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Malik A, Malik MI, Amjad W, Javaid S. Efficacy of endoscopic trans-papillary gallbladder stenting and drainage in acute calculous cholecystitis in high-risk patients: a systematic review and meta-analysis. Ther Adv Gastrointest Endosc 2023; 16:26317745231192177. [PMID: 37664530 PMCID: PMC10469246 DOI: 10.1177/26317745231192177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/07/2023] [Indexed: 09/05/2023] Open
Abstract
Background and aims Acute calculous cholecystitis (ACC) represents about one-third of all surgical emergencies. The gold standard management of ACC is laparoscopic cholecystectomy. Although cholecystectomy is a safe procedure, it may be dangerous and contraindicated in patients with complex comorbidities. Endoscopic transpapillary gallbladder stenting (ETGBS) and drainage had been widely used to manage patients suffering from ACC with comorbidities. Methods We searched PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant studies assessing the use of ETGBS in patients suffering from ACC with various comorbidities. Risk of bias assessment was performed using the National Institues of Health (NIH) tool. We included the following outcomes: clinical success, technical success, late complications, and pancreatitis. Results We included seven studies that met our inclusion criteria. We found that the pooled proportion of clinical success, technical success, late complications, and pancreatitis was [91.3%, 95% confidence interval (CI) (86.8%, 95.9%)], [92.8%, 95% CI (89%, 96.5%)], [5.4%, 95% CI (2.9%, 7.9%)], and [3.5%, 95% CI (1.2%, 5.8%)], respectively. Conclusion We found that an ETGBS was an effective and well-tolerated method for the treatment of cholecystitis, especially in high-risk individuals.
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Affiliation(s)
- Adnan Malik
- Mountain Vista Medical Center, 1301 S Crismon Rd, Mesa, AZ 85209, USA
| | - Muhammad Imran Malik
- Department of Hematology specialty, Airedale general hospital, West Yorkshire, England
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2
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Gallstone Disease in Cirrhosis-Pathogenesis and Management. J Clin Exp Hepatol 2022; 12:551-559. [PMID: 35535063 PMCID: PMC9077239 DOI: 10.1016/j.jceh.2021.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022] Open
Abstract
Gallstones are more common in patients with cirrhosis of the liver, and the incidence increases with severity of liver disease. Pigment stones are the most frequent type of gallstones (GSs) in cirrhotics, and majority remain asymptomatic. Hepatitis C virus infection and nonalcoholic fatty liver disease are the underlying etiologies of liver diseases that most often associated with GSs. Multiple altered mechanisms in cirrhosis such as chronic hemolysis due to hypersplenism, reduced bile acid synthesis and transport, decreased cholesterol secretion, decreased apolipoprotein A-I and A-II secretion, gallbladder hypo-motility, autonomic dysfunction, and portal hypertension collectively lead to increased risk of lithogenesis. Asymptomatic GSs should be followed up closely and offered laparoscopic cholecystectomy once symptomatic in Child-Pugh class A and B patients. The model for the end-stage liver disease score is the best predictor of the outcome after cholecystectomy. In patients of Child-Pugh class C, conservative or minimally invasive approaches should be used to treat complications of GSs.
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Key Words
- ACLF, acute-on-chronic liver failure
- CBD, common bile duct
- CTP, Child-Pugh
- Child-Pugh class
- EPBD, Endoscopic papillary balloon dilatation
- EST, endoscopic sphincterotomy
- EUS, endoscopic ultrasound
- FXR, farnesoid X receptors
- GSs, Gallstones
- HBV, hepatitis B virus
- HCV, Hepatitis C virus
- IR, insulin resistance
- LC, laparoscopic cholecystectomy
- MELD, Model for end-stage liver disease
- NAFLD, non-alcoholic fatty liver disease
- NS 5A, non-structural protein 5A
- cirrhosis
- gallstone
- laparoscopic cholecystectomy
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3
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Inoue T, Yoshida M, Suzuki Y, Kitano R, Okumura F, Naitoh I. Long-Term Outcomes of Endoscopic Gallbladder Drainage for Cholecystitis in Poor Surgical Candidates: An Updated Comprehensive Review. J Clin Med 2021; 10:jcm10214842. [PMID: 34768361 PMCID: PMC8584655 DOI: 10.3390/jcm10214842] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/22/2022] Open
Abstract
Laparoscopic cholecystectomy is the standard and fundamental treatment of choice for acute cholecystitis; however, there are cases in which patients may be poor surgical candidates due to advanced age, comorbidities, and/or general condition. The rate of recurrent cholecystitis is high in patients who are not surgically treated; therefore, the prevention of recurrence in this patient population is an important subject of investigation in the management of cholecystitis. Although it has recently been reported that long-term stent placement by endoscopic gallbladder stenting or endoscopic ultrasound-guided gallbladder drainage may reduce the recurrence rate, its efficacy and safety remain controversial. Additionally, details surrounding the long-term stent management of these treatment methods should be further investigated. In this review, we summarize the updated evidence regarding the usefulness of long-term stent placement with endoscopic gallbladder stenting or endoscopic ultrasound-guided gallbladder drainage as a preventive measure for recurrence of cholecystitis and discuss issues that should be addressed in future studies.
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Affiliation(s)
- Tadahisa Inoue
- Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute 480-1195, Japan;
- Correspondence: ; Tel.: +81-561-62-3311; Fax: +81-561-63-3208
| | - Michihiro Yoshida
- Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (M.Y.); (I.N.)
| | - Yuta Suzuki
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, 5-161 Maehata-cho, Tajimi 507-8522, Japan; (Y.S.); (F.O.)
| | - Rena Kitano
- Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute 480-1195, Japan;
| | - Fumihiro Okumura
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, 5-161 Maehata-cho, Tajimi 507-8522, Japan; (Y.S.); (F.O.)
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (M.Y.); (I.N.)
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4
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Sobani ZA, Ling C, Rustagi T. Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis. Dig Dis Sci 2021; 66:1425-1435. [PMID: 32588249 DOI: 10.1007/s10620-020-06422-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023]
Abstract
The mainstay of management of acute cholecystitis has been surgical, with percutaneous gallbladder drainage in patients deemed high risk for surgical intervention. Endoscopic management of acute cholecytitis with transpapillary and transmural drainage of the gall bladder is emerging as a viable alternative in high-risk surgical patients. In this article, we discuss the background, current status, technical challenges and strategies to overcome them, adverse events, and outcomes of endoscopic transpapillary gallbladder drainage for management of acute cholecystitis.
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Affiliation(s)
- Zain A Sobani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of New Mexico, MSC10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Christina Ling
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of New Mexico, MSC10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Tarun Rustagi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of New Mexico, MSC10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
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Graham DS, Ito T, Lu M, Dinorcia J, Agopian VG, Farmer DG, Busuttil RW, Kaldas FM. Cholecystitis in Patients Undergoing Liver Transplantation: A Five-Year Analysis of Incidence, Causes, and Impact. Am Surg 2020; 86:1254-1259. [PMID: 33125269 DOI: 10.1177/0003134820964210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a paucity of data on cholecystitis in liver transplant candidates (LTC), including the incidence of the cholecystitis and the associated outcomes in this patient population. As such, this study examines the incidence of and factors associated with cholecystitis in the high-acuity LTC population, as well as the association between cholecystitis and graft and patient survival. Liver transplant candidates undergoing orthotopic liver transplantation (OLT) at a large transplant center from January 1, 2012 to December 31, 2016 were included in the initial analysis. Surgical pathology reports were examined for the presence of cholecystitis. Univariate analyses were performed to determine the association between patient factors and cholecystitis. Kaplan-Meier analyses and multivariate Cox proportional hazard models were performed to examine the association between cholecystitis and graft and patient survival. Of the 405 patients in the final study population, 267 (65.9%) had no cholecystitis, 21 (5.2%) had acute cholecystitis, and 117 (28.9%) had chronic cholecystitis. The presence of cholecystitis was associated with preoperative WBC, sepsis within 10 days prior to transplant, location prior to transplant, and total length of stay. While this study revealed no association between cholecystitis and graft or patient survival, it also suggests that cholecystitis is under-recognized in high-model end-stage liver disease (MELD) OLT candidates. Therefore, a high index of suspicion for cholecystitis may be helpful in caring for this vulnerable patient population; however, further studies must be performed to determine the optimal management of cholecystitis in these patients.
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Affiliation(s)
- Danielle S Graham
- Department of Surgery, University of California Los Angeles, CA, USA
| | - Takahiro Ito
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
| | - Michelle Lu
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
| | - Joseph Dinorcia
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
| | - Vatche G Agopian
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
| | - Douglas G Farmer
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
| | - Ronald W Busuttil
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
| | - Fady M Kaldas
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
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6
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Kim TH, Park DE, Chon HK. Endoscopic transpapillary gallbladder drainage for the management of acute calculus cholecystitis patients unfit for urgent cholecystectomy. PLoS One 2020; 15:e0240219. [PMID: 33035230 PMCID: PMC7546490 DOI: 10.1371/journal.pone.0240219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives Endoscopic transpapillary gallbladder drainage (ETGBD) has been proposed as an alternative to surgery or percutaneous cholecystostomy in patients with acute calculus cholecystitis (ACC). We aimed to evaluate the safety and efficacy of ETGBD via endoscopic transpapillary gallbladder stenting (ETGBS) or endoscopic naso-gallbladder drainage (ENGBD) as either a bridging or a definitive treatment option for patients with ACC when a cholecystectomy is delayed or cannot be performed. Methods From July 2014 to December 2018, 171 patients with ACC in whom ETGBD were attempted were retrospectively reviewed. The technical and clinical success rates and adverse events were evaluated. Moreover, the predictive factors for technical success and the stent patency in the ETGBS group with high surgical risk were examined. Results The technical and clinical success rates by intention-to-treat analysis for ETGBD were 90.6% (155/171) and 90.1% (154/171), respectively. Visible cystic duct on cholangiography were significant technical success predictor (adjusted odds ratio: 7.099, 95% confidence interval: 1.983–25.407, P = 0.003) as per logistic regression analysis. Adverse events occurred in 12.2% of patients (21/171: mild pancreatitis, n = 9; acute cholangitis, n = 6; post-endoscopic sphincterotomy bleeding, n = 4; and stent migration, n = 1; ACC recurrence, n = 1), but all patients were treated with conservative management and endoscopic treatment. Among the ETGBS group, the median stent patency in 70 patients with high surgical risk was 503 days (interquartile range: 404.25–775 days). Conclusions ETGBD, using either ETGBS or ENGBD, may be a suitable bridging option for ACC patients unfit for urgent cholecystectomy. In high surgical risk patients, ETGBS may be a promising and useful treatment modality with low ACC recurrence.
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Affiliation(s)
- Tae Hyeon Kim
- Department of Internal Medicine, Wonkwang University College of Medicine and Hospital, Iksan, Republic of Korea
| | - Dong Eun Park
- Department of Surgery, Wonkwang University College of Medicine and Hospital, Iksan, Republic of Korea
| | - Hyung Ku Chon
- Department of Internal Medicine, Wonkwang University College of Medicine and Hospital, Iksan, Republic of Korea
- * E-mail:
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Biesterveld BE, Alam HB. Evidence-Based Management of Calculous Biliary Disease for the Acute Care Surgeon. Surg Infect (Larchmt) 2020; 22:121-130. [PMID: 32471330 DOI: 10.1089/sur.2020.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Background: Gallstones and cholecystitis are common clinical problems. There is a wide spectrum of disease severity, from rare symptoms of biliary colic to severe cholecystitis with marked gallbladder infection and inflammation that can cause life-threatening sepsis. The care of such patients is similarly varied and multi-disciplinary. Despite the prevalence of cholecystitis, there remain questions about how to manage patients appropriately. Methods: A multi-disciplinary team created institutional cholecystitis guidelines, and supporting evidence was compiled for review. Results: Even in "routine" cholecystitis, patient triage and work-up can be variable, resulting in unnecessary tests and delay to cholecystectomy. Beyond this, there are new treatment options available that may serve special populations particularly well, although the appropriate pattern of emerging endoscopic and percutaneous treatment modalities is not well defined. Conclusions: This review outlines evidence-based management of cholecystitis from diagnosis to treatment with a focused discussion of special populations and emerging therapies.
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Affiliation(s)
- Ben E Biesterveld
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Hasan B Alam
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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8
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Hayes D, Lucas G, Discolo A, French B, Wells S. Endoscopic transpapillary stenting for the management of acute cholecystitis. Langenbecks Arch Surg 2020; 405:191-198. [PMID: 32318834 DOI: 10.1007/s00423-020-01870-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/23/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Cholecystectomy is the gold standard treatment of acute cholecystitis. Patients who are considered not to be candidates for cholecystectomy are commonly recommended to undergo percutaneous transhepatic gallbladder drainage (PTGBD) tube placement; however, external drainage is undesirable for many patients. Endoscopic transpapillary stent placement (ETSP) has been described as an alternative method for decompression of the gallbladder. Data in support of this technique is limited to a handful of observational studies with variable indications. Our study sought to expand on the available data for the use of ETSP exclusively in the context of acute cholecystitis. METHODS We performed a retrospective chart review of patients with cholecystitis who underwent ETSP at our institution between January 2012 and July 2018. We collected data on indication, comorbidities, length of stay, laboratory values, outcomes, additional procedures, and whether cholecystectomy was eventually performed. RESULTS During the study period, 12 patients underwent ETSP. The mean age was 68.2 years (± SD 12.4) with an average Anesthesia Society Assessment (ASA) class of 3.2. The Charlson Comorbidity Index was greater than seven in 75% of patients, indicating a 0% estimated 10-year survival. The National Surgical Quality Improvement Program (NSQIP) surgical risk calculator was used to estimate an average mortality risk for laparoscopic cholecystectomy of 4.8% (± 3.3, 95% CI) in our study population; the estimated risk in the general population is 0.1%. Immediate resolution of symptoms with endoscopic drainage was achieved in 11 of 12 patients (91.7%); one patient experienced no symptom resolution with endoscopic drainage nor subsequent PTGBD tube placement. Six of 12 (50%) patients experienced recurrence of symptoms requiring hospitalization, and two of 12 patients (16.7%) died secondary to biliary sepsis. CONCLUSION Endoscopic transpapillary stent placement is an alternative method for the management of acute cholecystitis patients who are not candidates for surgery. ETSP has a high technical success rate; however, it may result in a high rate of symptom recurrence and should only be utilized in select patients. Randomized studies would be beneficial to further investigate the utility and safety of ETSP in the management of acute cholecystitis.
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Affiliation(s)
- Danielle Hayes
- Department of Surgery, Swedish Medical Center - First Hill, 747 Broadway, Heath Tenth, Seattle, WA, 98122, USA.
| | - Gary Lucas
- Department of Surgery, Swedish Medical Center - First Hill, 747 Broadway, Heath Tenth, Seattle, WA, 98122, USA
| | - Andrew Discolo
- Department of Surgery, Swedish Medical Center - First Hill, 747 Broadway, Heath Tenth, Seattle, WA, 98122, USA
| | - Bryce French
- Department of Surgery, Swedish Medical Center - First Hill, 747 Broadway, Heath Tenth, Seattle, WA, 98122, USA
| | - Sean Wells
- Department of Surgery, Swedish Medical Center - First Hill, 747 Broadway, Heath Tenth, Seattle, WA, 98122, USA
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Sagami R, Hayasaka K, Nishikiori H, Harada H, Amano Y. Current Status in the Treatment of Acute Cholecystitis Patients Receiving Antithrombotic Therapy: Is Endoscopic Drainage Feasible?- A Systematic Review. Clin Endosc 2020; 53:176-188. [PMID: 31914723 PMCID: PMC7137572 DOI: 10.5946/ce.2019.177] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/12/2019] [Indexed: 12/15/2022] Open
Abstract
The bleeding complication risk of surgery or percutaneous transhepatic gallbladder drainage (PTGBD) may increase in patients with acute cholecystitis receiving antithrombotic therapy (ATT). Endoscopic gallbladder drainage (EGBD) may be recommended for such patients. English articles published between 1991 and 2018 in peer-reviewed journals that discuss cholecystectomy, PTGBD, and EGBD in patients with ATT or coagulopathy were reviewed to assess the safety of the procedures, especially in terms of the bleeding complication. There were 8 studies on cholecystectomy, 3 on PTGBD, and 1 on endoscopic transpapillary gallbladder drainage (ETGBD) in patients receiving ATT. With respect to EGBD, 28 studies on ETGBD (including 1 study already mentioned above) and 26 studies on endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) were also analyzed. The overall bleeding complication rate in patients with ATT who underwent cholecystectomy was significantly higher than that in patients without ATT (6.5% [23/354] vs. 1.2% [26/2,224], p<0.001). However, the bleeding risk of cholecystectomy and PTGBD in patients receiving ATT was controversial. The overall technical success, clinical success, and bleeding complication rates of ETGBD vs. EUS-GBD were 84% vs. 96% (p<0.001), 92% vs. 97% (p<0.001), and 0.65% vs. 2.1% (p=0.005), respectively. One patient treated with ETGBD experienced bleeding complication among 191 patients with bleeding tendency. ETGBD may be an ideal drainage procedure for patients receiving ATT from the viewpoint of bleeding, although EUS-GBD is also efficacious.
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Affiliation(s)
- Ryota Sagami
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Kenji Hayasaka
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | | | - Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Yuji Amano
- Department of Endoscopy, New Tokyo Hospital, Chiba, Japan
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Siddiqui A, Kunda R, Tyberg A, Arain MA, Noor A, Mumtaz T, Iqbal U, Loren DE, Kowalski TE, Adler DG, Saumoy M, Gaidhane M, Mallery S, Christiansen EM, Nieto J, Kahaleh M. Three-way comparative study of endoscopic ultrasound-guided transmural gallbladder drainage using lumen-apposing metal stents versus endoscopic transpapillary drainage versus percutaneous cholecystostomy for gallbladder drainage in high-risk surgical patients with acute cholecystitis: clinical outcomes and success in an International, Multicenter Study. Surg Endosc 2018; 33:1260-1270. [DOI: 10.1007/s00464-018-6406-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 08/24/2018] [Indexed: 02/06/2023]
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Long-Term Management of Recurrent Cholecystitis after Initial Conservative Treatment: Endoscopic Transpapillary Gallbladder Stenting. Can J Gastroenterol Hepatol 2018; 2018:3983707. [PMID: 29850454 PMCID: PMC5925167 DOI: 10.1155/2018/3983707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 12/19/2017] [Accepted: 01/14/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Endoscopic transpapillary gallbladder stenting (ETGBS) is an effective procedure for treating high-risk patients with acute cholecystitis and severe comorbidities. However, the efficacy of ETGBS for recurrent cholecystitis (RC) remains unclear. This study aimed to explore its efficacy in patients with RC for whom cholecystectomy is contraindicated because of its high surgical risk. METHODS Data on 19 high-risk patients who had undergone ETGBS for RC after initial conservative therapy in our institution between June 2006 and May 2012 were retrospectively examined. The primary outcome was the clinical success rate, which was defined as no recurrences of acute cholecystitis after ETGBS until death or the end of the follow-up period. Secondary outcomes were technical success rate and adverse events (AEs). RESULTS The clinical success rate of ETGBS was 100%, the technical success rate 94.7%, and AE rate 5%: one patient developed procedure-related mild acute pancreatitis. The clinical courses of all patients were as follows: four died of nonbiliary disease, and the remaining 15 were subsequently treated conservatively. The median duration of follow-up was 14.95 months (range 3-42 months). CONCLUSIONS ETGBS is an effective alternative for managing RC in high-risk patients with severe comorbidities.
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12
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Iino C, Shimoyama T, Igarashi T, Aihara T, Ishii K, Sakamoto J, Tono H, Fukuda S. Perforated emphysematous cholecystitis managed by endoscopic transpapillary gallbladder drainage. Clin J Gastroenterol 2017; 10:388-391. [PMID: 28516371 DOI: 10.1007/s12328-017-0746-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/05/2017] [Indexed: 12/07/2022]
Abstract
An 88-year-old woman with dementia was diagnosed as having perforated emphysematous cholecystitis with localized peritonitis. Because she was at high risk for surgery, gallbladder drainage was required before surgery. Endoscopic transpapillary gallbladder drainage instead of percutaneous transhepatic biliary drainage was performed because bile could leak from the puncture site to free space around the perforated gallbladder. After the insertion of a nasobiliary drainage tube, the gallbladder was drained and cleaned with saline solution. Subsequently, a nasobiliary drainage tube was replaced with a double-pigtail stent because she was at high risk of dislodging the nasobiliary drainage tube. Although clinical improvement was observed, she was treated conservatively without surgery. She was followed up for 6 months without developing cholecystitis. For perforated cholecystitis without developing panperitonitis, endoscopic transpapillary gallbladder drainage would be an effective option as a bridge to surgery for the initial treatment and as an alternative to surgery for long-term management for a later treatment. This is the first reported case of perforated emphysematous cholecystitis with localized peritonitis treated with endoscopic transpapillary gallbladder drainage.
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Affiliation(s)
- Chikara Iino
- Department of Internal Medicine, Hirosaki Municipal Hospital, 8-1, 3chome, Omachi, Hirosaki, Aomori, 036-8004, Japan. .,Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Tadashi Shimoyama
- Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takasato Igarashi
- Department of Internal Medicine, Hirosaki Municipal Hospital, 8-1, 3chome, Omachi, Hirosaki, Aomori, 036-8004, Japan.,Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoyuki Aihara
- Department of Internal Medicine, Hirosaki Municipal Hospital, 8-1, 3chome, Omachi, Hirosaki, Aomori, 036-8004, Japan
| | - Kentaro Ishii
- Department of Internal Medicine, Hirosaki Municipal Hospital, 8-1, 3chome, Omachi, Hirosaki, Aomori, 036-8004, Japan
| | - Juichi Sakamoto
- Department of Internal Medicine, Hirosaki Municipal Hospital, 8-1, 3chome, Omachi, Hirosaki, Aomori, 036-8004, Japan
| | - Hiroshi Tono
- Department of Internal Medicine, Hirosaki Municipal Hospital, 8-1, 3chome, Omachi, Hirosaki, Aomori, 036-8004, Japan
| | - Shinsaku Fukuda
- Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Bekki Y, Ikegami T, Yoshida Y, Motomura T, Itoh S, Harada N, Harimoto N, Uchiyama H, Yoshizumi T, Maehara Y. Living donor liver transplantation indicated for compensated liver cirrhosis with symptomatic gallstone diseases: report of two cases. Surg Case Rep 2016; 2:45. [PMID: 27215224 PMCID: PMC4877343 DOI: 10.1186/s40792-016-0172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical interventions for symptomatic gallstone disease could be dangerous in patients with severe comorbid conditions including liver cirrhosis. Here, we report our experience of living donor liver transplantation (LDLT) indicated for two patients with liver cirrhosis complicated with gallstone diseases. CASE 1 A 70-year-old woman with a history of hepatitis C virus infection was diagnosed as symptomatic choledocholithiasis. She had open cholecystectomy and choledochotomy with choledocholithotomy, which complicated with postoperative liver failure. Her Child-Pugh score increased from 7 to 12 points and Model for End-Stage Liver Disease (MELD) score from 11 to 36. She underwent LDLT, using the right lobe graft donated by her 47-year-old daughter. The post-transplant graft function was excellent, and the patient was discharged from the hospital on postoperative day 27. CASE 2 A 46-year-old man with a history of hepatitis B virus infection was diagnosed as cholecystitis. He had cholecystostomy without any complications and his Child-Pugh score remained to be 9 and MELD score 17, followed by LDLT using the right lobe graft donated by his 45-year-old wife. The post-transplant graft function was excellent, and the patient was discharged from the hospital on postoperative day 44. CONCLUSION LDLT is one of treatment options when patients with Child-Pugh B cirrhosis accompanied with gallstone diseases, likely to be deteriorating their liver functions in the near future.
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Affiliation(s)
- Yuki Bekki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiro Yoshida
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takashi Motomura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Norifumi Harimoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hideaki Uchiyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
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Hatanaka T, Itoi T, Ijima M, Matsui A, Kurihara E, Okuno N, Kobatake T, Kakizaki S, Yamada M. Efficacy and Safety of Endoscopic Gallbladder Stenting for Acute Cholecystitis in Patients with Concomitant Unresectable Cancer. Intern Med 2016; 55:1411-7. [PMID: 27250045 DOI: 10.2169/internalmedicine.55.5820] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Objective Endoscopic gallbladder stenting (EGBS) is an alternative treatment option for high-risk surgical patients with acute cholecystitis. However, there are no reports focusing on EGBS in patients with concomitant unresectable cancer. The aim of this study was thus to evaluate EGBS in such patients. Methods Twenty-two consecutive patients with acute cholecystitis and unresectable cancer were enrolled between September 2010 and December 2014. Their median age was 74.5 years (range: 51-95). Thirteen patients were men and nine were women. The primary cancers of the patients were biliary tract cancer (9), pancreas cancer (9), lung cancer (2), gastric cancer (1), and colon cancer (1). The causes of cholecystitis were calculus cholecystitis (7), obstruction by malignant tumor (13), and obstruction by fully covered stent (2). Results EGBS was successfully performed in 17 patients (77.2%). The technical success rates for calculus cholecystitis, obstruction by malignant tumor, and obstruction by fully covered stent were 85.7% (6/7), 69.2% (9/13), and 100% (2/2), respectively. No complications were observed. Percutaneous transhepatic gallbladder drainage was conducted on two patients in whom EGBS had failed and then we performed EGBS by a rendezvous approach. Of the 19 patients in whom we finally deployed EGBS, the median follow-up period was 229 days (range: 14-880 days). A recurrence of acute cholecystitis occurred in three (15.7%) patients 14, 130, and 440 days after EGBS placement. The rates of recurrence of cholecystitis at one and two years were 10.5% and 18.7%, respectively. Conclusion Our study demonstrated that EGBS is a safe and effective method for acute cholecystitis in patients with concomitant unresectable cancer.
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Affiliation(s)
- Takeshi Hatanaka
- Department of Internal Medicine, Isesaki Municipal Hospital, Japan
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15
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Transpapillary Gallbladder Stents Can Stabilize or Improve Decompensated Cirrhosis in Patients Awaiting Liver Transplantation. J Clin Gastroenterol 2015; 49:771-7. [PMID: 25437155 DOI: 10.1097/mcg.0000000000000269] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
GOALS To describe the short-term and long-term outcomes in 34 consecutive decompensated cirrhotic patients with symptomatic gallbladder disease undergoing transpapillary gallbladder stent (TGS) placement. BACKGROUND Endoscopic TGS placement is a minimally invasive means of treating symptomatic gallbladder disease in poor surgical candidates. STUDY Between June 2005 and June 2011, 34 patients with cirrhosis and symptomatic gallbladder disease underwent attempted TGS placement. RESULTS Median patient age was 52 years, 56% were hospitalized, and 48% were listed for liver transplantation. The median model for end-stage liver disease (MELD) score was 15 (range, 6 to 40) and 88% were Child-Turcotte-Pugh class B/C. A double pigtailed stent was successfully placed in 94% of the patients. At 1-month follow-up, clinical improvement was noted in 82% of the treated subjects and the MELD scores in 14 of 22 (64%) evaluable subjects improved or stabilized. Actuarial transplant-free survival was 53% in the liver transplant candidates with a mean follow-up of 352 days, whereas survival was 44% in the 18 nontransplant candidates with a mean follow-up of 1.5 years. Periprocedural complications included pancreatitis in 5 patients, cholangitis in 3, and 1 patient with cystic duct perforation. In addition, 2 subjects had symptomatic bleeding from traumatic duodenal ulcerations 2 years after TGS placement that necessitated stent removal. CONCLUSIONS Endoscopic TGS placement was technically feasible in 94% of decompensated cirrhotics and was associated with a relatively low rate of periprocedural (26%) and long-term complications (6%). Stabilization or improvement in clinical status and MELD scores was seen in the majority of treated patients.
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16
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Widmer J, Alvarez P, Sharaiha RZ, Gossain S, Kedia P, Sarkaria S, Sethi A, Turner BG, Millman J, Lieberman M, Nandakumar G, Umrania H, Gaidhane M, Kahaleh M. Endoscopic Gallbladder Drainage for Acute Cholecystitis. Clin Endosc 2015; 48:411-20. [PMID: 26473125 PMCID: PMC4604280 DOI: 10.5946/ce.2015.48.5.411] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 11/12/2014] [Accepted: 02/12/2015] [Indexed: 12/11/2022] Open
Abstract
Background/Aims Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. Methods Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. Results During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). Conclusions Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities.
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Affiliation(s)
- Jessica Widmer
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Paloma Alvarez
- Division of Gastroenterology and Hepatology, Central University Hospital of Asturias, Asturias, Spain
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Sonia Gossain
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Prashant Kedia
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Savreet Sarkaria
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Amrita Sethi
- Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
| | - Brian G Turner
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Jennifer Millman
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Michael Lieberman
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Govind Nandakumar
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Hiren Umrania
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Monica Gaidhane
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
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Abstract
Acute cholecystitis is an inflammatory disease of the gallbladder. Inflammation often remains in the gallbladder, but some patients may take a fatal course with exacerbation of inflammation. Although laparoscopic cholecystectomy is recommended for moderate and severe acute cystitis, sometimes cholecystectomy is impossible in elder patients. Because many elder patients have bad general conditions, cholecystectomy should not be performed. Such patients are generally treated by percutaneous transhepatic gallbladder drainage (PTGBD), but PTGBD has the risk of intra-abdominal bleeding. In previous reports, endoscopic gallbladder stenting (EGBS) has been shown to be an effective strategy in cirrhosis patients with symptomatic cholelithiasis as a bridge to transplantation. Recent studies on EGBS have demonstrated an effective long-term management of acute cholecystitis in elderly patients who are poor surgical candidates. Here, we reviewed EGBS for the management of acute cholecystitis.
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18
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Maekawa S, Nomura R, Murase T, Ann Y, Oeholm M, Harada M. Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older. BMC Gastroenterol 2013; 13:65. [PMID: 23586815 PMCID: PMC3675408 DOI: 10.1186/1471-230x-13-65] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/10/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Endoscopic transpapillary pernasal gallbladder drainage and endoscopic gallbladder stenting (EGS) have recently been reported to be useful in patients with acute cholecystitis for whom a percutaneous approach is contraindicated. The aim of this study was to evaluate the efficacy of permanent EGS for management of acute cholecystitis in elderly patients who were poor surgical candidates. METHODS We retrospectively studied 46 elderly patients aged 65 years or older with acute cholecystitis who were treated at Japan Labour Health and Welfare Organization Niigata Rosai Hospital. In 40 patients, acute cholecystitis was diagnosed by transabdominal ultrasonography and computed tomography, while 6 patients were transferred from other hospitals after primary management of acute cholecystitis. All patients underwent EGS, with a 7Fr double pig-tail stent being inserted into the gallbladder. If EGS failed, percutaneous transhepatic gallbladder drainage or percutaneous transhepatic gallbladder aspiration was subsequently performed. The main outcome measure of this study was the efficacy of EGS. RESULTS Permanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis. The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13). In 30 of these 31 patients (96.7%), there was no recurrence of cholecystitis and 29 patients (93.5%) remained asymptomatic until death or the end of the study period (after 1 month to 5 years). CONCLUSIONS EGS can be effective for elderly patients with acute cholecystitis who are poor surgical candidates and can provide a solution for several years.
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Affiliation(s)
- Satoshi Maekawa
- Department of Gastroenterological Medicine, Japan Labour Health and Welfare
Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata,
942-8502, Japan
| | - Ryosuke Nomura
- Department of Gastroenterological Medicine, Japan Labour Health and Welfare
Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata,
942-8502, Japan
| | - Takayuki Murase
- Department of Gastroenterological Medicine, Japan Labour Health and Welfare
Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata,
942-8502, Japan
| | - Yasuyoshi Ann
- Department of Gastroenterological Medicine, Japan Labour Health and Welfare
Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata,
942-8502, Japan
| | - Masayuki Oeholm
- Department of Gastroenterological Medicine, Japan Labour Health and Welfare
Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata,
942-8502, Japan
| | - Masaru Harada
- Third Department of Internal Medicine, University of Occupational and
Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka,
807-8555, Japan
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19
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Abstract
INTRODUCTION Historically the presence of liver cirrhosis has been an absolute or relative contraindication to laparoscopic cholecystectomy (LC). Accumulating experience in LC has resulted in an increasing number of investigators reporting that LC can be safely performed in cirrhotic patients. The aim of this study was to report the efficacy and safety of LC in the treatment of symptomatic cholelithiasis in cirrhotic patients, and a review of the literature in the matter. METHODS Between January 2006 and July 2010, from 503 patients under LC, we reviewed 43 cirrhotic patients of Child-Pugh Classification A, B, and C, with symptomatic gallstones. RESULTS Conversion to an open procedure was necessary in 5 patients due to multiple factors. The mean operative time and length of hospital stay were significantly longer and higher in cirrhotic group (P<0.05). Postoperative complications were observed in 37.2% of patients. Trocar site hematoma (P=0.02), wound complications (P=0.02), and intra-abdominal collection (P=0.01) occurred more frequently in patients with cirrhosis (Child B and C class) than in patients without cirrhosis. One case of continuing hemorrhage from the gallbladder bed required a reoperation for hemostasis. Two patients with Child-Pugh class C and 1 patient with class B cirrhosis developed ascites after surgery; 1 patient with Child-Pugh class A had bile leakage. No deaths occurred. CONCLUSIONS LC is an effective and safe procedure and should be the treatment of choice for symptomatic cholelithiasis or cholecystitis in patients with compensated cirrhosis.
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20
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Abstract
Biliary plastic stenting plays a key role in the endoscopic management of benign biliary diseases. Complications following surgery of the biliary tract and liver transplantation are amenable to endoscopic treatment by plastic stenting. Insertion of an increasing number of plastic stents is currently the method of choice to treat postoperative biliary strictures. Benign biliary strictures secondary to chronic pancreatitis or primary sclerosing cholangitis may benefit from plastic stenting in select cases. There is a role for plastic stent placement in nonoperative candidates with acute cholecystitis and in patients with irretrievable bile duct stones.
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21
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Elmunzer BJ, Novelli PM, Taylor JR, Piraka CR, Shields JJ. Percutaneous cholecystostomy as a bridge to definitive endoscopic gallbladder stent placement. Clin Gastroenterol Hepatol 2011; 9:18-20. [PMID: 20951833 DOI: 10.1016/j.cgh.2010.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 09/25/2010] [Accepted: 09/28/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Percutaneous cholecystostomy (PC) is an effective treatment for acute cholecystitis (AC) in patients who are poor surgical candidates, although it is generally used as a bridge to cholecystectomy, given its long-term risks, the need for repeated procedures, and patient dissatisfaction. Ongoing patient comorbidity, however, might preclude cholecystectomy after recovery from the acute illness. METHODS Four patients with AC who were poor immediate and long-term candidates for cholecystectomy underwent PC as primary therapy for AC, followed by endoscopic placement of a transpapillary gallbladder stent as definitive long-term management. RESULTS All 4 patients were successfully treated for AC with PC. After recovery, the patients underwent endoscopic gallbladder stent placement and removal of the PC. In 2 cases, endoscopic transpapillary access to the gallbladder was facilitated by advancing a guidewire through the cholecystostomy tract into the duodenum. All patients had favorable outcomes. CONCLUSIONS PC as a bridge to permanent therapy with endoscopic gallbladder stenting appears to be a viable strategy in the management of patients with AC who are poor immediate and long-term candidates for cholecystectomy.
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Affiliation(s)
- B Joseph Elmunzer
- Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, MI, USA.
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22
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Uzzaman MM, Nair MS, Myint F. An unusual complication encountered incidentally at laparoscopic cholecystectomy: a case series. J Gastrointest Surg 2010; 14:1608-12. [PMID: 20652438 DOI: 10.1007/s11605-010-1238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 05/25/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This is a case series of erosion of the common bile duct by an in situ stent found incidentally during laparoscopic cholecystectomy (LC). To the best of our knowledge, this is one of the first reported incidences of this nature. METHOD Four individual case reports. RESULTS Thirty nine patients with an in situ CBD stent underwent LC for symptomatic gallstones in our institution over a 4-year time period (2005 to 2009). Four patients were found to have the stent eroding through the wall of the CBD. In these four patients, endoscopic retrograde cholangiopancreatography (ERCP) had previously been performed - extracting stone(s) - followed by sphincterotomy and insertion of a 7 Fr pigtail stent (measuring 4 cm). The operation was converted to open in two patients, and the procedure was abandoned in one of these cases. In the other two patients, the anatomy of Calots triangle was delineated well, and the operator was able to complete LC. The duration between initial pigtail stent insertion and LC ranged from 32 to 400 days. None of our patients required a definitive surgical repair of the CBD or T-tube placement. The stent was removed during surgery in one case, removed endoscopically at a later date in two patients, and passed spontaneously in one patient. All four patients made a good postoperative recovery. CONCLUSION CBD erosion is a complication of plastic biliary stent insertion. CBD stent erosion will make surgery more hazardous especially if it remains in situ for a significant period of time. CBD erosion can generally be managed conservatively without the need for surgical repair. Awareness of this complication should prompt earlier surgery or earlier removal of plastic pigtail stents.
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Affiliation(s)
- Mohammed Mohsin Uzzaman
- Department of General Surgery, North Middlesex University Hospital, 62 Kensington Avenue, London E12 6NP, UK.
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23
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Miyayama S, Yamashiro M, Takeda T, Aburano H, Komatsu T, Sanada T, Kosaka S, Toya D, Matsui O. Acute Cholecystitis Caused by Malignant Cystic Duct Obstruction: Treatment with Metallic Stent Placement. Cardiovasc Intervent Radiol 2007; 31 Suppl 2:S221-6. [DOI: 10.1007/s00270-007-9228-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 10/02/2007] [Accepted: 10/16/2007] [Indexed: 11/30/2022]
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Tsuyuguchi T, Takada T, Kawarada Y, Nimura Y, Wada K, Nagino M, Mayumi T, Yoshida M, Miura F, Tanaka A, Yamashita Y, Hirota M, Hirata K, Yasuda H, Kimura Y, Neuhaus H, Strasberg S, Pitt H, Belghiti J, Belli G, Windsor JA, Chen MF, Kim SW, Dervenis C. Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis. ACTA ACUST UNITED AC 2007; 14:46-51. [PMID: 17252296 PMCID: PMC2784517 DOI: 10.1007/s00534-006-1155-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 08/06/2006] [Indexed: 12/19/2022]
Abstract
The principal management of acute cholecystitis is early cholecystectomy. However, percutaneous transhepatic gallbladder drainage (PTGBD) may be preferable for patients with moderate (grade II) or severe (grade III) acute cholecystitis. For patients with moderate (grade II) disease, PTGBD should be applied only when they do not respond to conservative treatment. For patients with severe (grade III) disease, PTGBD is recommended with intensive care. Percutaneous transhepatic gallbladder aspiration (PTGBA) is a simple alternative drainage method with fewer complications; however, its clinical usefulness has been shown only by case-series studies. To clarify the clinical value of these drainage methods, proper randomized trials should be done. This article describes techniques of drainage for acute cholecystitis.
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Affiliation(s)
- Toshio Tsuyuguchi
- Department of Medicine and Clinical Oncology, Graduate School of Medicine Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
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Shrestha R, Grunkemeier DMS. Endoscopic treatment of biliary tract disease prior to orthotopic liver transplantation. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2006; 9:133-44. [PMID: 16539874 DOI: 10.1007/s11938-006-0032-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Endoscopic therapy for biliary tract disease in patients with end-stage liver disease (ESLD) before liver transplantation is safe and effective. Reported results in patients with choledocholithiasis, primary sclerosing cholangitis (PSC), and symptomatic gallbladder diseases are encouraging. Prompt recognition and appropriate treatment of symptomatic gallbladder and bile duct disease are important in reducing morbidity and mortality in these high-risk patients while they await liver transplantation. Confirmation of tissue diagnosis of cholangiocarcinoma in patients with sclerosing cholangitis is still difficult. Better screening tools and diagnostic methods are necessary for early detection. Because liver transplantation is the only definitive therapy for patients with advanced cirrhosis, maintenance of their candidacy with either endoscopic or radiologic therapeutic interventions is warranted until transplantation. Endoscopic therapy is the preferred method when feasible. If necessary, percutaneous transhepatic biliary drainage (PTBD) is a viable alternative because both avoid the attendant risks of surgery in a high-risk population with advanced liver disease.
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Affiliation(s)
- Roshan Shrestha
- Liver Transplant Program, Piedmont Hospital, Atlanta, GA 30309, USA.
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26
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Schlenker C, Trotter JF, Shah RJ, Everson G, Chen YK, Antillon D, Antillon MR. Endoscopic gallbladder stent placement for treatment of symptomatic cholelithiasis in patients with end-stage liver disease. Am J Gastroenterol 2006; 101:278-83. [PMID: 16454831 DOI: 10.1111/j.1572-0241.2006.00403.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Symptomatic cholelithiasis is a common disease in the general population with an increased prevalence in patients with cirrhosis. While cholecystectomy is the procedure of choice for the treatment of symptomatic cholelithiasis, cirrhotics have an increased risk of complications associated with this therapy. We have found that placement of an endoscopic gallbladder stent is an alternative, less invasive treatment for cirrhotic patients with symptomatic gallbladder disease and describe our experience here. METHODS A retrospective medical record review of 23 patients with cirrhosis who underwent endoscopic retrograde cholangiography with gallbladder stent placement for symptomatic gallbladder disease from July 1994 to August 2004. RESULTS Indications for stent placement included recurrent biliary colic (56.5%), acute calculous cholecystitis (39%), acalculous cholecystitis (8.6%), and gallstone pancreatitis (8.6%). All patients experienced resolution of their symptoms following stent placement. Twenty patients (87%) were asymptomatic from 5 days to 3 years post-procedure until transplantation, death, or end of study period. Nine patients (39%) underwent liver transplantation, 5 days to 34 months after the procedure. Eleven patients are well, with ten patients awaiting liver transplantation. Three patients developed late complications and were treated successfully with antibiotics. CONCLUSION Endoscopic stenting of the gallbladder may be a potential treatment for symptomatic gallbladder disease in patients with cirrhosis awaiting liver transplantation, considered to be high-risk for cholecystectomy.
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Affiliation(s)
- Christine Schlenker
- Division of Gastroenterology/Hepatology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA
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Kubota K, Abe Y, Inamori M, Kawamura H, Kirikoshi H, Kobayashi N, Saito S, Ueno N, Nakajima A. Percutaneous transhepatic gallbladder stenting for recurrent acute acalculous cholecystitis after failed endoscopic attempt. ACTA ACUST UNITED AC 2005; 12:286-9. [PMID: 16133694 DOI: 10.1007/s00534-005-0989-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 03/30/2005] [Indexed: 10/25/2022]
Abstract
Endoscopic gallbladder stenting is useful palliative therapy for acute cholecystitis in high-risk patients. Although the success rate of endoscopic gallbladder stenting is 79%-100%, an alternative method has not been reported. We succeeded in employing a method for percutaneous gallbladder stenting (PTGS) and herein describe this new method. A patient with acute acalculous cholecystitis related to ischemic atherosclerotic vascular disease, cholangitis due to Lemmel syndrome, and severe congestive heart failure underwent PTGS through the cystic duct from the gallbladder to the duodenal papilla, because an endoscopic method failed in the treatment of Lemmel syndrome. Because we were unable to place endoscopic transpapillary gallbladder drainage, percutaneous transhepatic gallbladder drainage (PTGBD) was performed and both the cholecystitis and cholangitis ceased. PTGS was performed as an alternative to endoscopic gallbladder stenting. Access to the cystic duct and gallbladder was obtained by the PTGBD route, using a guidewire (0.035-inch diameter) and seeking catheter (6.5 Fr) under fluoroscopic control. A 7-Fr 12-cm double-pigtail biliary polyethylene stent was placed. The patient remained asymptomatic for 3 months after the PTGS until he died, of an acute recurrent myocardial infarction. This new PTGS placement is an alternative treatment for symptomatic gallbladder disease in patients with increased operative risk when the endoscopic method is unsuccessful.
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Affiliation(s)
- Kensuke Kubota
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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Conway JD, Russo MW, Shrestha R. Endoscopic stent insertion into the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease. Gastrointest Endosc 2005; 61:32-6. [PMID: 15672053 DOI: 10.1016/s0016-5107(04)02445-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic stent insertion into the gallbladder entails placement of a double-pigtail polyethylene stent between the gallbladder and the duodenum at ERCP. This procedure may be an effective temporary measure in patients with severe comorbid conditions, especially end-stage liver disease, that subsequently allows more definitive therapy, including liver transplantation. METHODS The records for 29 patients who underwent attempted endoscopic gallbladder stent insertion between May 1999 and May 2004 were reviewed retrospectively. RESULTS Mean patient age was 47 years; 86% of the patients were listed for liver transplantation, with a mean model for end-stage liver disease score of 15; 72% had Child's class B cirrhosis. Indications for gallbladder stent placement included recurrent biliary colic (69%), acute cholecystitis (17%), acalculous cholecystitis (7%), and gallstone pancreatitis (7%). Of the 29 patients who underwent ERCP, stent placement was successful in 26 (90%). Median follow-up was 9.4 months (range 0.1-40.5 months). Of those who had a stent placed, 6 (22%) subsequently underwent liver transplantation and another 15 (56%) were alive, most awaiting liver transplantation. Only 3 patients had late a complication or recurrence of biliary symptoms after stent placement. CONCLUSIONS Endoscopic stent placement in the gallbladder is a safe and an effective palliative treatment for patients with symptoms caused by gallbladder disease who are poor surgical candidates.
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Affiliation(s)
- Jason D Conway
- Department of Medicine: Division of Gastroenterology and Hepatology, Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, 27599-7080, USA
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Sheiman RG, Stuart K. Percutaneous cystic duct stent placement for the treatment of acute cholecystitis resulting from common bile duct stent placement for malignant obstruction. J Vasc Interv Radiol 2004; 15:999-1001. [PMID: 15361570 DOI: 10.1097/01.rvi.0000128793.28540.b5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Common bile duct (CBD) stent placement to relieve malignant biliary obstruction can occasionally cause cystic duct obstruction and acute cholecystitis. Cholecystostomy tube placement is often performed in patients with limited life expectancy but can have a significant impact on quality of life. To allow cholecystostomy tube removal, percutaneous metallic stent placement was performed across the cystic duct via the tube tract in such a patient. The procedure included traversal across the previously placed CBD stent. At 5-month follow-up, the patient remained symptom-free. In select patients who develop acute cholecystitis after CBD stent placement for malignant obstruction, percutaneous stent placement across the cystic duct may be considered a treatment option.
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Affiliation(s)
- Robert G Sheiman
- Departments of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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Abstract
BACKGROUND Few articles address the issue of LC in patients with cirrhosis. Existing articles are retrospective and with small sample sizes, which makes it difficult to draw conclusions about indications and complications with LC in this setting. STUDY DESIGN An extensive search of the Medline, Embase, and Cochrane databases using the terms "laparoscopic cholecystectomy" and "cirrhosis" or "cirrhotic" was conducted. The data from each study were extracted, combined with those of similar studies, and analyzed. RESULTS Twenty-five publications (400 patients with cirrhosis undergoing LC) from 1993 to 2001 were identified. Four articles compared LC with open cholecystectomy in patients with cirrhosis, and six compared patients with cirrhosis to patients without cirrhosis. Patients were primarily in Child-Pugh class A or B, with only six patients in Child-Pugh class C. Compared with patients without cirrhosis, patients with cirrhosis had higher conversion rates (7.06% versus 3.64%, p = 0.024), operative times (98.2 minutes versus 70 minutes, p = 0.005), bleeding complications (26.4% versus 3.1%, p < 0.001), and overall morbidity (20.86% versus 7.99%, p < 0.001). Acute cholecystitis was evident in 47% of patients with cirrhosis versus 14.7% of patients without cirrhosis (p < 0.001). When LC was compared with open cholecystectomy in patients with cirrhosis, LC was associated with less operative blood loss (113 mL versus 425.2 mL, p = 0.015), operative time (123.3 minutes versus 150.2 minutes, p < 0.042), and length of hospital stay (6 days versus 12.2 days, p < 0.001). CONCLUSIONS Patients with cirrhosis undergo cholecystectomies for more emergent reasons and have higher morbidity. The laparoscopic approach offers advantages of less blood loss, shorter operative time, and shorter length of hospitalization in patients with cirrhosis. Prospective studies will establish which factors affect outcomes and determine the appropriateness of LC in Child's-Pugh class C cirrhosis.
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Affiliation(s)
- W R Brugge
- Gastrointestinal Unit, Massachusetts General Hospital, Boston 02114, USA.
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