Gallbladder Stenting Research Articles

Feasibility of a novel 5-Fr plastic stent in endoscopic transpapillary gallbladder drainage for acute cholecystitis

Background and study aims: Many reports have demonstrated the efficacy of endoscopic transpapillary gallbladder stenting (EGBS) for acute cholecystitis (AC), most of which have traditionally used a 7-Fr plastic stent. The study aim was to evaluate the efficacy of a novel 5-Fr plastic stent in EGBS for AC. Patients and methods: We designed a retrospective study that compared the outcomes between 7-Fr and 5-Fr stents in patients undergoing EGBS. Among 147 patients who underwent endoscopic transpapillary gallbladder drainage for AC between January 2019 and July 2023, 104 who underwent EGBS using a 7-Fr (n = 53) or 5-Fr (n = 51) plastic stent were included in the analysis. Results: The technical success rate of EGBS, clinical success rate for AC, and early adverse events (AEs) rate in the 7-Fr and 5-Fr groups were 92.5% vs 100%, 100% vs 98.0%, and 5.7% vs 3.9%, respectively, with no significant differences. However, only in the 7-Fr group, 4 patients failed stent insertion and 3 patients developed postprocedural pancreatitis. Furthermore, the incidence of hyperamylasemia was lower in the 5-Fr group (24.5% vs 9.8%, P = 0.047). The late AE rate did not differ significantly between the 7-Fr and 5-Fr group (14.3% vs 10.0%). The median time to late AE was 238 days for the 7-Fr group and 187 days for the 5-Fr group, with no significant difference. Conclusions: A 5-Fr stent can provide outcomes comparable to those of a 7-Fr stent and help prevent hyperamylasemia.

Endoscopic Transpapillary Gallbladder Drainage With 2 Stents Versus 1 Stent Reduces Reinterventions: A Multicenter Study

Background and AimsEndoscopic transpapillary gallbladder drainage (ETGBD) is a therapeutic option for gallstone-related gallbladder disease in non-surgical candidates. However, the optimal stenting strategy and follow-up has not been established. We aimed to determine whether there was a decreased need for unplanned reintervention in patients undergoing placement of two transpapillary gallbladder stents as compared to one. MethodsWe performed a multicenter retrospective analysis of patients undergoing ETGBD between June 2013 and October 2022. The primary outcome was clinical success as defined by resolution of symptoms without the need for another drainage strategy. Secondary outcomes included the adverse events of post-ERCP pancreatitis, cholangitis, bleeding, perforation, or death. Factors associated with placement of two stents, unplanned reintervention, and adverse events were assessed. ResultsWe included 75 patients undergoing ETGBD, with a median follow-up of 407 days (IQR: 71-1504). Technical and clinical success were 88.2% and 81.3%, respectively. Unplanned reintervention was significantly lower in the double stenting group (0% vs. 25.4%, P=0.02). Use of a 7 French stent (OR: 15.5; 95% CI: 1.9-125; p=0.01) and presence of a percutaneous cholecystostomy tube (OR: 10.8; 95% CI: 2.8-41.3; p=0.001) were associated with placement of two stents. There was no significant difference in adverse events between groups (OR: 0.9; 95% CI: 0.09-8.8; P=0.94). ConclusionsETGBD is safe and effective in non-operative candidates. Single transpapillary gallbladder stenting is associated with more unplanned reinterventions, and 7 French stent diameter and prior percutaneous cholecystostomy tube may be associated with ability to place a second stent. Endoscopists should consider planned exchange of solitary transpapillary gallbladder stents or interval placement of a second stent if placement of two stents was unsuccessful at the index procedure.

Benefits of endoscopic gallbladder stenting following percutaneous transhepatic gallbladder drainage.

