Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of46 elderly patients aged 65 years or older

Abstract

BackgroundEndoscopic transpapillary pernasal gallbladder drainage and endoscopic gallbladder stenting (EGS) have recently been reported to be useful in patients with acute cholecystitis for whom a percutaneous approach is contraindicated. The aim of this study was to evaluate the efficacy of permanent EGS for management of acute cholecystitis in elderly patients who were poor surgical candidates.MethodsWe retrospectively studied 46 elderly patients aged 65 years or older with acute cholecystitis who were treated at Japan Labour Health and Welfare Organization Niigata Rosai Hospital. In 40 patients, acute cholecystitis was diagnosed by transabdominal ultrasonography and computed tomography, while 6 patients were transferred from other hospitals after primary management of acute cholecystitis. All patients underwent EGS, with a 7Fr double pig-tail stent being inserted into the gallbladder. If EGS failed, percutaneous transhepatic gallbladder drainage or percutaneous transhepatic gallbladder aspiration was subsequently performed. The main outcome measure of this study was the efficacy of EGS.ResultsPermanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis. The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13). In 30 of these 31 patients (96.7%), there was no recurrence of cholecystitis and 29 patients (93.5%) remained asymptomatic until death or the end of the study period (after 1 month to 5 years).ConclusionsEGS can be effective for elderly patients with acute cholecystitis who are poor surgical candidates and can provide a solution for several years.

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

“…In cystic duct cannulation, the guidewire maneuver is difficult because of the corkscrew shape and narrowness of the cystic duct, as well as the presence of the spiral valve of Heister. In addition, the cystic duct may show stricture or obstruction in acute cholecystitis [7]. In the present case, cystic duct stricture and tortuosity were also found in the cholecystogram (Fig.…”

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

“…Several investigators have reported that ETGBD is effective and safe for patients with acute cholecystitis (6)(7)(8)17) and that EGBS is one of the promising alternative treatment options (9)(10)(11)(12)(13)(14)(15)(16)(17). In patients with concomitant unresectable cancer, it is important to control infectious diseases, including acute cholecystitis.…”

“…Cholecystectomy is generally a safe procedure, but the surgical risk is high in patients with severe medical or surgical comorbidities (3). In such high-risk patients, percutaneous der stenting (EGBS) is a promising alternative treatment option for critically ill patients with symptomatic acute cholecystitis (10)(11)(12)(13)(14)(15)(16)(17).…”

Late onset pancreatitis 6 months after endoscopic transpapillary gallbladder stenting for acute cholecystitis

“…Late onset pancreatitis 6 months after endoscopic transpapillary gallbladder stenting for acute cholecystitis Recently, endoscopic transpapillary gallbladder stenting (ETGS) has been proposed as an alternative to percutaneous transhepatic gallbladder drainage in patients with severe critical illness, particularly in the presence of coagulopathy or thrombocytopenia. [1][2][3][4][5] Although ETGS is reported to be a safe and effective procedure, little information is available regarding its long-term follow-up results and delayed adverse events. 2,3 Herein, we report the case of a patient who developed late onset pancreatitis following ETGS for acute cholecystitis.…”

“…[1][2][3][4][5] Although ETGS is reported to be a safe and effective procedure, little information is available regarding its long-term follow-up results and delayed adverse events. 2,3 Herein, we report the case of a patient who developed late onset pancreatitis following ETGS for acute cholecystitis.…”