Risk factors for cholecystitis after stent placement in patients with distal malignant biliary obstruction

Abstract

Background /PurposeLimited data are available for acute cholecystitis after Self‐Expandable Metallic Stent (SEMS) placement in patients with malignant distal biliary obstruction. We aimed to identify risk factors for cholecystitis.MethodsThis was a retrospective, single‐center study of 280 patients (336 stents) who received endoscopic SEMS placement between May 2005 and April 2016. Clinical records were used to perform risk factor analyses.ResultsOf 336 SEMS placement procedures, 25 (7.4%) led to development of cholecystitis. Logistic regression analysis revealed three independent risk factors: covered SEMS (P = .014), tumor involvement to the cystic duct (P = .017), and presence of gallstones (P = .022). Median time to cholecystitis onset was shorter with covered SEMS than with uncovered SEMS (P = .034), and in patients with pancreatic cancer compared to those with other cancers (P = .001). Severe cholecystitis developed within 30 days after covered SEMS placement in three patients with pancreatic cancer without tumor involvement to the cystic duct.ConclusionsUse of covered SEMS might be a risk factor for cholecystitis onset within 30 days after placement. Clinicians should be aware of the risk for severe cholecystitis after covered SEMS placement, even if the tumor does not invade the cystic duct.

EUS-guided gallbladder drainage and subsequent peroral endoscopic cholecystolithotomy: A tool to reduce chemotherapy discontinuation in neoplastic patients?

“…POEC-CL has been explored in an initial proof-of-concept series of 5 to 25 cases, with a very high rate of technical success (88%-100%) and a low rate of adverse events (0%-3.84%). [6][7][8][9][10][11] This possibility pushes EUS-GBD beyond AC palliation in patients unfit for surgery, offering a potentially "curative" option in all patients in whom surgery is undesirable.…”

“…In this scenario, AC might be an expected adverse event of local cancer invasion or palliative procedures (eg, SEMS placement). 7,8 An eventual surgical treatment can expose these patients to a discontinuation or delay in chemotherapy that could significantly affect their prognosis. In another elderly, frail, and comorbid patient with a severe form of myeloprolierative disease, the procedure resulted in a dramatic improvement of severe septic shock.…”

Usefulness of half‐covered metallic stent placement in preventing acute cholecystitis complication in pancreatic cancer‐induced distal biliary stricture

“…[10][11][12][13][14][15][16][17] Takinami et al reported that CSEMS is an important risk factor of acute cholecystitis. 18 Acute cholecystitis development needs some intervention procedures, such as cholecystectomy or percutaneous drainage, which could be fatal. Isayama et al previously described that cholecystitis development is not related to the type of metallic stent but the presence of tumor invasion into the cystic duct orifice.…”

“…Takinami et al . reported that CSEMS is an important risk factor of acute cholecystitis 18 . Acute cholecystitis development needs some intervention procedures, such as cholecystectomy or percutaneous drainage, which could be fatal.…”

Endoscopic ultrasound-guided gallbladder drainage after real-time assessment of cystic duct exclusion following biliary placement of an uncovered metal

“…Obstructive cholecystitis may complicate around 15 % of SEMS placements [2]. Its occurrence seems unrelated to whether the SEMS is covered or uncovered [3], and to be favored by neoplastic infiltration of the cystic duct [2,4]. Although E-Videos ▶ Fig.…”