Details

Autor(en) / Beteiligte

• Majmudar, Kaushal
• Murad, Faris

Titel

Fully-Covered Self-Expandable Metal Stents May Increase the Risk of Cholecystitis in Patients With Intact Gallbladders Compared to Uncovered Self-Expandable Metal Stents When Placed for Malignant Biliary Obstruction: 7

Ist Teil von

• The American journal of gastroenterology, 2018-10, Vol.113 (Supplement), p.S6-S6

Ort / Verlag

New York: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins

Erscheinungsjahr

2018

Beschreibungen/Notizen

• Introduction: Malignant biliary obstruction (MB O) can be managed by endoscopic placement of plastic or self-expandable metal biliary stents (SEMS). SEMS provide longer patency than plastic stents. Uncovered SEMS (USEMS) have higher rates of tissue or tumor ingrowth while fully covered SEMS (FCSEMS) have higher rates of stent migration after deployment. Biliary stents of any type may result in cholecystitis. We sought to compare the incidence of cholecystitis in patients with intact gallbladders who had either a FCSEMS or USEMS placed in the extrahepatic bile duct for MBO. Methods: This retrospective cohort study was conducted on all patients with an intact gallbladder who underwent extrahepatic biliary SEMS placement for MBO between 2013 and 2018. Patients were excluded if they had radiographic evidence of cholecystitis prior to SEMS placement, underwent percutaneous cholecystostomy prior to SEMS placement, or had both FCSEMS and USEMS placed. Results: 136 patients were included in our study with a mean age of 71.7 (+13.6 years). 45 FCSEMS and 91 USEMS were placed. 7 (15.6%) patients with FCSEMS developed cholecystitis compared to 0 (0.0%) with USEMS (p<0.005). Of the 7 patients who developed cholecystitis, 5 required placement of a percutaneous cholecystostomy (PC) tube. In all patients who required PC tube placement, the tube remained until death from malignancy. The median survival time following the onset of cholecystitis was 53 (IQR 43.5) days. Of the 2 patients who did not undergo placement of a PC tube, one underwent ERCP with FCSEMS removal and plastic biliary stent placement, which led to resolution of cholecystitis. The other patient was discharged to hospice without intervention and died shortly after. Conclusion: Fully covered self-expandable metal biliary stent placement for malignant biliary obstruction leads to a higher incidence of cholecystitis compared to uncovered self-expandable metal stents in patients with intact gallbladders. When fully covered stents are placed, percutaneous cholecystostomy and/or ERCP with stent removal can relieve cholecystitis. Caution should be exercised when considering placement of a fully covered stent in patients with an intact gallbladder as this may lead to increased morbidity and indefinite placement of a percutaneous drain until time of death.