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Endoscopic transpapillary stenting for the management of acute cholecystitis

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Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

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

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Authors and Affiliations

  1. Department of Surgery, Swedish Medical Center - First Hill, 747 Broadway, Heath Tenth, Seattle, WA, 98122, USA

    Danielle Hayes, Gary Lucas, Andrew Discolo, Bryce French & Sean Wells

Authors
  1. Danielle Hayes
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  2. Gary Lucas
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  3. Andrew Discolo
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  4. Bryce French
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  5. Sean Wells
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Contributions

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.

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Correspondence to Danielle Hayes.

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Hayes, D., Lucas, G., Discolo, A. et al. Endoscopic transpapillary stenting for the management of acute cholecystitis. Langenbecks Arch Surg 405, 191–198 (2020). https://doi.org/10.1007/s00423-020-01870-7

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  • DOI: https://doi.org/10.1007/s00423-020-01870-7

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