Efficacy and Safety of Endoscopic Gallbladder Stenting for Acute Cholecystitis in Patients with Concomitant Unresectable Cancer

Abstract

Objective Endoscopic gallbladder stenting (EGBS) is an alternative treatment option for high-risk surgical patients with acute cholecystitis. However, there are no reports focusing on EGBS in patients with concomitant unresectable cancer. The aim of this study was thus to evaluate EGBS in such patients. Methods Twenty-two consecutive patients with acute cholecystitis and unresectable cancer were enrolled between September 2010 and December 2014. Their median age was 74.5 years (range: 51-95). Thirteen patients were men and nine were women. The primary cancers of the patients were biliary tract cancer (9), pancreas cancer (9), lung cancer (2), gastric cancer (1), and colon cancer (1). The causes of cholecystitis were calculus cholecystitis (7), obstruction by malignant tumor (13), and obstruction by fully covered stent (2). Results EGBS was successfully performed in 17 patients (77.2%). The technical success rates for calculus cholecystitis, obstruction by malignant tumor, and obstruction by fully covered stent were 85.7% (6/7), 69.2% (9/13), and 100% (2/2), respectively. No complications were observed. Percutaneous transhepatic gallbladder drainage was conducted on two patients in whom EGBS had failed and then we performed EGBS by a rendezvous approach. Of the 19 patients in whom we finally deployed EGBS, the median follow-up period was 229 days (range: 14-880 days). A recurrence of acute cholecystitis occurred in three (15.7%) patients 14, 130, and 440 days after EGBS placement. The rates of recurrence of cholecystitis at one and two years were 10.5% and 18.7%, respectively. Conclusion Our study demonstrated that EGBS is a safe and effective method for acute cholecystitis in patients with concomitant unresectable cancer.

Comparable efficacy of endoscopic transpapillary gallbladder drainage and percutaneous transhepatic gallbladder drainage in acute cholecystitis

“…The complications typically associated with ETGBD are post-ERCP pancreatitis, perforation of the cystic duct, and cholangitis. The rate of complications is reported to be 0 % to 16 % 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 , which is similar to our results. Two patients developed mild pancreatitis after ETGBD.…”

“…There were no significant differences between ETGBD and PTGBD with respect to decrease in WBC count and serum CRP levels after gallbladder drainage. Reportedly, ETGBD is a practical and effective alternative to PTGBD 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 . However, it has not been established as a standard treatment owing to technical difficulty 5 .…”

“…However, it cannot be performed in patients with thrombocytopenia, coagulation disorders, massive ascites, or those taking anticoagulants or antiplatelet drugs. There are several reports on the usefulness and safety of endoscopic transpapillary gallbladder drainage (ETGBD) including endoscopic nasogallbladder drainage (ENGBD) 6 7 8 9 10 11 12 13 and endoscopic gallbladder stenting (EGBS) in patients with acute cholecystitis 14 15 16 17 18 19 20 21 . However, there are few studies comparing the efficacy of ETGBD and PTGBD in the treatment of acute cholecystitis.…”

Hybrid procedure combining endoscopic gallbladder lavage and internal drainage with elective cholecystectomy for acute cholecystitis: A prospective pilot study (The BLADE study)

“…11 However, spontaneous drainage through EGBS does carry the risk of stent occlusion as a result of the high viscosity of the drained biliary contents, with previous research reporting EGBS placement after cholecystitis resolution with external drainage. 15,16 Our gallbladder drainage procedure is unique in this way, providing both gallbladder irrigation and stenting during the same endoscopic intervention, thereby providing the combined benefits of both internal and external drainage.…”

Conversion of Percutaneous Cholecystostomy to Endoscopic Gallbladder Stenting by Using the Rendezvous Technique

“…The success rate of the procedure was 100% (5 of 5) and was higher than that of emergent ETGS (77.5%, 31 of 40). Hatanaka et al reported on 2 patients with unresectable cancer who had undergone PC because of failed ETGS, and then underwent a successful ETGS with a rendezvous approach [8]. During the rendezvous procedure, a PC-placed guidewire was grasped at the tip of the duodenoscope; then, the duodenoscope and wire were withdrawn.…”