = 184) and who underwent ETGS between 2012 and 2021. A 7-Fr, 15-cm, double-pigtail plastic stent was placed for ETGS without scheduled stent exchange. Biliary event-free rates (i. e. cholecystitis and cholangitis) were determined at 6 months, 1 year, and ≥ 2 years. Technical and clinical success rates were 84.6 % (198/234) and 97.4 % (193/198), respectively. Kaplan-Meier analysis (n = 193) showed a biliary event-free rate of 99 % (95 %CI 0.95-1.00) at 6 months, 92 % (95 %CI 0.87-0.97) at 1 year, and 76 % (95 %CI 0.65-0.93) at ≥ 2 years, during a median follow-up period of 564 days (range 200-3001 days). ETGS is an effective biliary drainage method that should be considered in selected cases with common bile duct stone where cholecystectomy could not be performed or was deferred. The biliary event-free rates of ≥ 76 % up to ≥ 2 years further support the use of ETGS in these patient groups.

Efficacy of endoscopic trans-papillary gallbladder stenting and drainage in acute calculous cholecystitis in high-risk patients: a systematic review and meta-analysis.

Acute calculous cholecystitis (ACC) represents about one-third of all surgical emergencies. The gold standard management of ACC is laparoscopic cholecystectomy. Although cholecystectomy is a safe procedure, it may be dangerous and contraindicated in patients with complex comorbidities. Endoscopic transpapillary gallbladder stenting (ETGBS) and drainage had been widely used to manage patients suffering from ACC with comorbidities. We searched PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant studies assessing the use of ETGBS in patients suffering from ACC with various comorbidities. Risk of bias assessment was performed using the National Institues of Health (NIH) tool. We included the following outcomes: clinical success, technical success, late complications, and pancreatitis. We included seven studies that met our inclusion criteria. We found that the pooled proportion of clinical success, technical success, late complications, and pancreatitis was [91.3%, 95% confidence interval (CI) (86.8%, 95.9%)], [92.8%, 95% CI (89%, 96.5%)], [5.4%, 95% CI (2.9%, 7.9%)], and [3.5%, 95% CI (1.2%, 5.8%)], respectively. We found that an ETGBS was an effective and well-tolerated method for the treatment of cholecystitis, especially in high-risk individuals.

Feasibility of a Single Pigtail Stent Made by Cutting a Nasobiliary Drainage Tube in Endoscopic Transpapillary Gallbladder Stenting for Acute Cholecystitis.

Background and objectiveIn this study, we aimed to evaluate the efficacy and safety of a single pigtail stent made by cutting a nasobiliary drainage tube (NBD stent) by comparing the clinical outcomes of using an NBD stent and those of using a ready-made double pigtail stent (RDP stent) in endoscopic gallbladder stenting (EGBS) for acute cholecystitis.Materials and methodsThis was a single-center retrospective study involving 20 cases that had technical success with EGBS for acute cholecystitis; the patients were divided into two groups: those using NBD stent (NBD group) and those using RDP stent (RDP group). The baseline characteristics and clinical outcomes were compared between the two groups.ResultsThere were 13 patients in the NBD group and seven in the RDP group. The rates of clinical success (NBD group: 92% vs. RDP group: 100%, p=0.45) did not differ significantly between the groups. Regarding adverse events, gallbladder perforation occurred in one case in the NBD group; however, no other adverse events occurred in either group (NBD group: 7.7% vs. RDP group: 0%, p=0.45). The stent patency periods did not differ significantly between the groups [NBD group: 43 (12-64) days vs. RDP group: 97 (58-215) days, p=0.17]. The stent patency period in cases of long-term stent placement after EGBS was 1,381 days and 1,579 days in the NBD group and 305 days in the RDP group, respectively.ConclusionNBD stents are considered as effective as RDP stents in EGBS for acute cholecystitis. They are highly versatile and can be used for both bridging to surgery and long-term stent placement.

Efficacy and safety of conversion of percutaneous cholecystostomy to endoscopic transpapillary gallbladder stenting in high-risk surgical patients

Efficacy and safety of conversion of percutaneous cholecystostomy to endoscopic transpapillary gallbladder stenting in high-risk surgical patients

Ultimate outcomes of three modalities for non-surgical gallbladder drainage in acute cholecystitis with or without concomitant common bile duct stones.

