Transpapillary Gallbladder Stents Can Stabilize or Improve Decompensated Cirrhosis in Patients Awaiting Liver Transplantation

Shannan R. Tujios, Sahand Rahnama-Moghadam, Joseph B. Elmunzer, Richard Kwon, Amit G. Singal, Michelle A. Anderson, Erik Jan Wamsteker, Jason R. Taylor, James Scheiman, Grace Elta, Robert J. Fontana, Cyrus R. Piraka

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10 Scopus citations

Abstract

Goals: To describe the short-term and long-term outcomes in 34 consecutive decompensated cirrhotic patients with symptomatic gallbladder disease undergoing transpapillary gallbladder stent (TGS) placement. Background: Endoscopic TGS placement is a minimally invasive means of treating symptomatic gallbladder disease in poor surgical candidates. Study: Between June 2005 and June 2011, 34 patients with cirrhosis and symptomatic gallbladder disease underwent attempted TGS placement. Results: Median patient age was 52 years, 56% were hospitalized, and 48% were listed for liver transplantation. The median model for end-stage liver disease (MELD) score was 15 (range, 6 to 40) and 88% were Child-Turcotte-Pugh class B/C. A double pigtailed stent was successfully placed in 94% of the patients. At 1-month follow-up, clinical improvement was noted in 82% of the treated subjects and the MELD scores in 14 of 22 (64%) evaluable subjects improved or stabilized. Actuarial transplant-free survival was 53% in the liver transplant candidates with a mean follow-up of 352 days, whereas survival was 44% in the 18 nontransplant candidates with a mean follow-up of 1.5 years. Periprocedural complications included pancreatitis in 5 patients, cholangitis in 3, and 1 patient with cystic duct perforation. In addition, 2 subjects had symptomatic bleeding from traumatic duodenal ulcerations 2 years after TGS placement that necessitated stent removal. Conclusions: Endoscopic TGS placement was technically feasible in 94% of decompensated cirrhotics and was associated with a relatively low rate of periprocedural (26%) and long-term complications (6%). Stabilization or improvement in clinical status and MELD scores was seen in the majority of treated patients.

Original languageEnglish (US)
Pages (from-to)771-777
Number of pages7
JournalJournal of Clinical Gastroenterology
Volume49
Issue number9
DOIs
StatePublished - Sep 23 2015

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Keywords

  • cholecystitis
  • cholelithiasis
  • cirrhosis
  • cystic duct
  • endoscopic retrograde cholangiopancreatography

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Tujios, S. R., Rahnama-Moghadam, S., Elmunzer, J. B., Kwon, R., Singal, A. G., Anderson, M. A., Wamsteker, E. J., Taylor, J. R., Scheiman, J., Elta, G., Fontana, R. J., & Piraka, C. R. (2015). Transpapillary Gallbladder Stents Can Stabilize or Improve Decompensated Cirrhosis in Patients Awaiting Liver Transplantation. Journal of Clinical Gastroenterology, 49(9), 771-777. https://doi.org/10.1097/MCG.0000000000000269