Abstract
Purpose
Covered self-expanding metal stents (CSEMS) have been used for palliation of malignant distal biliary strictures. Occlusion of the cystic duct by CSEMS may be complicated by cholecystitis. This potentially could be prevented by placement of a transpapillary gallbladder stent (GBS).
Patients and Methods
Between 11/2006 and 10/2007, a total of 73 patients (50 male) aged 65 ± 14 years underwent CSEMS placement for palliation of malignant obstructive jaundice. In cases where CSEMS placement caused occlusion of the cystic duct, a 7 French transpapillary pigtail gallbladder stent (GBS) was inserted to prevent cholecystitis.
Results
Of the 73 patients, 18 had a prior cholecystectomy; 34 had the CSEMS placed below the cystic duct insertion. In 19 out of the 21 patients who had a CSEMS covering the cystic duct ostium, GBS placement was attempted, which was successful in 11 individuals (58%). An attempt to access the gallbladder was complicated by wire perforation of the cystic duct in three patients; one patient requiring emergent cholecystostomy tube placement. None of the patients who underwent successful GBS placement developed cholecystitis. One GBS dislodged and was repositioned. Cholecystitis occurred in two (20%) of the ten patients without transpapillary gallbladder decompression who had a CSEMS covering the cystic duct.
Conclusions
The ideal placement of a CSEMS is below the cystic duct insertion. Should the cystic duct ostium be occluded, placement of a GBS should be considered to minimize the risk of cholecystitis.
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References
Michelassi F, Erroi F, Dawson PJ, et al. Experience with 647 consecutive tumors of the duodenum, ampulla, head of the pancreas, and distal common bile duct. Ann Surg. 1989;210:544–554; discussion 554–546.
Ishii N, Suzuki S, Fujitani S, et al. A case of recurrent gallbladder cancer responding to chemotherapy with gemcitabine after endoscopic metallic biliary stent implantation. Gan To Kagaku Ryoho. 2008;35:1403–1405.
Krishnan S, Rana V, Evans DB, et al. Role of adjuvant chemoradiation therapy in adenocarcinomas of the ampulla of vater. Int J Radiat Oncol Biol Phys. 2008;70:735–743.
Smith AC, Dowsett JF, Russell RC, Hatfield AR, Cotton PB. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction. Lancet. 1994;344:1655–1660.
Jeurnink SM, Steyerberg EW, Hof G, van Eijck CH, Kuipers EJ, Siersema PD. Gastrojejunostomy versus stent placement in patients with malignant gastric outlet obstruction: a comparison in 95 patients. J Surg Oncol. 2007;96:389–396.
Raty S, Sand J, Piironen A, Nordback I. Complications of palliative hepaticojejunostomy and gastrojejunostomy in unresectable periampullary cancer: patient- and disease-related risk factors. Hepatogastroenterology. 2006;53:133–137.
Brandabur JJ, Kozarek RA, Ball TJ, et al. Nonoperative versus operative treatment of obstructive jaundice in pancreatic cancer: cost and survival analysis. Am J Gastroenterol. 1988;83:1132–1139.
Kahaleh M, Brock A, Conaway MR, et al. Covered self-expandable metal stents in pancreatic malignancy regardless of resectability: a new concept validated by a decision analysis. Endoscopy. 2007;39:319–324.
Raikar GV, Melin MM, Ress A, et al. Cost-effective analysis of surgical palliation versus endoscopic stenting in the management of unresectable pancreatic cancer. Ann Surg Oncol. 1996;3:470–475.
Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992;340:1488–1492.
Moss AC, Morris E, Mac Mathuna P. Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Rev. 2006: CD004200.
Tsuyuguchi T, Takada T, Miyazaki M, et al. Stenting and interventional radiology for obstructive jaundice in patients with unresectable biliary tract carcinomas. J Hepatobiliary Pancreat Surg. 2008;15:69–73.
do Park H, Kim MH, Choi JS, et al. Covered versus uncovered wallstent for malignant extrahepatic biliary obstruction: a cohort comparative analysis. Clin Gastroenterol Hepatol. 2006;4:790–796.
Yoon WJ, Lee JK, Lee KH, et al. A comparison of covered and uncovered wallstents for the management of distal malignant biliary obstruction. Gastrointest Endosc. 2006;63:996–1000.
Isayama H, Kawabe T, Nakai Y, et al. Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction. Clin Gastroenterol Hepatol. 2006;4:1148–1153.
Suk KT, Kim HS, Kim JW, et al. Risk factors for cholecystitis after metal stent placement in malignant biliary obstruction. Gastrointest Endosc. 2006;64:522–529.
Kahaleh M, Tokar J, Le T, Yeaton P. Removal of self-expandable metallic wallstents. Gastrointest Endosc. 2004;60:640–644.
Fumex F, Coumaros D, Napoleon B, et al. Similar performance but higher cholecystitis rate with covered biliary stents: results from a prospective multicenter evaluation. Endoscopy. 2006;38:787–792.
Ogawa O, Yoshikumi H, Maruoka N, et al. Predicting the success of endoscopic transpapillary gallbladder drainage for patients with acute cholecystitis during pretreatment evaluation. Can J Gastroenterol. 2008;22:681–685.
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;61:32–36.
Kjaer DW, Kruse A, Funch-Jensen P. Endoscopic gallbladder drainage of patients with acute cholecystitis. Endoscopy. 2007;39:304–308.
Pannala R, Petersen BT, Gostout CJ, Topazian MD, Levy MJ, Baron TH. Endoscopic transpapillary gallbladder drainage: 10-year single center experience. Minerva Gastroenterol Dietol. 2008;54:107–113.
Saluja SS, Gulati M, Garg PK, et al. Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment. Clin Gastroenterol Hepatol. 2008;6:944–950. (e943).
Schlenker C, Trotter JF, Shah RJ, et al. Endoscopic gallbladder stent placement for treatment of symptomatic cholelithiasis in patients with end-stage liver disease. Am J Gastroenterol. 2006;101:278–283.
Kaassis M, Boyer J, Dumas R, et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc. 2003;57:178–182.
Levy MJ, Baron TH, Gostout CJ, Petersen BT, Farnell MB. Palliation of malignant extrahepatic biliary obstruction with plastic versus expandable metal stents: an evidence-based approach. Clin Gastroenterol Hepatol. 2004;2:273–285.
Lammer J, Hausegger KA, Fluckiger F, et al. Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents. Radiology. 1996;201:167–172.
Schmassmann A, von Gunten E, Knuchel J, Scheurer U, Fehr HF, Halter F. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol. 1996;91:654–659.
Yeoh KG, Zimmerman MJ, Cunningham JT, Cotton PB. Comparative costs of metal versus plastic biliary stent strategies for malignant obstructive jaundice by decision analysis. Gastrointest Endosc. 1999;49:466–471.
Isayama H, Komatsu Y, Tsujino T, et al. A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut. 2004;53:729–734.
Kahaleh M, Tokar J, Conaway MR, et al. Efficacy and complications of covered wallstents in malignant distal biliary obstruction. Gastrointest Endosc. 2005;61:528–533.
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Gosain, S., Bonatti, H., Smith, L. et al. Gallbladder Stent Placement for Prevention of Cholecystitis in Patients Receiving Covered Metal Stent for Malignant Obstructive Jaundice: A Feasibility Study. Dig Dis Sci 55, 2406–2411 (2010). https://doi.org/10.1007/s10620-009-1024-9
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DOI: https://doi.org/10.1007/s10620-009-1024-9