Transpapillary Gallbladder Stent Placement Usually Successful as Destination Therapy
Bret T. Petersen, MD, MASGE, reviewing Storm AC, et al. Gastrointest Endosc 2021 Mar 30.
Severe acute cholecystitis (AC) often is palliated with percutaneous or endoscopic drainage 6 to 12 weeks prior to preplanned interval cholecystectomy. Many patients with severe comorbidities are deemed to be poor candidates for surgery even following resolution of AC. Whether ERCP-guided transpapillary gallbladder drainage (TPGD) can provide indefinite long-term palliation against recurrent cholecystitis is unknown. In this study, the authors sought to determine the technical and long-term clinical success of TPGD among 49 patients in whom this modality was pursued as destination therapy during a 12-year interval.
Placement of 1 or more double-pigtail stents to the gallbladder was technically successful in 96% of patients (49/51). Following stent placement, all symptoms were resolved and patients were dismissed from the hospital. Long-term success (defined as the absence of AC or unplanned reintervention before death or within 6 months of TPGD) was achieved in 47 of 49 patients, with a mean follow-up of 453 days (range, 18-1879 days post-TPGD). Adverse events were mild and infrequent (5.9%). The frequency of repeat procedures and time to recurrent AC both trended toward better outcomes with dual rather than single stents. Stent removal without definitive surgery or alternative drainage was also a risk factor for recurrent AC.
COMMENTEndoscopic palliation of acute cholecystitis often is performed without complete awareness of the patient’s candidacy for subsequent surgical management. Among patients requiring ERCP for clearance of duct stones, TPGD can usually be accomplished during the same procedure. Percutaneous alternatives are generally less desirable for patients requiring longer-term or indefinite palliation, and transduodenal EUS-guided stent placement may complicate eventual elective cholecystectomy.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Storm AC, Vargas EJ, Chin JY, et al. Transpapillary gallbladder stent placement for long-term therapy of acute cholecystitis. Gastrointest Endosc 2021 Mar 30. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.03.025)
