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

Published:March 30, 2021DOI:

      Background and Aims

      Select patients with acute cholecystitis (AC) are poor candidates for cholecystectomy. ERCP-guided transpapillary gallbladder (GB) drainage (ERGD) is one modality for nonoperative management of AC in these patients. Our primary aim was to evaluate long-term success of destination ERGD. Secondary aims were the rate of technical and clinical success, number of repeat procedures, rate of adverse events, and risk factors for recurrent AC.


      Consecutive patients with AC who were not candidates for cholecystectomy underwent ERGD with attempted transpapillary 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 GB and clinical success as resolution of AC symptoms with discharge from the hospital.


      Long-term success was achieved in 95.9% of patients (47/49), technical success in 96% (49/51), and clinical success 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 1 GB stent placed (P = .13), and more repeat procedures were performed when a single stent was placed (P = .045).


      ERGD with transpapillary GB double-pigtail stent placement is a 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.

      Graphical abstract


      AC (acute cholecystitis), ERGD (ERCP-guided transpapillary gallbladder drainage), GB (gallbladder)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Csikesz N.G.
        • Singla A.
        • Murphy M.M.
        • et al.
        Surgeon volume metrics in laparoscopic cholecystectomy.
        Dig Dis Sci. 2010; 55: 2398-2405
        • Wakabayashi G.
        • Iwashita Y.
        • Hibi T.
        • et al.
        Tokyo guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos).
        J Hepatobil Pancreat Sci. 2018; 25: 73-86
        • Thulstrup A.M.
        • Sorensen H.T.
        • Vilstrup H.
        Mortality after open cholecystectomy in patients with cirrhosis of the liver: a population-based study in Denmark.
        Eur J Surg. 2001; 167: 679-683
        • Sandblom G.
        • Videhult P.
        • Crona Guterstam Y.
        • et al.
        Mortality after a cholecystectomy: a population-based study.
        HPB (Oxford). 2015; 17: 239-243
        • Leveau P.
        • Andersson E.
        • Carlgren I.
        • et al.
        Percutaneous cholecystostomy: a bridge to surgery or definite management of acute cholecystitis in high-risk patients?.
        Scand J Gastroenterol. 2008; 43: 593-596
        • Pannala R.
        • Petersen B.T.
        • Gostout C.J.
        • et al.
        Endoscopic transpapillary gallbladder drainage: 10-year single center experience.
        Min Gastroenterol Dietol. 2008; 54: 107-113
        • Iino C.
        • Shimoyama T.
        • Igarashi T.
        • et al.
        Comparable efficacy of endoscopic transpapillary gallbladder drainage and percutaneous transhepatic gallbladder drainage in acute cholecystitis.
        Endosc Int Open. 2018; 6: E594-E601
        • Mohan B.P.
        • Khan S.R.
        • Trakroo S.
        • et al.
        Endoscopic ultrasound-guided gallbladder drainage, transpapillary drainage, or percutaneous drainage in high risk acute cholecystitis patients: a systematic review and comparative meta-analysis.
        Endoscopy. 2020; 52: 96-106
        • Ogawa O.
        • Yoshikumi H.
        • Maruoka N.
        • et al.
        Predicting the success of endoscopic transpapillary gallbladder drainage for patients with acute cholecystitis during pretreatment evaluation.
        Can J Gastroenterol. 2008; 22: 681-685
        • Widmer J.
        • Alvarez P.
        • Sharaiha R.Z.
        • et al.
        Endoscopic gallbladder drainage for acute cholecystitis.
        Clin Endosc. 2015; 48: 411-420
        • Kaura K.
        • Bazerbachi F.
        • Sawas T.
        • et al.
        Surgical outcomes of ERCP-guided transpapillary gallbladder drainage versus percutaneous cholecystostomy as bridging therapies for acute cholecystitis followed by interval cholecystectomy.
        HPB (Oxford). 2020; 22: 996-1003
        • Cotton P.B.
        • Eisen G.M.
        • Aabakken L.
        • et al.
        A lexicon for endoscopic adverse events: report of an ASGE workshop.
        Gastrointest Endosc. 2010; 71: 446-454
        • Yuste R.T.
        • Garcia-Alonso F.J.
        • Sanchez-Ocana R.
        • et al.
        Safety and clinical outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents in patients with dwell time over one year.
        Ann Gastroenterol. 2019; 32: 514-521
        • Anderloni A.
        • Buda A.
        • Vieceli F.
        • et al.
        Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis.
        Surg Endosc. 2016; 30: 5200-5208
        • Saumoy M.
        • Tyberg A.
        • Brown E.
        • et al.
        Successful cholecystectomy after endoscopic ultrasound gallbladder drainage compared with percutaneous cholecystostomy: Can it be done?.
        J Clin Gastroenterol. 2019; 53: 231-235
        • Corral J.E.
        • Das A.
        • Krner P.T.
        • et al.
        Cost effectiveness of endoscopic gallbladder drainage to treat acute cholecystitis in poor surgical candidates.
        Surg Endosc. 2019; 33: 3567-3577
        • Kozarek R.A.
        Selective cannulation of the cystic duct at time of ERCP.
        J Clin Gastroenterol. 1984; 6: 37-40
        • Feretis C.B.
        • Manouras A.J.
        • Apostolidis N.S.
        • et al.
        Endoscopic transpapillary drainage of gallbladder empyema.
        Gastrointest Endosc. 1990; 36: 523-525
        • 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
        • Kjaer D.W.
        • Kruse A.
        • Funch-Jensen P.
        Endoscopic gallbladder drainage of patients with acute cholecystitis.
        Endoscopy. 2007; 39: 304-308
        • Ridtitid W.
        • Piyachaturawat P.
        • Teeratorn N.
        • et al.
        Single-operator peroral cholangioscopy cystic duct cannulation for transpapillary gallbladder stent placement in patients with acute cholecystitis at moderate to high surgical risk (with videos).
        Gastrointest Endosc. 2020; 92: 634-644
        • Larkin C.J.
        • Workman A.
        • Wright R.E.
        • et al.
        Radiation doses to patients during ERCP.
        Gastrointest Endosc. 2001; 53: 161-164

      Linked Article

      • Transpapillary gallbladder stent placement remains a challenge for endoscopists
        Gastrointestinal EndoscopyVol. 95Issue 5
        • Preview
          We read the study by Storm et al1 with interest. The authors evaluated the long-term efficacy of ERCP-guided transpapillary gallbladder drainage (ERGD) with a plastic double-pigtail stent for acute cholecystitis patients who were not candidates for surgery. They demonstrated that long-term success and technical success were achieved in 95.9% (47/49) and 96% (49/51) of patients, respectively. However, there are some existing issues worthy of discussion.
        • Full-Text
        • PDF
      • Endoscopic treatment of acute cholecystitis: Can transpapillary stent placement silence the LAMS?
        Gastrointestinal EndoscopyVol. 94Issue 4
        • Preview
          The development of acute cholecystitis has traditionally required surgical therapy, with percutaneous drainage by interventional radiologists reserved for patients deemed to be nonsurgical candidates. In this issue of Gastrointestinal Endoscopy, Storm et al1 add to the growing literature by, and experience of, endoscopists in the management of inflammatory gallbladder disease. They report on an observational cohort of 51 patients with acute cholecystitis treated over 11 years at a single institution with a mean follow-up time of a little over a year.
        • Full-Text
        • PDF