Select patients with acute cholecystitis (AC) may be poor candidates for cholecystectomy. ERCP-guided transpapillary gallbladder (GB) drainage (ERGD), gives one modality for nonoperative management of AC in these patients to evaluate the long-term success of destination ERGD and determine the rate of technical and clinical success, number of repeat procedures, rate of adverse events, and risk factors for recurrent AC were evaluated.
Consecutive patients with AC, who were not candidates for cholecystectomy underwent ERGD with attempted transpapillary GB plastic, double-pigtail stent placement in a tertiary hospital from January 2008 to December 2019. Long term success was defined as no AC after ERGD until 6 months, death, or reintervention. Technical success was defined as placement of at least 1 transpapillary stent into the GB and clinical success as resolution of AC symptoms with discharge from the hospital.
Long-term success was achieved in 95.9% of patients (47/49), technical success in 96% (49/51), and clinical success 100% in those with technical success. Mild adverse events occurred in 5.9% (N=3). Mean follow-up was 453 days after ERGD (range, 18-1879). A trend toward longer time for recurrence of AC was seen in patients with 2, rather than 1 GB stent placed and more repeat procedures were performed when a single stent was placed. It was concluded that ERGD with transpapillary GB double-pigtail stent placement was a safe and effective long-term therapy for a poor surgical candidate with AC. Risk factors for recurrence include stent removal and single-stent therapy. Double-stent therapy is not always technically feasible, but may salvage failed single-stent therapy or recurrence after elective stent removal and may therefore be the preferred treatment modality.
Storm, A., Vargas, E., Chin, J., et al. “Transpapillary Gallbladder Stent Placement for Long-Term Therapy of Acute Cholecystitis.” Gastrointestinal Endoscopy, 2021; Vol. 94, pp. 742-748.