Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis using Two Gallbladder Stents (Dual Gallbladder Stenting)

Abstract

Background/Aims: Endoscopic transpapillary gallbladder drainage (ETPGBD) is gaining popularity for the management of acute cholecystitis (AC) in high-risk patients. However, the stents placed during the procedure are not immune to obstruction. Here we describe a novel technique of stenting with two transpapillary stents and evaluate its technical feasibility, safety, and efficacy in AC. Methods: A retrospective analysis of all patients undergoing ETPGBD using dual stents for AC at our institution between November 1, 2017 and August 31, 2020 was conducted. We abstracted patient data to evaluate technical and clinical success, adverse events, and long-term outcomes. Two stents were placed either during the index procedure or during an interval procedure performed 4-6 weeks after the index procedure. Results: A total of 21 patients underwent ETPGBD with dual stenting (57.14% male, mean age: 62.14±17.21 years). The median interval between the placement of the first and the second stents was 37 days (range: 0-226 days). Technical and clinical success rates were 100%, with a recurrence rate of 4.76% (n=1) and adverse event rate of 9.52% (n=2) during a mean follow-up period of 471.74±345.64 days (median: 341 days, range: 55-1084 days). Conclusions: ETPGBD with dual gallbladder stenting is a safe and effective technique for long-term gallbladder drainage in non-surgical candidates. Larger controlled studies are needed to validate our findings for the widespread implementation of this technique. Clin Endosc 2021 May 31. [Epub ahead of print]

Intermediate- to long-term outcomes of endoscopic transpapillary gallbladder stenting in patients with gallstone-related disease: a 10-year single-center experience

“…In a retrospective US study by Storm et al, recurrent cholecystitis occurred in 2 of 18 patients with a single stent placement [12]; no recurrence was noted in patients with double stent placement (n = 31). However, recurrence was reported in 4.8 % with acute cholecystitis with double gallbladder stents (6-7 Fr) in a retrospective study by Sobani et al (n = 21) [18]. Based on these findings, ETGS with placement of a 7-Fr, double-pigtail, plastic stent is effective at preventing recurrent biliary events in the intermediate-to-long term for these patients.…”

Assessment of Gallbladder Drainage Methods in the Treatment of Acute Cholecystitis: A Literature Review

“…One of the main concerns after successful stent placement is the possibility of stent occlusion and subsequent recurrent inflammation. Due to this issue, certain authors advocate the placement of two stents rather than only one [80].…”

Endoscopic Gallbladder Drainage: A Comprehensive Review on Indications, Techniques, and Future Perspectives

“…Alternatively, a nasogallbladder drainage tube can be placed instead of a plastic stent for temporary drainage [22,23]. In some cases, it may be necessary to dilate a stenosed cystic duct with mechanical dilators or a small caliber balloon to allow stent insertion, especially on rare occasions where more than one stent is planned to be placed [24]. However, placement of a second transcystic pigtail stent may be successful in less than half of attempted cases, according to a retrospective report on 51 TGBD patients [25].…”

“…or a small caliber balloon to allow stent insertion, especially on rare occasions where mor than one stent is planned to be placed [24]. However, placement of a second transcyst pigtail stent may be successful in less than half of attempted cases, according to a retro spective report on 51 TGBD patients [25].…”