Backgrounds/AimsIn moderate and high-surgical risk patients with acute cholecystitis, studies comparing percutaneous cholecystostomy (PC) vs. endoscopic transpapillary gallbladder stenting (ETGS) vs. endoscopic ultrasound-guided transmural gallbladder stenting (EUGS) are limited. Thus, the aim of this study was to compare efficacy and recurrence of cholecystitis after PC, ETGS, or EUGS during follow-up.MethodsWe reviewed 143 moderate and high-surgical risk patients with acute cholecystitis with or without concomitant common bile duct stones who underwent PC, ETGS, or EUGS at our hospital. Technical success rate (TSR), clinical success rate (CSR), and recurrence were compared.ResultsTSR in PC or EUGS group was higher than that in the ETGS group for those with concomitant common bile duct stones (100% vs. 100% vs. 73.2%; p = 0.07) and for those without concomitant common bile duct stones (100% vs. 100% vs. 77.3%; p < 0.001). CSR in ETGS or EUGS group was higher than that in the PC group for those with concomitant common bile duct stones (96.2% vs. 100% vs. 87.5%; p = 0.41) and for those without concomitant common bile duct stones (94.1% vs. 100% vs. 63.0%; p = 0.006). Using Kaplan–Meier analysis, the overall recurrent risk was the highest in the PC group (p = 0.004).ConclusionsIn moderate and high-surgical risk patients with acute cholecystitis, EUGS provides significantly higher CSR with comparable TSR to PC. Thus, ETGS should be the first choice in those with concomitant common bile duct stones. Among the three patient groups, those who received PC had the highest rate of recurrence.

Technique of straightening the guidewire using a balloon catheter for successful endoscopic transpapillary gallbladder stenting.

Video 1The technique of straightening the guidewire, looped in the neck of the gallbladder because of segmental adenomyomatosis, using a balloon catheter during endoscopic transpapillary gallbladder stent placement.

Efficacy and Safety of Conversion of Percutaneous Cholecystostomy to Endoscopic Transpapillary Gallbladder Stenting in High-risk Surgical Patients

Introduction: Endoscopic transpapillary gallbladder stenting (ETGBS) has been used as an alternative to percutaneous cholecystostomy in patients with acute cholecystitis who are considered unfit for surgery. However, there are few data on the efficacy and safety of ETGBS replacement of percutaneous cholecystostomy in high-risk surgical patients. This study aimed to evaluate the feasibility, efficacy, and safety of ETGBS to replace percutaneous cholecystostomy in high-risk surgical patients.

Endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis in patients receiving FCEMS for benign biliary stricture.

Background and study aims Fully covered self-expanding metal stents (FCSEMS) are being increasingly used for benign biliary strictures (BBS); however, they are associated with risk of acute cholecystitis. Prophylactic endoscopic transpapillary gallbladder stenting (ETPGBS) can facilitate 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 to prevent acute cholecystitis in patients receiving FCSEMS for BBS. Patients and methods This was a retrospective analysis of a prospectively collected database at a single center of all patients who underwent prophylactic ETPGBS with FCSEMS for BBS between December 1, 2016 and November 30, 2020. Results A total of 71 ETPGBS were placed during the study period. Sixteen patients (mean age: 66.4 ± 19.8 years; 81 % male) underwent ETPGBS prior to biliary FCSEMS during the same endoscopic session. FCSEMS were left in place (stent dwell time) for a median of 173 days (range: 69–473; mean 196 ± 121) with resolution of BBS and successful removal of ETPGBS and FCSEMS in 12 patients. There was significant improvement in total bilirubin level (5.25 ± 5.53 vs 0.94 ± 0.85 gm/dL; P = 0.008). No episodes of acute cholecystitis or any other post-procedural complications were noted during the median follow-up of 337 days (range: 150–856; mean 394 ± 236). Conclusions ETPGBS prevented stent-related acute cholecystitis with continued efficacy of FCSEMS for BBS.

