Transpapillary gallbladder stent placement for long-term therapy of acute cholecystitis.

BACKGROUND AND AIMS: Select patients with acute cholecystitis (AC) are poor candidates for cholecystectomy. Endoscopic retrograde cholangiopancreatography (ERCP)-guided transpapillary gallbladder drainage (ERGD) is one modality for nonoperative management of AC in these patients. The primary aim was to evaluate long-term success of destination ERGD. Secondary aims include rate of technical and clinical success, number of repeat procedures, adverse event rate, and risk factors for recurrent AC.

METHODS: Consecutive patients with AC who were not candidates for cholecystectomy underwent ERGD with attempted transpapillary gallbladder (GB) plastic double-pigtail stent placement at a tertiary hospital from January 2008 to December 2019. Long-term success was defined as no AC after ERGD until 6 months, death, or reintervention. Technical success was defined as placement of at least 1 transpapillary stent into the gallbladder, and clinical success as resolution of AC symptoms with discharge from the hospital.

RESULTS: Long-term success was achieved in 95.9% (47/49). Technical success was 96% (49/51) and clinical success was 100% in those with technical success. Mild adverse events occurred in 5.9% (n=3). Mean follow-up was 453 days after ERGD (range 18-1879). A trend toward longer time to recurrence of AC was seen in patients with 2 rather than one GB stent placed (p=0.13), and more repeat procedures were performed when a single stent was placed (p=0.045).

CONCLUSIONS: ERGD with transpapillary GB double-pigtail stent placement is safe and effective long-term therapy for poor surgical candidates with AC. Risk factors for recurrence include stent removal and single stent therapy. Double-stent therapy is not always technically feasible but may salvage failed single-stent therapy or recurrence after elective stent removal and may therefore be the preferred treatment modality.