title: Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older.
abstract: BACKGROUND
  Endoscopic transpapillary pernasal gallbladder drainage and endoscopic gallbladder stenting (EGS) have recently been reported to be useful in patients with acute cholecystitis for whom a percutaneous approach is contraindicated. The aim of this study was to evaluate the efficacy of permanent EGS for management of acute cholecystitis in elderly patients who were poor surgical candidates.
  
  
  METHODS
  We retrospectively studied 46 elderly patients aged 65 years or older with acute cholecystitis who were treated at Japan Labour Health and Welfare Organization Niigata Rosai Hospital. In 40 patients, acute cholecystitis was diagnosed by transabdominal ultrasonography and computed tomography, while 6 patients were transferred from other hospitals after primary management of acute cholecystitis. All patients underwent EGS, with a 7Fr double pig-tail stent being inserted into the gallbladder. If EGS failed, percutaneous transhepatic gallbladder drainage or percutaneous transhepatic gallbladder aspiration was subsequently performed. The main outcome measure of this study was the efficacy of EGS.
  
  
  RESULTS
  Permanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis. The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13). In 30 of these 31 patients (96.7%), there was no recurrence of cholecystitis and 29 patients (93.5%) remained asymptomatic until death or the end of the study period (after 1 month to 5 years).
  
  
  CONCLUSIONS
  EGS can be effective for elderly patients with acute cholecystitis who are poor surgical candidates and can provide a solution for several years.
authors.affiliation: Department of Gastroenterological Medicine, Japan Labour Health and Welfare Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata 942-8502, Japan. s5083m@niirou.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Maekawa
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Nomura
authors.forename: Takayuki
authors.initials: T
authors.lastname: Murase
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Ann
authors.forename: Masayuki
authors.initials: M
authors.lastname: Oeholm
authors.forename: Masaru
authors.initials: M
authors.lastname: Harada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002544:Cerebral Infarction / Q000150:complications; D002758:Cholangiography; D041881:Cholecystitis, Acute / Q000150:complications / Q000601:surgery*; D003704:Dementia / Q000150:complications; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D005704:Gallbladder; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents