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Long-Term Impact of Endoscopic Gallbladder Stenting for Calculous Cholecystitis in Poor Surgical Candidates: A Multi-center Comparative Study

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Abstract

Background

Although long-term stent placement using endoscopic gallbladder stenting (EGBS) reportedly reduces cholecystitis recurrence in patients unfit to undergo cholecystectomy, its efficacy and safety remain uncertain.

Aims

This study aimed to examine the long-term effect of EGBS in poor surgical candidates of cholecystectomy.

Methods

A total of 528 high-risk surgical patients with acute calculous cholecystitis met this study’s eligibility criteria. The technical success and adverse events (AE) were compared between patients who underwent EGBS and those who underwent percutaneous transhepatic gallbladder drainage (PTGBD). Elective stent exchange and removal were not performed after EGBS. The external tube was removed after improvement of cholecystitis following PTGBD.

Results

The technical success rate was significantly lower with EGBS compared to PTGBD (75.4% versus 98.7%, P < 0.001), while the early-AE rate did not differ significantly between the two methods (7.7% versus 4.3%, P = 0.146). The 1-, 3-, and 5-year cumulative incidence rates of cholecystitis were 3.8%, 7.2%, and 7.2% with EGBS, and 11.7%, 17.6%, and 30.2% with PTGBD, respectively (P = 0.001). Conversely, those of symptomatic late-AE (except cholecystitis) were 8.2%, 22.7%, and 31.4% with EGBS, and 7.5%, 10.9%, and 13.1% with PTGBD, respectively (P = 0.035). Thus, the 1-, 3-, and 5-year cumulative incidence of overall late-AE was 12.0%, 30.4%, and 40.4% with EGBS, and 19.2%, 28.3%, and 42.5% with PTGBD, respectively (P = 0.649).

Conclusions

Long-term stent placement via EGBS is useful for preventing the recurrence of cholecystitis, but the success rate is low and the frequency of other late-AE increases with the prolongation of the indwelling period.

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Acknowledgments

We thank all the clinicians and nursing staffs at each institution for their support and assistance during the treatment.

Funding

This study did not receive funding from any source.

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Authors and Affiliations

  1. Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan

    Tadahisa Inoue, Rena Kitano & Masashi Yoneda

  2. Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, 5-161 Maehata-cho, Tajimi, Gifu, 507-8522, Japan

    Yuta Suzuki, Fumihiro Okumura & Kenichi Haneda

  3. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan

    Michihiro Yoshida, Itaru Naitoh & Kazuki Hayashi

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  1. Tadahisa Inoue
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  3. Michihiro Yoshida
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  4. Itaru Naitoh
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Contributions

TI, YS, MY: conception and design, data acquisition, analysis and interpretation, and drafting and revision of the manuscript. IN, FO: conception and design, data interpretation, and revision of the manuscript. RK: data acquisition and interpretation, and revision of the manuscript. KH, KH, MY: data interpretation, and revision of the manuscript.

Corresponding author

Correspondence to Tadahisa Inoue.

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The authors declare no conflict of interests for this study.

Ethical approval

Each hospital’s institutional review board approved this study in accordance with the principles of the Declaration of Helsinki.

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Inoue, T., Suzuki, Y., Yoshida, M. et al. Long-Term Impact of Endoscopic Gallbladder Stenting for Calculous Cholecystitis in Poor Surgical Candidates: A Multi-center Comparative Study. Dig Dis Sci 68, 1529–1538 (2023). https://doi.org/10.1007/s10620-022-07651-0

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