Clin Endosc.  2024 Sep;57(5):647-655. 10.5946/ce.2023.284.

Prophylactic endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis induced after metallic stent placement for malignant biliary strictures: a retrospective study in Japan

• Kozakai F
• Kanno Y
• Koshita S
• Ogawa T
• Kusunose H
• Sakai T
• Yonamine K
• Miyamoto K
• Okano H
• Matsuoka Y
• Hosokawa K
• Sumiya H
• Ito K

• KMID: 2559216
• DOI: http://doi.org/10.5946/ce.2023.284

Abstract

Background/Aims
Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study evaluated the efficacy of prophylactic gallbladder stents (GBS) during SEMS placement.
Methods
Among 158 patients who underwent SEMS placement for malignant biliary strictures between January 2018 and March 2023, 30 patients who attempted to undergo prophylactic GBS placement before SEMS placement were included.
Results
Technical success was achieved in 21 cases (70.0%). The mean diameter of the cystic duct was more significant in the successful cases (6.5 mm vs. 3.7 mm, p<0.05). Adverse events occurred for 7 patients (23.3%: acute pancreatitis in 7; non-obstructive cholangitis in 1; perforation of the cystic duct in 1 with an overlap), all of which improved with conservative treatment. No patients developed AC when the GBS placement was successful, whereas 25 of the 128 patients (19.5%) without a prophylactic GBS developed AC during the median follow-up period of 357 days (p=0.043). In the multivariable analysis, GBS placement was a significant factor in preventing AC (hazard ratio, 0.61; 95% confidence interval, 0.37–0.99; p=0.045).
Conclusions
GBS may contribute to the prevention of AC after SEMS placement for malignant biliary strictures.

Keyword

Endoscopic biliary drainage; Endoscopic transpapillary gallbladder drainage; Gallbladder stent; Malignant biliary strictures; Percutaneous transhepatic gallbladder drainage

Figure

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  Fig. 1. Plastic stent for the gallbladder, IYO stent (Gadelius Medical K.K.). The stent is 5 Fr with a 10-cm long straight section. The distal end is coiled in a multi-layered pigtail configuration, allowing it to be placed and secured in gallbladders of various shapes and sizes. In addition, side holes are spirally opened at 5-mm intervals, which are expected to prevent stent occlusion.

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  Fig. 2. Gallbladder stent placement in combination with a biliary metallic stent for malignant biliary strictures. After confirming the presence of a biliary stricture and cystic duct by cholangiography (A), a guidewire was placed in the gallbladder (B), and the IYO stent was inserted along the wire (C). A covered self-expandable metallic stent was placed into the biliary stricture afterward (D, E).

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  Fig. 3. Flowchart of this study. SEMS, self-expandable metallic stent; CD, cystic duct; GBS, gallbladder stent.

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  Fig. 4. Kaplan-Meier analysis of the cumulative rate of recurrent obstruction (RBO) (A) and overall survival (OS) (B). There was no statistical difference in time to RBO and OS between the GBS (+) and GBS (–) groups (370 days vs. 291 days; p=0.898; 357 days vs. 309 days, p=0.979). GBS, gallbladder stent.

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