Clin Endosc.  2021 Jul;54(4):589-595. 10.5946/ce.2020.136.

Cholecystitis after Placement of Covered Self-Expandable Metallic Stents in Patients with Distal Malignant Biliary Obstructions

• Watanabe M
• Okuwaki K
• Woo J
• Kida M
• Imaizumi H
• Iwai T
• Yamauchi H
• Kaneko T
• Hasegawa R
• Kurosu T
• Minato N
• Haradome H
• Koizumi W

• KMID: 2518863
• DOI: http://doi.org/10.5946/ce.2020.136

Abstract

Background/Aims
Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement.
Methods
We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively.
Results
The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis.
Conclusions
The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.

Keyword

Cholecystitis; Endoscopic retrograde cholangiopancreatography; Malignant biliary obstruction; Risk factors; Self-expandable metallic stents

Figure

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  Fig. 1. Flow of contrast agent into the gallbladder. Flow of the contrast agent into the gallbladder was deemed positive when the contrast agent was observed flowing into the gallbladder or cystic duct on fluoroscopic imaging in endoscopic retrograde cholangiopancreatography.

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  Fig. 2. Tumor invasion to the cystic artery. Tumor invasion to the cystic artery (arrow) was visible on multidetector computed tomography.

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  Fig. 3. Tumor involvement to the orifice of cystic duct. Multidetector computed tomography (A) shows cholangiocarcinoma of the common bile duct (*) and contrast enhancement at the cystic duct (arrow). Infiltration of the tumor from the bile to the cystic duct was visible on intraductal ultrasonography (arrowheads) (B).

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