title: Gallbladder stent placement for prevention of cholecystitis in patients receiving covered metal stent for malignant obstructive jaundice: a feasibility study.
abstract: OBJECTIVE
  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).
  
  
  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.
authors.affiliation: Digestive Health Center, University of Virginia Health System, Charlottesville, VA 22908-0708, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Gosain
authors.forename: Hugo
authors.initials: H
authors.lastname: Bonatti
authors.forename: LaVone
authors.initials: L
authors.lastname: Smith
authors.forename: Michele E
authors.initials: ME
authors.lastname: Rehan
authors.forename: Andrew
authors.initials: A
authors.lastname: Brock
authors.forename: Anshu
authors.initials: A
authors.lastname: Mahajan
authors.forename: Melissa
authors.initials: M
authors.lastname: Phillips
authors.forename: Henry C
authors.initials: HC
authors.lastname: Ho
authors.forename: Kristi
authors.initials: K
authors.lastname: Ellen
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Shami
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000601:surgery*; D005260:Female; D005704:Gallbladder; D006801:Humans; D041781:Jaundice, Obstructive / Q000150:complications / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015607:Stents