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

Abstract

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 7F plastic stent. The study aim was to evaluate the efficacy of a novel 5F plastic stent in EGBS for AC.

Patients and methods

We designed a retrospective study that compared the outcomes between 7F and 5F 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 7F (n = 53) or 5F (n = 51) plastic stent were included in the analysis.

Results

The technical success rate for EGBS, clinical success rate for AC, and early adverse events (AEs) rate in the 7F and 5F 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 7F group, four patients failed stent insertion and three patients developed postprocedure pancreatitis. Furthermore, incidence of hyperamylasemia was lower in the 5F group (24.5% vs 9.8%, P = 0.047). The late AE rate did not differ significantly between the 7F and 5F groups (14.3% vs 10.0%). The median time to late AE was 238 days for the 7F group and 187 days for the 5F group, with no significant difference.

Conclusions

A 5F stent can provide outcomes comparable to those of a 7F stent and help prevent hyperamylasemia.

Keywords

Pancreatobiliary (ERCP/PTCD) - Stones - ERC topics

Publication History

Received: 05 August 2024

Accepted after revision: 07 November 2024

Accepted Manuscript online:
11 November 2024

Article published online:
07 January 2025

• References

• 1 Mori Y, Itoi T, Baron TH. et al. Tokyo Guidelines 2018: Management strategies for gallbladder drainage in patients with acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25: 87-95
• 2 Radder RW. Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging 1980; 49: 330-333
• 3 Baron TH, Grimm IS, Swanstrom LL. Interventional approaches to gallbladder disease. N Engl J Med 2015; 373: 357-365
• 4 Itoi T, Coelho-Prabhu N, Baron TH. Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointes Endosc 2010; 71: 1038-1045
• 5 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
• 6 Oh D, Song TJ, Cho DH. et al. EUS-guided cholecystostomy versus endoscopic transpapillary cholecystostomy for acute cholecystitis in high-risk surgical patients. Gastrointest Endosc 2019; 89: 289-298
• 7 Kozarek RA. Selective cannulation of the cystic duct at time of ERCP. J Clin Gastroenterol 1984; 6: 37-40
• 8 Feretis CB, Manouras AJ, Apostolidis NS. et al. Endoscopic transpapillary drainage of gallbladder empyema. Gastrointest Endosc 1990; 36: 523-525
• 9 Itoi T, Sofuni A, Itokawa F. et al. Endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis in whom percutaneous transhepatic approach is contraindicated or anatomically impossible (with video). Gastrointest Endosc 2008; 68: 455-460
• 10 Sagami R, Hayasaka K, Ujihara T. et al. Endoscopic transpapillary gallbladder drainage for acute cholecystitis is feasible for patients receiving antithrombotic therapy. Dig Endosc 2020; 32: 1092-1099
• 11 Itoi T, Kawakami H, Katanuma A. et al. Endoscopic nasogallbladder tube or stent placement in acute cholecystitis: a preliminary prospective randomized trial in Japan (with videos). Gastrointest Endosc 2015; 81: 111-118
• 12 Yang MJ, Yoo BM, Kim JH. et al. Endoscopic naso-gallbladder drainage versus gallbladder stenting before cholecystectomy in patients with acute cholecystitis and a high suspicion of choledocholithiasis: a prospective randomised preliminary study. Scand J Gastroenterol 2016; 51: 472-478
• 13 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
• 14 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
• 15 Nakahara K, Michikawa Y, Morita R. et al. Endoscopic transpapillary gallbladder stenting using a newly designed plastic stent for acute cholecystitis. Endosc Int Open 2019; 7: E1105-E1114
• 16 Sato J, Nakahara K, Michikawa Y. et al. Long-term outcomes of endoscopic transpapillary gallbladder drainage using a novel spiral plastic stent in acute calculus cholecystitis. BMC Gastroenterol 2022; 22: 539
• 17 Doi S, Yasuda I, Mabuchi M. et al. Hybrid procedure combining endoscopic gallbladder lavage and internal drainage with elective cholecystectomy for acute cholecystitis: A prospective pilot study (The BLADE study). Dig Endosc 2018; 30: 501-507
• 18 Takano Y, Noda J, Yamawaki M. et al. Permanent endoscopic transpapillary gallbladder drainage using a novel spiral stent (IYO-stent). DEN Open 2021; 2: e40
• 19 Yokoe M, Hata J, Takada T. et al. Tokyo Guidelines 2018: Diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25: 41-54
• 20 Cotton PB, Lehman G, Vennes J. et al. Endoscopic sphincterotomy complications and their management: An attempt at consensus. Gastrointest Endosc 1991; 37: 383-393
• 21 Khan MA, Atiq O, Kubiliun N. et al. Efficacy and safety of endoscopic gallbladder drainage in acute cholecystitis: Is it better than percutaneous gallbladder drainage?. Gastrointest Endosc 2017; 85: 76-87
• 22 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
• 23 McCarty TR, Hathorn KE, Bazarbashi AN. et al. Endoscopic gallbladder drainage for symptomatic gallbladder disease: a cumulative systematic review meta-analysis. Surg Endosc 2021; 35: 4964-4985
• 24 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
• 25 Schmassmann A, von Gunten E, Knuchel J. et al. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol 1996; 91: 654-659
• 26 Shepherd HA, Royle G, Ross AP. et al. Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg 1988; 75: 1166-1168
• 27 Dumonceau JM, Tringali A, Blero D. et al. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2012; 44: 277-298
• 28 Maruta A, Iwashita T, Iwata K. et al. Permanent endoscopic gallbladder stenting versus removal of gallbladder drainage, long-term outcomes after management of acute cholecystitis in high-risk surgical patients for cholecystectomy: Multi-center retrospective cohort study. J Hepatobiliary Pancreat Sci 2021; 28: 1138-1146
• 29 Elmunzer BJ, Novelli PM, Taylor JR. et al. Percutaneous cholecystostomy as a bridge to definitive endoscopic gallbladder stent placement. Clin Gastroenterol Hepatol 2011; 9: 18-20
• 30 Park SW, Lee SS. Current status of endoscopic management of cholecystitis. Dig Endosc 2022; 34: 439-450