Endoscopic Transpapillary Gallbladder Stent Placement Is Safe and Effective in High-Risk Patients Without Cirrhosis
Endoscopic transpapillary gallbladder stent (ETGS) placement is a proposed minimally invasive alternative to cholecystectomy in high-risk patients with symptomatic gallbladder disease.
To describe the safety and efficacy of ETGS placement in 29 consecutive patients without cirrhosis.
A retrospective analysis of consecutive ETGS cases from 2005 to 2013 at a referral center was undertaken.
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.
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.
KeywordsGallbladder stent ERCP Cholecystitis Cholecystostomy
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.
- 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