Efficacy and safety of conversion of percutaneous cholecystostomy to endoscopic transpapillary gallbladder stenting in high-risk surgical patients

BackgroundEndoscopic transpapillary gallbladder stenting (ETGBS) has been used as an alternative to percutaneous cholecystostomy in patients with acute cholecystitis who are considered unfit for surgery. However, there are few data on the efficacy and safety of ETGBS replacement of percutaneous cholecystostomy in high-risk surgical patients. This study aimed to evaluate the feasibility, efficacy, and safety of ETGBS to replace percutaneous cholecystostomy in high-risk surgical patients. MethodsThis single center retrospective study reviewed the data of patients who attempted ETGBS to replace percutaneous cholecystostomy between January 2017 and September 2019. The technical success, clinical success, adverse events, and stent patency were evaluated. ResultsETGBS was performed in 43 patients (24 male, mean age 80.7 ± 7.4 years) to replace percutaneous cholecystostomy due to high surgical risk. The technical success rate and clinical success rate were 97.7% (42/43) and 90.5% (38/42), respectively. Procedure-related adverse events and stent-related late adverse events occurred in 7.0% (3/43) and 11.6% (5/43), respectively. Of the patients who successfully underwent ETGBS (n = 42), only one had recurrent acute cholecystitis during follow-up. The median stent patency was 415 days (interquartile range 240–528 days). ConclusionsETGBS, as a secondary intervention for the purpose of internalizing gallbladder drainage in patients following placement of a percutaneous cholecystostomy, is safe, effective, and technically feasible. Thus, conversion of percutaneous cholecystostomy to ETGBS may be considered as a viable option in high-risk surgical patients.

Laparoscopic cholecystectomy after endoscopic trans-papillary gallbladder stenting for acute cholecystitis: a pilot study of surgical feasibility

BackgroundPercutaneous transhepatic gallbladder drainage (PTGBD) is indicated for patients with acute cholecystitis (AC) who are not indicated for urgent surgery, but external tubes reduce quality of life (QOL) while waiting for elective surgery. The objective of the present study was to investigate the feasibility of laparoscopic cholecystectomy after endoscopic trans-papillary gallbladder stenting (ETGBS) comparing with after PTGBD.MethodsIntraoperative and postoperative outcomes of patients with ETGBS and PTGBD were retrospectively compared.ResultsEighteen ETGBS and ten PTGBD patients were compared. Differences in the duration of ETGBS and PTGBD [median 209 min (range 107–357) and median 161 min (range 130–273), respectively, P = 0.10], median blood loss [ETGBS 2 (range 2–180 ml) and PTGBD 24 (range 2–100 ml), P = 0.89], switch to laparotomy (ETGBS 11% and PTGBD 20%, P = 0.52), and median postoperative hospital stay [ETGBS 8 (range 4–24 days) and ETGBS 8 (range 4–16 days), P = 0.99]. Thickening of the cystic duct that occurred in 60% of the ETGBS patients and none of the PTGBD patients (P = 0.005) interfered with closure of the duct by clipping. No obstruction occurred in ETGBS patients.ConclusionETGBS did not make laparoscopic cholecystectomy less feasible than after PTGBD. This is a pilot study, and further investigations are needed to validate the results of the present study.

Endoscopic transpapillary gallbladder drainage for the management of acute calculus cholecystitis patients unfit for urgent cholecystectomy.

Endoscopic transpapillary gallbladder drainage (ETGBD) has been proposed as an alternative to surgery or percutaneous cholecystostomy in patients with acute calculus cholecystitis (ACC). We aimed to evaluate the safety and efficacy of ETGBD via endoscopic transpapillary gallbladder stenting (ETGBS) or endoscopic naso-gallbladder drainage (ENGBD) as either a bridging or a definitive treatment option for patients with ACC when a cholecystectomy is delayed or cannot be performed. From July 2014 to December 2018, 171 patients with ACC in whom ETGBD were attempted were retrospectively reviewed. The technical and clinical success rates and adverse events were evaluated. Moreover, the predictive factors for technical success and the stent patency in the ETGBS group with high surgical risk were examined. The technical and clinical success rates by intention-to-treat analysis for ETGBD were 90.6% (155/171) and 90.1% (154/171), respectively. Visible cystic duct on cholangiography were significant technical success predictor (adjusted odds ratio: 7.099, 95% confidence interval: 1.983-25.407, P = 0.003) as per logistic regression analysis. Adverse events occurred in 12.2% of patients (21/171: mild pancreatitis, n = 9; acute cholangitis, n = 6; post-endoscopic sphincterotomy bleeding, n = 4; and stent migration, n = 1; ACC recurrence, n = 1), but all patients were treated with conservative management and endoscopic treatment. Among the ETGBS group, the median stent patency in 70 patients with high surgical risk was 503 days (interquartile range: 404.25-775 days). ETGBD, using either ETGBS or ENGBD, may be a suitable bridging option for ACC patients unfit for urgent cholecystectomy. In high surgical risk patients, ETGBS may be a promising and useful treatment modality with low ACC recurrence.

