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

Published:January 13, 2023DOI:https://doi.org/10.1016/j.gie.2023.01.009
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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

      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)
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