Surgical outcomes of ERCP-guided transpapillary gallbladder drainage versus percutaneous cholecystostomy as bridging therapies for acute cholecystitis followed by interval cholecystectomy

Abstract

Background: Select patients with acute cholecystitis (AC) are not candidates for index cholecystectomy. We compared the influence of ERCP-guided transpapillary gallbladder drainage (ERGD) versus percutaneous cholecystostomy (PC) on delayed cholecystectomy outcomes. Methods: Consecutive patients undergoing ERGD or PC for AC from January 2007 to October 2018 were included. Primary outcome was the rate of conversion to open cholecystectomy and perioperative complications in groups.Results: The study included 52 patients with ERGD and 140 with PC prior to cholecystectomy (median 68 days [IQR: 47-105.5]). Technical success was higher in the PC group (100% vs 91%; P = 0.0004).There was a nonsignificant trend to lower postoperative complications with ERGD (30.7% vs 43.5%; P = 0.07). No difference in conversion to open cholecystectomy OR: 1.5 (95% CI: 0.68-3.65; P = 0.28) or severity of complications (Clavien-Dindo grade >2) OR: 0.60, (95% CI: 0.19-1.87; P = 0.38) was noted between the ERGD and PC groups. PC was associated with higher rates of unplanned repeat intervention (16.4% vs 7.7%; P = 0.02). Conclusion:ERGD is suitable for patients with AC who is candidates for delayed cholecystectomy and should be considered for gallbladder drainage in patients with concomitant choledocholithiasis or cholangitis who require ERCP.

Use of a double-lumen cytology brush catheter to allow double-guidewire technique for endoscopic interventions

“…For example, a recent study of ERCP-guided gallbladder drainage demonstrated that almost a third of patients undergo a second procedure to upsize and add a second stent when only a single stent is placed. 5 Another example is to mitigate the risk of iatrogenic cholecystitis when a fully covered metal stent is placed across the common bile duct and a low-lying cystic duct insertion is present. In such a scenario, we have attempted to place 2 protective stents into the gallbladder using this technique, followed by deploying a parallel, fully covered metal stent (Fig.…”

Endoscopic therapies for gallbladder drainage

“…A comparative study following these approaches demonstrated no statistically significant difference in operative outcomes for subsequent CCY, including conversion to open surgery or severity of operative AEs. 49…”

Endoscopic transpapillary gallbladder drainage for the management of acute calculus cholecystitis patients unfit for urgent cholecystectomy

“…Compared with PC, ETGBD may provide more physiological drainage and be more cost-effective by shortening hospital stays, decreasing patient pain, and by being a more tolerable procedure [23]. As a bridging option to subsequent cholecystectomy, ETGBD had lower rates of unplanned repeated interventions compared with PC without affecting surgical outcomes [24]. In addition, concomitant CBD stones can be removed during the same session.…”