Endoscopic transpapillary gallbladder drainage is challenging because of the complexity of the procedure and high incidence of adverse events (AEs). To overcome these problems, endoscopic gallbladder stenting (EGBS) after percutaneous transhepatic gallbladder drainage (PTGBD) can be effective, as it mitigates inflammation and adhesion. To examine the benefits of EGBS after PTGBD to assess its efficacy and impact on AEs. We retrospectively analyzed data from 35 patients who underwent EGBS after PTGBD at a single center between January 2016 and December 2023. The primary outcomes were technical success and AEs, and the rate of recurrent cholecystitis was evaluated. In addition, the reasons for the failure of the procedure were identified. Among the 35 patients, the technical success rate was 77.1% and the final contrast of the cystic duct was successful in 97.1% of patients. The incidence of early AEs was relatively low (11.4%), with no instances of cystic duct perforation. The rate of recurrent cholecystitis was 3.7%, and no other biliary events were observed. EGBS after PTGBD may be significantly beneficial, with a substantial success rate and minimal AEs in both short- and long-term follow-ups.

Prophylactic endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis induced after metallic stent placement for malignant biliary strictures: a retrospective study in Japan.

Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study evaluated the efficacy of prophylactic gallbladder stents (GBS) during SEMS placement. Among 158 patients who underwent SEMS placement for malignant biliary strictures between January 2018 and March 2023, 30 patients who attempted to undergo prophylactic GBS placement before SEMS placement were included. Technical success was achieved in 21 cases (70.0%). The mean diameter of the cystic duct was more significant in the successful cases (6.5 mm vs. 3.7 mm, p<0.05). Adverse events occurred for 7 patients (23.3%: acute pancreatitis in 7; non-obstructive cholangitis in 1; perforation of the cystic duct in 1 with an overlap), all of which improved with conservative treatment. No patients developed AC when the GBS placement was successful, whereas 25 of the 128 patients (19.5%) without a prophylactic GBS developed AC during the median follow-up period of 357 days (p=0.043). In the multivariable analysis, GBS placement was a significant factor in preventing AC (hazard ratio, 0.61; 95% confidence interval, 0.37-0.99; p=0.045). GBS may contribute to the prevention of AC after SEMS placement for malignant biliary strictures.

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.

Elective Cholecystectomy After Endoscopic Gallbladder Stenting for Acute Cholecystitis: A Propensity Score Matching Analysis.

To investigate the influence of endoscopic gallbladder stenting (EGBS) on subsequent cholecystectomy. We retrospectively compared the surgical outcomes of EGBS, followed by elective cholecystectomy with those of immediate cholecystectomy (IC). A total of 503 patients were included in this study. Patients who underwent EGBS as initial treatment for acute cholecystitis, followed by elective cholecystectomy, were included in the EGBS group and patients who underwent IC during hospitalization were included in the IC group. Propensity score matching analysis was used to compare the surgical outcomes. In addition, the factors that increased the amount of bleeding were examined by multivariate analysis after matching. Fifty-seven matched pairs were obtained after propensity matching the EGBS group and the IC group. The rate of laparoscopic cholecystectomy in the EGBS versus IC groups was 91.2% versus 49.1% ( P < 0.001). The amount of bleeding was 5mL in the EGBS versus 188mL in the IC group ( P < 0.001). In the EGBS and IC groups, multivariate analysis of factors associated with more blood loss revealed IC (odds ratio: 4.76, 95% CI: 1.25-20.76, P = 0.022) as an independent risk factor. EGBS as the initial treatment for acute cholecystitis and subsequent elective cholecystectomy after the inflammation has disappeared can be performed in minimally invasive procedures and safely.

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.

