Clin Endosc.  2022 Nov;55(6):784-792. 10.5946/ce.2021.244.

The feasibility of percutaneous transhepatic gallbladder aspiration for acute cholecystitis after self-expandable metallic stent placement for malignant biliary obstruction: a 10-year retrospective analysis in a single center

• Ohno A
• Fujimori N
• Kaku T
• Hijioka M
• Kawabe K
• Harada N
• Nakamuta M
• Oono T
• Ogawa Y

• KMID: 2536079
• DOI: http://doi.org/10.5946/ce.2021.244

Abstract

Background/Aims
Patients with acute cholecystitis (AC) after metallic stent (MS) placement for malignant biliary obstruction (MBO) have a high surgical risk. We performed percutaneous transhepatic gallbladder aspiration (PTGBA) as the first treatment for AC. We aimed to identify the risk factors for AC after MS placement and the poor response factors of PTGBA.
Methods
We enrolled 401 patients who underwent MS placement for MBO between April 2011 and March 2020. The incidence of AC was 10.7%. Of these 43 patients, 37 underwent PTGBA as the first treatment. The patients’ responses to PTGBA were divided into good and poor response groups.
Results
There were 20 patients in good response group and 17 patients in poor response group. Risk factors for cholecystitis after MS placement included cystic duct obstruction (p<0.001) and covered MS (p<0.001). Cystic duct obstruction (p=0.003) and uncovered MS (p=0.011) demonstrated significantly poor responses to PTGBA. Cystic duct obstruction is a risk factor for cholecystitis and poor response factor for PTGBA, whereas covered MS is a risk factor for cholecystitis and an uncovered MS is a poor response factor of PTGBA for cholecystitis.
Conclusions
The onset and poor response factors of AC after MS placement were different between covered and uncovered MS. PTGBA can be a viable option for AC after MS placement, especially in patients with covered MS.

Keyword

Acute cholecystitis; Biliary metallic stent; Gallbladder drainage; Percutaneous gallbladder aspiration; Uncovered metallic stent

Figure

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  Fig. 1. Flow chart of patients enrolled in the study. SEMS, self-expandable metallic stent; AC, acute cholecystitis; ERCP, endoscopic retrograde cholangiopancreatography; EUS-GBD, endoscopic ultrasonography-guided gallbladder drainage; PTGBA, percutaneous transhepatic gallbladder aspiration; PTGBD, percutaneous transhepatic gallbladder drainage; ETGBD, endoscopic transpapillary gallbladder drainage.

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  Fig. 2. Comparison with the median time from self-expandable metallic stent (SEMS) placement to the onset of acute cholecystitis between uncovered (U)-SEMS and covered (C)-SEMS groups.

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  Fig. 3. Treatment strategy for high-risk surgical patients with acute cholecystitis after biliary metallic stent. PTGBA, percutaneous transhepatic gallbladder aspiration; PTGBD, percutaneous transhepatic gallbladder drainage; EUS-GBD, endoscopic ultrasonography-guided gallbladder drainage.

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