Endoscopic transpapillary gallbladder stenting using a newly designed plastic stent for acute cholecystitis

Abstract

Background and study aims Biliary plastic stents are generally substituted for gallbladder stents in endoscopic transpapillary gallbladder stenting (EGBS), there is no sufficient evidence about what type of plastic stent is suitable. We examined outcomes of EGBS using standard biliary stents and a novel stent for acute cholecystitis and evaluated the efficacy of the novel stent. Patients and methods Seventy patients with acute cholecystitis in whom EGBS was performed were evaluated retrospectively. We performed EGBS in 23 patients using the novel stent (novel stent group) and 47 patients using standard biliary stents (pigtail: 35, straight: 12) (control group). In the two groups, we examined outcomes of EGBS. Results There were no significant differences in patient backgrounds or rates of technical success, clinical success, or early adverse events (AE) between the novel stent group and the control groups. However, rates of late AEs were 4.3 % in the novel stent group (liver abscess: 1) and 40.4 % in the control group (stent migration: 15, recurrence of cholecystitis: 4), indicating a significantly higher rate in the control group (P = 0.004). The rate of stent migration was significantly higher in the control group (P = 0.006). Multivariate analysis identified a straight type stent as the risk factor for stent migration (odds ratio: 8.81, 95 % confidence interval: 1.66 – 46.83). Conclusions The novel stent had significantly lower rates of late AEs and stent migration. Thus, for long-term stent placement, the novel stent was more effective than traditional biliary stents.

The Influence of Pre-Procedural Imaging and Cystic Duct Cholangiography on Endoscopic Transpapillary Gallbladder Drainage in Acute Cholecystitis

“…Finally, we placed a plastic stent or naso-drainage catheter for ETGBD. The stents used for endoscopic gallbladder stenting (EGBS) were as follows: a new stent designed for EGBS (GBest-N stent; Hanaco Medical Co., Saitama, Japan) [ 12 ], double-pigtail stents (Advanix; Boston Scientific, Natick, Massachusetts, United States; SET-ERBD-72 stent; Hanaco Medical Co., Saitama, Japan; CX-T stents; Gadelius Medical, Tokyo, Japan; PBD-203 stent; Olympus Medical Systems, Tokyo, Japan; and Zimmon biliary stent; COOK Japan, Tokyo, Japan), and a straight-type stent (Through pass; Gadelius Medical, Tokyo, Japan). In cases where ETGBD could not be performed successfully, we usually performed endoscopic biliary stenting (EBS) or 6-Fr endoscopic nasobiliary drainage (ENBD) for bile duct drainage during the same ERCP session.…”

Endoscopic therapies for gallbladder drainage

“…22 Some investigators also recommend advancing a catheter/ sphincterotome or a balloon/graduated dilator over the guidewire across the cystic duct and into the gallbladder to straighten and dilate the cystic duct before stent insertion. 14,16,23 Moreover, an existing PC can be converted to an ET-GBD whereby biliary guidewire access can be achieved from either an anterograde/rendezvous or retrograde approach. 24,25 There is no consensus regarding the preferred stent selection for transpapillary gallbladder drainage.…”

Endoscopic transpapillary gallbladder stent placement in the presence of uncovered biliary metal stents using a through-the-mesh technique

“…For these patients, endoscopic transpapillary gallbladder drainage (ETGBD) is the treatment of choice. [2][3][4][5] Furthermore, ETGBD may have another advantage over PTGBD: Prompt internal drainage can be achieved by endoscopic transpapillary gallbladder stent placement. [2][3][4] However, ETGBD is technically challenging, and access into the gallbladder through the cystic duct may be difficult, especially when the previously placed SEMS overlaps the orifice of the cystic duct (OCD).…”