Endoscopic Gallbladder Stenting to Prevent Recurrent Cholecystitis in Deferred Cholecystectomy: A Randomized Trial

Background and aimsEndoscopic transpapillary gallbladder stenting (ETGS) has been proposed as one of the adjunctive treatments, apart from antibiotics, before surgery in patients with acute cholecystitis whose cholecystectomy could not be performed or deferred. Currently, there are no comparative data on the outcomes of ETGS in those who receive and do not receive ETGS. We aimed to compare the rates of recurrent cholecystitis at 3 and 6 months in these two groups. MethodsBetween 2020-2023, eligible acute-calculous-cholecystitis patients with a high probability of common bile duct (CBD) stone, who were surgical candidates but could not have an early cholecystectomy during COVID-19 surgical lockdown, were randomized into groups A (received ETGS) and B (did not receive ETGS). A definitive cholecystectomy was performed at 3 months or later in both groups. ResultsA total of 120 eligible patients were randomized into group A (n=60) and group B (n=60). In group A, technical and clinical success rates were 90% (54/60) and 100% (54/54), respectively. Based on intention-to-treat analysis, group A had a significantly lower rate of recurrence than group B at 3 months [0% (0/60) vs. 18.3% (11/60); p=0.001]. At 3-6 months, group A showed a non-significantly lower rate of recurrent cholecystitis compared to group B [0% (0/32) vs. 10% (3/30); p=0.11]. ConclusionsETGS could prevent recurrent cholecystitis in acute cholecystitis patients with CBD stone whose cholecystectomy was deferred for 3 months. In those who did not receive ETGS, the majority of recurrences occurred within 3 months. (Thaiclinicaltrials.org, number: TCTR20200913001)

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

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A case report on unintentional gallbladder stenting during endoscopic management of choledocholithiasis found during laparoscopic cholecystectomy

A case report on unintentional gallbladder stenting during endoscopic management of choledocholithiasis found during laparoscopic cholecystectomy

Endoscopic gallbladder inside-stenting combined with aspirated lavage for calculous cholecystitis in poor surgical candidates: a prospective pilot study

Although long-term stent placement via endoscopic gallbladder stenting (EGBS) reportedly reduces cholecystitis recurrence in patients unfit to undergo cholecystectomy, it can increase the frequency of other late adverse events (AEs) such as cholangitis. This study aimed to examine the feasibility of endoscopic gallbladder inside-stenting (EGB-IS) with lavage and aspiration. This prospective, single-center, pilot study enrolled 83 patients with acute calculous cholecystitis who were poor candidates for surgery. A dedicated catheter with eight side holes was used for lavage and aspiration, and a dedicated single-pigtail stent equipped with a thread was used for EGB-IS. Outcomes such as technical success, clinical success, early AEs, recurrence of cholecystitis, and other symptomatic late AEs associated with EGB-IS with lavage and aspiration were evaluated. The technical and clinical success rates were 80.7% (67/83) and 98.5% (66/67), respectively. The rate of early AEs was 3.6% (3/83). The rate of recurrent cholecystitis was 4.5% (3/66) and that of symptomatic late AEs (besides cholecystitis) was 6.1% (4/66). Consequently, the rate of overall late AEs (cholecystitis plus other events) was 10.6% (7/66). The 1-, 2-, and 3-year cumulative incidence rates of all late AEs were 3.2%, 11.2%, and 18.9%, respectively. EGB-IS with lavage and aspiration for calculous cholecystitis showed promising results in poor surgical candidates. EGB-IS may be useful when EGBS with long-term stent placement is planned, since prevention of cholecystitis recurrence, without a rise in the incidence of other AEs, is anticipated.

Percutaneous transhepatic gallbladder drainage versus endoscopic gallbladder stenting for managing acute cholecystitis until laparoscopic cholecystectomy.

Gallbladder drainage by methods such as percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic gallbladder stenting (EGBS) is important in the early management of moderate to severe acute cholecystitis. In patients undergoing laparoscopic cholecystectomy (LC) for acute cholecystitis after a month or more of gallbladder drainage, the clinical course was compared between patients initially treated with PTGBD or EGBS. Among 331 patients undergoing LC for cholecystitis between 2018 and 2022, 43 first underwent 1 or more months of gallbladder drainage. The median interval between drainage initiation and LC was 89 days (range, 28-261) among 34 patients with PTGBD and 70 days (range, 62-188) among nine with EGBS (p = 0.644). During this waiting period, PTGBD was clamped in six patients and removed in five. Cholecystitis relapsed in three PTGBD patients (9%) and four EGBS patients (44%; p = 0.026). Relapses were managed with medications. Cholecystectomy duration (p = 0.022), intraoperative blood loss (p = 0.026), frequency of abdominal drain insertion (p = 0.023), and resort to bailout surgery such as fundus-first approaches (p = 0.030) were significantly greater in patients with EGBS. Postoperative complications were somewhat likelier (p = 0.095) and postoperative hospital stays were longer (p = 0.007) in the EGBS group. Among patients whose LC was performed 1 or more months after initiation of drainage, daily living during the waiting period associated with drainage was well supported by EGBS, but LC and the postoperative course were more complicated than in PTGBD patients.

