CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S13
DOI: 10.1055/s-0041-1730681
Abstract

Minimally Invasive Treatment of Benign Gallbladder Pathology in Nonsurgical Candidates: Cystic Duct Stenting

Mohammed Rashid Akhtar
The Royal London Hospital, Whitechapel, London, UK
› Author Affiliations

Background: M. R. Akhtar, A. Zaman, T. Fotheringham; Acute cholecystitis in critically ill patients carries a high mortality rate. Patients who are unresponsive to medical management and unsuitable for immediate cholecystectomy require an interventional solution. Percutaneous cholecystostomy is an effective bridging therapy providing immediate symptom control until surgery. A subgroup of patients with severe comorbidities will never be suitable for surgery; these patients can become dependent on long-term external drainage to avert recurrent cholecystitis. Percutaneous cystic duct (cholecystoduodenal) stenting offers a solution to internalize these drains in both delayed surgical candidates and nonsurgical candidates. We present our series with a long-term follow-up demonstrating the benefits of this procedure. Methods: Eleven patients unfit for surgery in our institution underwent cystic duct stent insertion for the management of acute cholecystitis from July 2009 to April 2017. A two-stage procedure involved an initial percutaneous transhepatic cholecystostomy and a subsequent cystic duct stent insertion. An 8 Fr × 16 cm transplant ureteric stent was positioned with the proximal loop in the gallbladder and the distal loop in the duodenum. The cholecystostomy drain was removed at a later date after a check cholangiogram. Results: One patient presented with gallbladder perforation, seven patients with acute cholecystitis, one with gangrenous cholecystitis, and two patients with gallbladder empyema. Ten cases were successful at the first attempt. One case was unsuccessful (unfavorable cholecystostomy site for the second stage) second attempt not performed as the clinical team decided on a different management plan. The technical success rate was 91% and no immediate major complications. Conclusion: Cystic duct stenting has a high technical success rate with a low rate of complications. The good clinical outcome with no reintervention. This series has also demonstrated a wider indication of benign diseases for this procedure. Cystic duct stenting should be considered as a temporary and long-term option in critically ill-cholecystitis patients.



Publication History

Article published online:
11 May 2021

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