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Abstract
Background and Aims
Acute cholecystitis is occasionally observed after biliary drainage using a covered
self-expandable metal stent (CSEMS) for distal biliary obstruction (DBO). Gallbladder
drainage prior to CSEMS placement may reduce cholecystitis. This study aimed to examine
the preventive effect of endoscopic gallbladder stenting (EGBS) on cholecystitis with
CSEMS.
Methods
We retrospectively analyzed patients with DBO who underwent CSEMS placement across
the orifice of the cystic duct between November 2014 and October 2021 and were negative
for cholecystitis on biliary drainage. Prophylactic EGBS was attempted before CSEMS
placement. The incidence of cholecystitis was compared between patients with and without
EGBS.
Results
A total of 286 patients (128 men; median age, 75 years) were included in this study.
EGBS was attempted in 32 patients before CSEMS placement, and technical success was
achieved in 24 (75%) patients. Adverse events were noted in three patients (9.4%;
penetration of cystic duct in one and acute pancreatitis in two). The cumulative incidence
of cholecystitis was significantly lower in patients with EGBS than in those without
EGBS (1 [4.2%] vs. 56 [21.4%]; p=0.045. In multivariable analysis, EGBS was a significant
protective factor against cholecystitis (hazard ratio, 0.11; 95% confidence interval,
0.01-0.79; p=0.028).
Conclusions
Although the transpapillary approach to the gallbladder is not easy for patients with
DBO, EGBS is effective in preventing cholecystitis associated with CSEMS.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
AEs (adverse events), CBD (common bile duct), CD (cystic duct), CSEMS (covered self-expandable metal stent), CT (computed tomography), DBO (distal biliary obstruction), EGBS (endoscopic gallbladder stenting), ETGBD (endoscopic transpapillary gallbladder drainage), EUS-GBD (endoscopic ultrasound-guided gallbladder drainage), PTGBA (percutaneous transhepatic gallbladder aspiration), PTGBD (percutaneous gallbladder drainage), SEMS (self-expandable metal stent)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
January 1,
2023
Received in revised form:
November 30,
2022
Received:
August 29,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Authors’ contributions
Conception and design: TI, TK
Performed endoscopic procedures and managed patient: TI, TK, KH, RN, KI, RA, HT, TS, TH, KT, and AK
Analysis and interpretation of the data: TI, TK and HY
Drafting of the article: TI
Critical revision of the manuscript for important intellectual content: TK, HY
Final approval of the manuscript: AK
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
