PTH-051 Endoscopic transpapillary gallbladder stenting for patients unsuitable for cholecystectomy: prospective single centre case series

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Abstract

Introduction

Cholecystectomy, the definitive treatment for symptomatic gallbladder disease, is precluded in many patients by a high operative risk. Endoscopic transpapillary gallbladder stenting (ETGS), first reported in 19901, is described as an effective treatment for cholecystitis and symptomatic choledocholithiasis in patients who are not candidates for surgery2. The technical success of ETGS is largely limited by the ability to pass a guidewire through the cystic duct (76%–90%)2. Despite adoption internationally ETGS has not been used widely in the UK.

Method

Prospective case series of ETGS at a single centre. All patients were referred for ETGS by an Upper GI surgeon after being deemed unsuitable for cholecystectomy due to a prohibitive operative or anaesthetic risk. Indications included calculous cholecystitis, choledocholithiasis and gallstone pancreatitis. Informed consent obtained from all patients with risks of ERCP outlined including pancreatitis and perforation.

Results

17 patients have been referred for ETGS thus far. 3 patients were declined for ETGS (2 with dementia, 1 symptoms deemed too mild). In total ETGS was attempted in 14 patients (8 female) with average age 78 years (56–91). CBD cannulation achieved at ERCP in all 14 patients (100%). ETGS were successfully inserted in 13 patients (93%), and one failure due to inability to achieve deep cannulation of the gall bladder despite entering the cystic duct. No procedure related complications thus far.

Results

First ETGS inserted November 2015. Thereafter, 2 of the 13 (15%) of patients with ETGS reported ongoing gallstone related symptoms during follow up (ongoing biliary pain and cholecystitis at 12 months; recurrent cholangitis at 6 months)

Conclusion

Hitherto, this is the largest prospective UK case series of ETGS for patients with symptomatic gallbladder disease in whom cholecystectomy is precluded. Whereas procedure related complications were not noted in our case series, 2 patients continued to experience gallstone related complications. Given the recent introduction of endoscopic ultrasound-guided transmural gallbladder drainage, we recommend further studies to compare the use of these 2 endoscopic modalities in this group of patients.

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