title: Transpapillary Gallbladder Stents Can Stabilize or Improve Decompensated Cirrhosis in Patients Awaiting Liver Transplantation.
abstract: OBJECTIVE
  To describe the short-term and long-term outcomes in 34 consecutive decompensated cirrhotic patients with symptomatic gallbladder disease undergoing transpapillary gallbladder stent (TGS) placement.
  
  
  BACKGROUND
  Endoscopic TGS placement is a minimally invasive means of treating symptomatic gallbladder disease in poor surgical candidates.
  
  
  METHODS
  Between June 2005 and June 2011, 34 patients with cirrhosis and symptomatic gallbladder disease underwent attempted TGS placement.
  
  
  RESULTS
  Median patient age was 52 years, 56% were hospitalized, and 48% were listed for liver transplantation. The median model for end-stage liver disease (MELD) score was 15 (range, 6 to 40) and 88% were Child-Turcotte-Pugh class B/C. A double pigtailed stent was successfully placed in 94% of the patients. At 1-month follow-up, clinical improvement was noted in 82% of the treated subjects and the MELD scores in 14 of 22 (64%) evaluable subjects improved or stabilized. Actuarial transplant-free survival was 53% in the liver transplant candidates with a mean follow-up of 352 days, whereas survival was 44% in the 18 nontransplant candidates with a mean follow-up of 1.5 years. Periprocedural complications included pancreatitis in 5 patients, cholangitis in 3, and 1 patient with cystic duct perforation. In addition, 2 subjects had symptomatic bleeding from traumatic duodenal ulcerations 2 years after TGS placement that necessitated stent removal.
  
  
  CONCLUSIONS
  Endoscopic TGS placement was technically feasible in 94% of decompensated cirrhotics and was associated with a relatively low rate of periprocedural (26%) and long-term complications (6%). Stabilization or improvement in clinical status and MELD scores was seen in the majority of treated patients.
authors.affiliation: *Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas †Department of Internal Medicine, University of Texas at San Antonio, San Antonio, TX ‡Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor ∥Department of Internal Medicine, Division of Gastroenterology, Henry Ford Hospital, Detroit, MI §Department of Gastroenterology & Hepatology, St Louis University, St Louis, MO.
authors.forename: Shannan R
authors.initials: SR
authors.lastname: Tujios
authors.forename: Sahand
authors.initials: S
authors.lastname: Rahnama-Moghadam
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Elmunzer
authors.forename: Richard
authors.initials: R
authors.lastname: Kwon
authors.forename: Amit G
authors.initials: AG
authors.lastname: Singal
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Anderson
authors.forename: Erik-Jan
authors.initials: EJ
authors.lastname: Wamsteker
authors.forename: Jason R
authors.initials: JR
authors.lastname: Taylor
authors.forename: James
authors.initials: J
authors.lastname: Scheiman
authors.forename: Grace
authors.initials: G
authors.lastname: Elta
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
authors.forename: Cyrus R
authors.initials: CR
authors.lastname: Piraka
mesh_terms: D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder / Q000473:pathology / Q000601:surgery; D005705:Gallbladder Diseases / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult