Skip to main content


Log in

Endoscopic transpapillary stenting for the management of acute cholecystitis

  • Original Articles
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript



Cholecystectomy is the gold standard treatment of acute cholecystitis. Patients who are considered not to be candidates for cholecystectomy are commonly recommended to undergo percutaneous transhepatic gallbladder drainage (PTGBD) tube placement; however, external drainage is undesirable for many patients. Endoscopic transpapillary stent placement (ETSP) has been described as an alternative method for decompression of the gallbladder. Data in support of this technique is limited to a handful of observational studies with variable indications. Our study sought to expand on the available data for the use of ETSP exclusively in the context of acute cholecystitis.


We performed a retrospective chart review of patients with cholecystitis who underwent ETSP at our institution between January 2012 and July 2018. We collected data on indication, comorbidities, length of stay, laboratory values, outcomes, additional procedures, and whether cholecystectomy was eventually performed.


During the study period, 12 patients underwent ETSP. The mean age was 68.2 years (± SD 12.4) with an average Anesthesia Society Assessment (ASA) class of 3.2. The Charlson Comorbidity Index was greater than seven in 75% of patients, indicating a 0% estimated 10-year survival. The National Surgical Quality Improvement Program (NSQIP) surgical risk calculator was used to estimate an average mortality risk for laparoscopic cholecystectomy of 4.8% (± 3.3, 95% CI) in our study population; the estimated risk in the general population is 0.1%. Immediate resolution of symptoms with endoscopic drainage was achieved in 11 of 12 patients (91.7%); one patient experienced no symptom resolution with endoscopic drainage nor subsequent PTGBD tube placement. Six of 12 (50%) patients experienced recurrence of symptoms requiring hospitalization, and two of 12 patients (16.7%) died secondary to biliary sepsis.


Endoscopic transpapillary stent placement is an alternative method for the management of acute cholecystitis patients who are not candidates for surgery. ETSP has a high technical success rate; however, it may result in a high rate of symptom recurrence and should only be utilized in select patients. Randomized studies would be beneficial to further investigate the utility and safety of ETSP in the management of acute cholecystitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, Kozaka K, Endo I, Deziel DJ, Miura F, Okamoto K, Hwang TL, Huang WS, Ker CG, Chen MF, Han HS, Yoon YS, Choi IS, Yoon DS, Noguchi Y, Shikata S, Ukai T, Higuchi R, Gabata T, Mori Y, Iwashita Y, Hibi T, Jagannath P, Jonas E, Liau KH, Dervenis C, Gouma DJ, Cherqui D, Belli G, Garden OJ, Giménez ME, de Santibañes E, Suzuki K, Umezawa A, Supe AN, Pitt HA, Singh H, Chan ACW, Lau WY, Teoh AYB, Honda G, Sugioka A, Asai K, Gomi H, Itoi T, Kiriyama S, Yoshida M, Mayumi T, Matsumura N, Tokumura H, Kitano S, Hirata K, Inui K, Sumiyama Y, Yamamoto M (2018) Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 25(1):41–54

    Article  Google Scholar 

  2. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, Iwashita Y, Hibi T, Pitt HA, Umezawa A, Asai K, Han HS, Hwang TL, Mori Y, Yoon YS, Huang WS, Belli G, Dervenis C, Yokoe M, Kiriyama S, Itoi T, Jagannath P, Garden OJ, Miura F, Nakamura M, Horiguchi A, Wakabayashi G, Cherqui D, de Santibañes E, Shikata S, Noguchi Y, Ukai T, Higuchi R, Wada K, Honda G, Supe AN, Yoshida M, Mayumi T, Gouma DJ, Deziel DJ, Liau KH, Chen MF, Shibao K, Liu KH, Su CH, Chan ACW, Yoon DS, Choi IS, Jonas E, Chen XP, Fan ST, Ker CG, Giménez ME, Kitano S, Inomata M, Hirata K, Inui K, Sumiyama Y, Yamamoto M (2018) Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci 25(1):55–72

    Article  Google Scholar 

  3. Gurusamy KS, Rossi M, Davidson BR (2013) Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database Syst Rev 8:CD007088

  4. Shrestha R, Trouillot TE, Everson GT (1999) Endoscopic stenting of the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease awaiting orthotopic liver transplantation. Liver Transpl 5:275–281

    Article  CAS  Google Scholar 

  5. Inoue T, Okumura F, Kachi K, Fukusada S, Iwasaki H, Ozeki T, Suzuki Y, Anbe K, Nishie H, Mizushima T, Sano H (2016) Long-term outcomes of endoscopic gallbladder stenting in high-risk surgical patients with calculous cholecystitis (with videos). Gastrointest Endosc 83(5):905–913

    Article  Google Scholar 

  6. Mccarthy ST, Tujios S, Fontana RJ et al (2015) Endoscopic transpapillary gallbladder stent placement is safe and effective in high-risk patients without cirrhosis. Dig Dis Sci 60(8):2516–2522

    Article  CAS  Google Scholar 

  7. Barkay O, Bucksot L, Sherman S (2009) Endoscopic transpapillary gallbladder drainage with the SpyGlass cholangiopancreatoscopy system. Gastrointest Endosc 70(5):1039–1040

    Article  Google Scholar 

  8. Widmer J, Alvarez P, Sharaiha RZ, Gossain S, Kedia P, Sarkaria S, Sethi A, Turner BG, Millman J, Lieberman M, Nandakumar G, Umrania H, Gaidhane M, Kahaleh M (2015) Endoscopic gallbladder drainage for acute cholecystitis. Clin Endosc 48(5):411–420

    Article  Google Scholar 

  9. Schlenker C, Trotter JF, Shah RJ, Everson G, Chen YK, Antillon D, Antillon MR (2006) Endoscopic gallbladder stent placement for treatment of symptomatic cholelithiasis in patients with end-stage liver disease. Am J Gastroenterol 101(2):278–283

    Article  Google Scholar 

  10. Alvino D, Fong Z, McCarthy C, Velmahos G, Lillemoe K, Mueller P, Fagenholz P (2017) Long-term outcomes following percutaneous cholecystostomy tube placement for treatment of acute calculous cholecystitis. J Gastrointest Surg 21(5):761–769

    Article  Google Scholar 

  11. Ge N, Wang S, Wang S, Wang G, Liu X, Guo J, Yang F, Liu W, Sun S (2015) Endoscopic ultrasound-assisted cholecystogastrostomy by a novel fully covered metal stent for the treatment of gallbladder stones. Endosc Ultrasound 4(2):152–155

    Article  Google Scholar 

  12. Gosain S, Bonatti H, Smith L et al (2010) Gallbladder stent placement for prevention of cholecystitis in patients receiving covered metal stent for malignant obstructive jaundice: a feasibility study. Dig Dis Sci 55(8):2406–2411

    Article  Google Scholar 

  13. Khan MA, Atiq O, Kubiliun N et al (2017) Efficacy and safety of endoscopic gallbladder drainage in acute cholecystitis: is it better than percutaneous gallbladder drainage? Gastrointest Endosc 85(1):76–87.e3

    Article  Google Scholar 

  14. Kawakubo K, Isayama H, Sasahira N, Nakai Y, Kogure H, Sasaki T, Hirano K, Tada M, Koike K (2011) Endoscopic transpapillary gallbladder drainage with replacement of a covered self-expandable metal stent. World J Gastrointest Endosc 3(2):46–48

    Article  Google Scholar 

Download references


We thank Dr. Rajnish Mishra (Swedish Medical Center) for his technical expertise with endoscopic transpapillary stenting.

Author information

Authors and Affiliations



As per the guidelines of the International Committee of Medical Journal Editors (ICMJE), all authors listed above have met the appropriate criteria to be listed as an author. Study conception and design was performed by Dr. Danielle Hayes and Dr. Sean Wells. Acquisition of data, analysis, and interpretation of data were performed by Dr. Danielle Hayes and Dr. Gary Lucas. Drafting of manuscript and critical revision of manuscript was performed by Dr. Danielle Hayes, Dr. Gary Lucas, Dr. Sean Wells, Dr. Bryce French, and Dr. Andrew Discolo.

Corresponding author

Correspondence to Danielle Hayes.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This article does not contain any studies with human participants; therefore informed consent was not obtained.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hayes, D., Lucas, G., Discolo, A. et al. Endoscopic transpapillary stenting for the management of acute cholecystitis. Langenbecks Arch Surg 405, 191–198 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: