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

Abstract

Background 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.

Methods 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.

Results 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).

Conclusions 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.

• References

• 1 Ridtitid W, Luangsukrerk T, Piyachaturawat P. et al. Ultimate outcomes of three modalities for non-surgical gallbladder drainage in acute cholecystitis with or without concomitant common bile duct stones. Ann Hepatobiliary Pancreat Surg 2022; 26: 104-112
• 2 Irani S, Ngamruengphong S, Teoh A. et al. Similar efficacies of endoscopic ultrasound gallbladder drainage with a lumen-apposing metal stent versus percutaneous transhepatic gallbladder drainage for acute cholecystitis. Clin Gastroenterol Hepatol 2017; 15: 738-745
• 3 Teoh AYB, Kitano M, Itoi T. et al. Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1). Gut 2020; 69: 1085-1091
• 4 Schlenker C, Trotter JF, Shah RJ. et al. Endoscopic gallbladder stent placement for treatment of symptomatic cholelithiasis in patients with end-stage liver disease. Am J Gastroenterol 2006; 101: 278-283
• 5 Conway JD, Russo MW, Shrestha R. Endoscopic stent insertion into the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease. Gastrointest Endosc 2005; 61: 32-36
• 6 Lee TH, Park DH, Lee SS. et al. Outcomes of endoscopic transpapillary gallbladder stenting for symptomatic gallbladder diseases: a multicenter prospective follow-up study. Endoscopy 2011; 43: 702-708
• 7 McCarthy ST, Tujios S, Fontana RJ. et al. Endoscopic transpapillary gallbladder stent placement is safe and effective in high-risk patients without cirrhosis. Dig Dis Sci 2015; 60: 2516-2522
• 8 Ridtitid W, Piyachaturawat P, Teeratorn N. et al. 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). Gastrointest Endosc 2020; 92: 634-644
• 9 Inoue T, Okumura F, Kachi K. et al. Long-term outcomes of endoscopic gallbladder stenting in high-risk surgical patients with calculous cholecystitis (with videos). Gastrointest Endosc 2016; 83: 905-913
• 10 Kaura K, Bazerbachi F, Sawas T. et al. Surgical outcomes of ERCP-guided transpapillary gallbladder drainage versus percutaneous cholecystostomy as bridging therapies for acute cholecystitis followed by interval cholecystectomy. HPB (Oxford) 2020; 22: 996-1003
• 11 Yoshida M, Naitoh I, Hayashi K. et al. Four-step classification of endoscopic transpapillary gallbladder drainage and the practical efficacy of cholangioscopic assistance. Gut Liver 2021; 15: 476-485
• 12 Storm AC, Vargas EJ, Chin JY. et al. Transpapillary gallbladder stent placement for long-term therapy of acute cholecystitis. Gastrointest Endosc 2021; 94: 742-748
• 13 Charlson ME, Pompei P, Ales KL. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383
• 14 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 15 Mohan BP, Khan SR, Trakroo S. et al. Endoscopic ultrasound-guided gallbladder drainage, transpapillary drainage, or percutaneous drainage in high risk acute cholecystitis patients: a systematic review and comparative meta-analysis. Endoscopy 2020; 52: 96-106
• 16 Siddiqui A, Kunda R, Tyberg A. et al. Three-way comparative study of endoscopic ultrasound-guided transmural gallbladder drainage using lumen-apposing metal stents versus endoscopic transpapillary drainage versus percutaneous cholecystostomy for gallbladder drainage in high-risk surgical patients with acute cholecystitis: clinical outcomes and success in an international, multicenter study. Surg Endosc 2019; 33: 1260-1270
• 17 Podboy A, Yuan J, Stave CD. et al. Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis: a systematic review with network meta-analysis. Gastrointest Endosc 2021; 93: 797-804
• 18 Sobani ZA, Sanchez-Luna SA, Rustagi T. Endoscopic transpapillary gallbladder drainage for acute cholecystitis using two gallbladder stents (dual gallbladder stenting). Clin Endosc 2021; 54: 899-902
• 19 Maekawa S, Nomura R, Murase T. et al. Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older. BMC Gastroenterol 2013; 13: 65
• 20 Nakahara K, Sato J, Morita R. et al. Incidence and management of cystic duct perforation during endoscopic transpapillary gallbladder drainage for acute cholecystitis. Dig Endosc 2022; 34: 207-214