title: Endoscopic Transpapillary Gallbladder Stent Placement Is Safe and Effective in High-Risk Patients Without Cirrhosis.
abstract: BACKGROUND
  Endoscopic transpapillary gallbladder stent (ETGS) placement is a proposed minimally invasive alternative to cholecystectomy in high-risk patients with symptomatic gallbladder disease.
  
  
  OBJECTIVE
  To describe the safety and efficacy of ETGS placement in 29 consecutive patients without cirrhosis.
  
  
  METHODS
  A retrospective analysis of consecutive ETGS cases from 2005 to 2013 at a referral center was undertaken.
  
  
  RESULTS
  The mean age was 70 years (range 40-91), and 62 % were hospitalized. The most common indication for ETGS was acute calculus cholecystitis (52 %). Comorbidities precluding cholecystectomy included advanced cancer (45 %), severe cardiopulmonary disease (21 %), and advanced age/frailty (17 %). Eighty-six percent of the patients had an ASA class of III or IV, and the Charlson comorbidity index was >3 in 55 %. An ETGS was successfully placed in 22 patients (76 %) with 18 being successful on the first attempt. A percutaneous rendezvous approach was required to obtain cystic duct access in six patients (21 %). During a mean follow-up of 376 days, a sustained clinical response was noted in 90 % of the patients with a stent placed. No peri-procedural complications were noted. However, two patients developed delayed complications of abdominal pain and cholangitis. Six patients were alive with their original stent still in place at a mean follow-up of 2.5 years.
  
  
  CONCLUSIONS
  ETGS is an effective and safe alternative to cholecystectomy in high-risk patients. Technical success can be facilitated by a percutaneous rendezvous technique. Our data and those of others suggest that scheduled stent exchanges may not be required unless a clinical change occurs.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA, semccart@med.umich.edu.
authors.forename: Sean T
authors.initials: ST
authors.lastname: McCarthy
authors.forename: Shannan
authors.initials: S
authors.lastname: Tujios
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
authors.forename: Sahand
authors.initials: S
authors.lastname: Rahnama-Moghadam
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kwon
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Wamsteker
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Anderson
authors.forename: James M
authors.initials: JM
authors.lastname: Scheiman
authors.forename: Grace H
authors.initials: GH
authors.lastname: Elta
authors.forename: Cyrus R
authors.initials: CR
authors.lastname: Piraka
mesh_terms: D042101:Acalculous Cholecystitis / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents