Endoscopic Transpapillary Gallbladder Stent Placement Is Safe and Effective in High-Risk Patients Without Cirrhosis

Sean T. McCarthy, Shannan Tujios, Robert J. Fontana, Sahand Rahnama-Moghadam, B. Joseph Elmunzer, Richard S. Kwon, Erik J. Wamsteker, Michelle A. Anderson, James M. Scheiman, Grace H. Elta, Cyrus R. Piraka

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Background: Endoscopic transpapillary gallbladder stent (ETGS) placement is a proposed minimally invasive alternative to cholecystectomy in high-risk patients with symptomatic gallbladder disease. Aims: To describe the safety and efficacy of ETGS placement in 29 consecutive patients without cirrhosis. Methods: A retrospective analysis of consecutive ETGS cases from 2005 to 2013 at a referral center was undertaken. Results: The mean age was 70 years (range 40–91), and 62 % were hospitalized. The most common indication for ETGS was acute calculus cholecystitis (52 %). Comorbidities precluding cholecystectomy included advanced cancer (45 %), severe cardiopulmonary disease (21 %), and advanced age/frailty (17 %). Eighty-six percent of the patients had an ASA class of III or IV, and the Charlson comorbidity index was >3 in 55 %. An ETGS was successfully placed in 22 patients (76 %) with 18 being successful on the first attempt. A percutaneous rendezvous approach was required to obtain cystic duct access in six patients (21 %). During a mean follow-up of 376 days, a sustained clinical response was noted in 90 % of the patients with a stent placed. No peri-procedural complications were noted. However, two patients developed delayed complications of abdominal pain and cholangitis. Six patients were alive with their original stent still in place at a mean follow-up of 2.5 years. Conclusions: ETGS is an effective and safe alternative to cholecystectomy in high-risk patients. Technical success can be facilitated by a percutaneous rendezvous technique. Our data and those of others suggest that scheduled stent exchanges may not be required unless a clinical change occurs.

Original languageEnglish (US)
Pages (from-to)2516-2522
Number of pages7
JournalDigestive Diseases and Sciences
Volume60
Issue number8
DOIs
StatePublished - Oct 7 2015

Keywords

  • Cholecystitis
  • Cholecystostomy
  • ERCP
  • Gallbladder stent

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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    McCarthy, S. T., Tujios, S., Fontana, R. J., Rahnama-Moghadam, S., Elmunzer, B. J., Kwon, R. S., Wamsteker, E. J., Anderson, M. A., Scheiman, J. M., Elta, G. H., & Piraka, C. R. (2015). Endoscopic Transpapillary Gallbladder Stent Placement Is Safe and Effective in High-Risk Patients Without Cirrhosis. Digestive Diseases and Sciences, 60(8), 2516-2522. https://doi.org/10.1007/s10620-014-3371-4