Advertisement

Digestive Diseases and Sciences

, Volume 60, Issue 8, pp 2516–2522 | Cite as

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
Original Article

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.

Keywords

Gallbladder stent ERCP Cholecystitis Cholecystostomy 

Notes

Conflict of interest

Robert Fontana has received grant support from Vertex, Gilead, and BMS, none relevant to this study, James M. Scheiman has served as a consultant to Pozen, Sanofi, Stryker, GSK, Pfizer, Astra-Zeneca within the past 5 years, none relevant to this study. For the remaining authors, none were declared.

References

  1. 1.
    Brunt LM, Quasebarth MA, Dunnegan DL, et al. Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc. 2001;15:700–705.PubMedCrossRefGoogle Scholar
  2. 2.
    Hannan EL, Imperato PJ, Nenner RP, et al. Laparoscopic and open cholecystectomy in New York State: mortality, complications and choice of procedure. Surgery. 1999;125:223–231.PubMedCrossRefGoogle Scholar
  3. 3.
    McGahan JP, Lindfors KK. Percutaneous cholecystostomy: an alternative to surgical cholecystostomy for acute cholecystitis. Radiology. 1989;173:481–485.PubMedCrossRefGoogle Scholar
  4. 4.
    Spira RM, Nissan A, Zamir O, et al. Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis. Am J Surg. 2002;183:62–66.PubMedCrossRefGoogle Scholar
  5. 5.
    Tamada K, Seki H, Sato K, et al. Efficacy of endoscopic retrograde cholecystoendoprosthesis (ERCCE) for cholecystitis. Endoscopy. 1991;23:1–2.CrossRefGoogle Scholar
  6. 6.
    Schlenker C, Trotter JF, Shah RJ, et al. Endoscopic gallbladder stent placement for treatment of symptomatic cholelithiasis in patients with end-stage liver disease. Am J Gastroenterol. 2006;101:278–283.PubMedCrossRefGoogle Scholar
  7. 7.
    Wolters U, Wolf T, Stuzer H, et al. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77:217–222.PubMedCrossRefGoogle Scholar
  8. 8.
    Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.PubMedCrossRefGoogle Scholar
  9. 9.
    Tujios SR, Rahnama-Moghadaam S, Elmunzer JB, et al. Transpapillary gallbladder stents can stabilize or improve decompensated cirrhosis in patients awaiting liver transplantation. J Clin Gastroenterol (Accepted Sept 2014).Google Scholar
  10. 10.
    Kalloo AN, Thuluvath PJ, Pasricha PJ. Treatment of high-risk patients with symptomatic cholelithiasis by endoscopic gallbladder stenting. Gastrointest Endosc. 1994;40:608–610.PubMedCrossRefGoogle Scholar
  11. 11.
    Siegel JH, Veerappan A, Cohen S, et al. Endoscopic sphincterotomy for biliary pancreatitis: an alternative to cholecystectomy in high-risk patients. Gastrointest Endosc. 1994;40:573–575.PubMedCrossRefGoogle Scholar
  12. 12.
    Hwand SS, Li BH, Haig PI. Gallstone pancreatitis without cholecystectomy. JAMA Surg. 2013;148:867–872.CrossRefGoogle Scholar
  13. 13.
    Shrestha R, Bilir BM, Everson GT, et al. Endoscopic stenting of the gallbladder for symptomatic cholelithiasis in patients with end-stage liver disease awaiting orthotopic liver transplantation. Am J Gastroenterol. 1996;91:595–598.PubMedGoogle Scholar
  14. 14.
    Lee TH, Park DH, Lee SS, et al. Outcomes of endoscopic transpapillary gallbladder stenting for symptomatic gallbladder diseases: a multicenter prospective follow-up study. Endoscopy. 2011;43:702–708.PubMedCrossRefGoogle Scholar
  15. 15.
    Maekawa S, Nomura R, Murase T, et al. Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older. BMC Gastroenterol. 2013;13:65.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sean T. McCarthy
    • 1
  • Shannan Tujios
    • 2
  • Robert J. Fontana
    • 1
  • Sahand Rahnama-Moghadam
    • 3
  • B. Joseph Elmunzer
    • 1
  • Richard S. Kwon
    • 1
  • Erik J. Wamsteker
    • 1
  • Michelle A. Anderson
    • 1
  • James M. Scheiman
    • 1
  • Grace H. Elta
    • 1
  • Cyrus R. Piraka
    • 4
  1. 1.Division of Gastroenterology, Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  2. 2.Division of Digestive and Liver Diseases, Department of Internal MedicineUniversity of Texas SouthwesternDallasUSA
  3. 3.Department of Internal MedicineUniversity of TexasSan AntonioUSA
  4. 4.Division of Gastroenterology, Department of Internal MedicineHenry Ford Health SystemDetroitUSA

Personalised recommendations