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

Abstract

Background and study aims: Endoscopic transpapillary gallbladder stenting (ETGS) can be a bridging therapy to elective cholecystectomy or a permanent gallbladder drainage in patients with symptomatic gallbladder disease who are unfit for surgery or have cholecystectomy deferral. We evaluated the intermediate to long-term outcomes of ETGS in these groups. Patients and methods: We retrospectively reviewed 234 patients (acute cholecystitis=147), who were unfit for surgery(n=50) or had deferred cholecystectomy(n=184), and all underwent ETGS between 2012-2021. A 7-Fr,15-cm double pigtail plastic stent was placed for ETGS without scheduled stent exchange. Biliary event (cholecystitis and cholangitis)-free rates were determined at the 6-month, 1-year and 2-year follow-up periods. Results: Technical and clinical success rates were 84.6%(198/234) and 97.4%(193/198), respectively. Kaplan-Meier analysis(n=193) showed a biliary event-free rate of 99% [95% confidence interval (CI),0.95-1.00] at 6 months, 92% [95%CI,0.87-0.97] at 1 year and 76% (95%CI,0.65-0.93) after 2 years during the median follow-up period of 564 days(200-3001 days). Conclusions: Endoscopic transpapillary gallbladder stenting is an effective biliary drainage that should be considered in selected cases with common bile duct stone whose cholecystectomy could not be performed or deferred. Biliary event-free rate was 99% at 6 months and remained 92% at 1 year and 76% after 2-year follow-ups.

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

“…A retrospective monocentric study reported the outcome of 234 patients who underwent TGBD with a single 7 French/15 cm DPS, without scheduled stent exchanges, with a median follow-up period of 564 days (range 200-3001 days). The authors reported a biliary event-free rate of 99% at 6 months, 92% at 1 year, and 76% at ≥2 years, supporting the use of TGBD as definitive treatment in high-risk patients due to a favorable biliary event-free rate at 2 years [52]. Another retrospective study including 49 TGBD reported a long-term clinical success (i.e., no acute cholecystitis recurrence; death or re-interventions at 6 months) of 95.9% (47/49) [25].…”

Efficacy and safety of double endoscopy combined with exploration in the treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis

“…These results suggest that advanced age alone should not be a contraindication for LC + LCBDE surgery. Furthermore, studies [ 25 – 30 ] also reported a special intraoperative technique as follows: after the continuous or intermittent suture of the incision site on the CBD was completed, intermittent suture should routinely be added to the surface of this site. This may help reduce tension, which could serve as a reason for reduced biliary leakage [ 31 , 32 ].…”

A Review on Endoscopic Management of Acute Cholecystitis: Endoscopic Ultrasound-Guided Gallbladder Drainage and Endoscopic Transpapillary Gallbladder Drainage

“…Over a median follow-up period of 564 days, Kaplan-Meier analysis revealed biliary event-free rates of 99% at 6 months, 92% at 1 year, and 76% at ≥2 years. These studies highlight the effectiveness of ETP-GBD as a biliary drainage method for selected patients, especially those unable to undergo cholecystectomy or with deferred cholecystectomy plans [26].…”

“…Complications of ETP-GBD include stent migration or occlusion, pancreatitis, postsphincterotomy bleeding, gallbladder injury or perforation, cystic duct injury with potential bile leak, postprocedural pain, pericholecystic fluid collection, and recurrent cholecystitis [6,26,27]. One study found that the cystic duct injury complication had a significant correlation with failure to complete the procedure successfully (Odds ratio [OR] of 11, 95% confidence interval [CI]-3.9-29) [25].…”