Su1559 THE EFFICACY AND SAFETY OF ENDOSCOPIC TRANS-PAPILLARY GALLBLADDER STENTING TO REPLACE PERCUTANEOUS CHOLECYSTOSTOMY IN POOR SURGICAL CANDIDATES

Endoscopic trans-papillary gallbladder stenting (ETGBS) is a useful alternative to percutaneous cholecystostomy (PC) in patients with acute cholecystitis when cholecystectomy must be delayed or cannot be performed. However, there are few data on the efficacy and safety of ETGBS replacement of PC in patients unfit for cholecystectomy. This single center retrospective study reviewed data of patients who attempted underwent ETGBS to replace PC between January 2017 and September 2019. Technical success, clinical success, adverse events, and stent patency were evaluated. ETGBS was performed in 43 patients (24 men, mean age 80.7 ± 7.5 years) to replace PC due to high surgical risk. The technical success rate and clinical success rate was 97.6% (42/43) and 92.8% (39/42), respectively. There were three adverse events, post endoscopic retrograde cholangiography related acute pancreatitis in two cases and hematoma around cystic duct in one case. PC was removed after ETGBS in 40 patients at a median of 11.5 days (range, 1-73 days). Median stent patency was 362.5 days (Interquartile range 160.5-483.5days). ETGBS as a secondary intervention for the purpose of internalizing gallbladder drainage in patients following placement of a PC is safe and effective, and technically feasible. Thus, switching to ETGBS may be considered as viable option in high surgical risk patient with PC.

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

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.

Single-operator peroral cholangioscopy cystic duct cannulation for transpapillary gallbladder stent placement in patients with acute cholecystitis at moderate to high surgical risk (with videos)

One of the main reasons for failed endoscopic transpapillary gallbladder stenting (ETGS) under fluoroscopic guidance is the inability to cannulate the cystic duct. Single-operator peroral cholangioscopy (SOC)-assisted ETGS is an adjunct technique to facilitate ETGS. We aimed to demonstrate its efficacy. Between 2015 and 2019, 104 patients with acute cholecystitis at moderate to high surgical risk underwent ETGS, which involved 3 steps: (1) cystic duct cannulation under fluoroscopic guidance with or without additional SOC guidance; (2) guidewire placement; and (3) stent placement in the gallbladder. The technical success rate was determined when stent placement was confirmed endoscopically and radiographically. Of 104 patients, 55 (53%) patients had successful ETGS under fluoroscopic guidance. Of 49 patients who had failed fluoroscopy-guided ETGS, 41 patients underwent additional SOC-assisted ETGS and 5 patients proceeded to other interventions. Of patients who underwent SOC-assisted ETGS (n= 41), 23 (56%) cystic cannulation followed by stent placement were successful; cystic duct cannulations, guidewire, and stent placement failed in 8, 9, and 1 patients, respectively. The overall technical success rate of ETGS increased from 53% (55 of 104) to 75% (78 of 104) after additional SOC assistance. Adverse events and recurrence were not different between patients who underwent ETGS under fluoroscopic guidance and those who underwent SOC-assisted ETGS. In patients with acute cholecystitis who are not surgical candidates, SOC-assisted ETGS can increase the technical success rate after failed fluoroscopic guidance. SOC can help for the cystic duct cannulation and guidewire placement steps but not for the stent placement step.