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 gallbladder stenting using a 0.018-inch guidewire and a novel spiral dilator.

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Prophylactic endoscopic gallbladder stenting for cholecystitis after covered metal stent placement for distal biliary obstruction.

Acute cholecystitis is occasionally observed after biliary drainage using a covered self-expandable metal stent (CSEMS) for distal biliary obstruction (DBO). Gallbladder drainage prior to CSEMS placement may reduce cholecystitis. This study aimed to examine the preventive effect of endoscopic gallbladder stenting (EGBS) on cholecystitis with CSEMS. We retrospectively analyzed patients with DBO who underwent CSEMS placement across the orifice of the cystic duct between November 2014 and October 2021 and were negative for cholecystitis on biliary drainage. Prophylactic EGBS was attempted before CSEMS placement. The incidence of cholecystitis was compared between patients with and without EGBS. A total of 286 patients (128 men; median age, 75 years) were included in this study. EGBS was attempted in 32 patients before CSEMS placement, and technical success was achieved in 24 (75%) patients. Adverse events were noted in three patients (9.4%; penetration of cystic duct in one and acute pancreatitis in two). The cumulative incidence of cholecystitis was significantly lower in patients with EGBS than in those without EGBS (1 [4.2%] vs. 56 [21.4%]; p=0.045. In multivariable analysis, EGBS was a significant protective factor against cholecystitis (hazard ratio, 0.11; 95% confidence interval, 0.01-0.79; p=0.028). Although the transpapillary approach to the gallbladder is not easy for patients with DBO, EGBS is effective in preventing cholecystitis associated with CSEMS.

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

Use of endoscopic gallbladder stenting and biliary scintigraphy for diagnosis of gallbladder dyskinesia: a case report.

A 40-year-old woman visited our hospital with a several-year history of right hypochondriac pain and vomiting after eating. She had been treated for functional dyspepsia, with no improvement in her symptoms. No gallstones were detected on imaging tests, but papillary insufficiency or dyskinesia of the gallbladder was suspected and biliary scintigraphy was performed. Biliary scintigraphy showed delayed excretion of radionuclides from the gallbladder and bile ducts into the duodenum. We initially suspected papillary dysfunction and performed endoscopic sphincterotomy, but there was no improvement in her symptoms. Biliary scintigraphy also showed delayed excretion of radionuclides, especially stagnation of radionuclides in the gallbladder. We suspected gallbladder dyskinesia and performed endoscopic gallbladder stenting, after which her symptoms disappeared and biliary scintigraphy showed improved excretion of radionuclides into the duodenum. Endoscopic gallbladder stenting may be useful for the diagnosis of gallbladder dyskinesia and for determining the efficacy of cholecystectomy.

Ruptured cystic artery pseudoaneurysm after long-term transpapillary placement of a gallbladder stent for acute cholecystitis.

Endoscopic transpapillary gallbladder drainage (ETGBD), including endoscopic gallbladder stenting (EGBS), has utility in the management of acute cholecystitis in patients considered to be high risk candidates for surgery [1]. A recent meta-analysis reported that the pooled rate of cholecystitis recurrence was 4.6 % following ETGBD in patients with acute cholecystitis [2]. Long-term biliary drainage via EGBS is often performed to prevent the recurrence of cholecystitis in patients with contraindications to cholecystectomy.

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.