Research Article|Articles in Press

Prophylactic endoscopic gallbladder stenting for cholecystitis after covered metal stent placement for distal biliary obstruction

Published:January 13, 2023DOI:
      This paper is only available as a PDF. To read, Please Download here.


      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.


      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.


      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).


      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



      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

      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