Clin Endosc.  2021 Jul;54(4):589-595. 10.5946/ce.2020.136.

Cholecystitis after Placement of Covered Self-Expandable Metallic Stents in Patients with Distal Malignant Biliary Obstructions

Affiliations
  • 1Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
  • 2Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
  • 3Department of Radiological Advanced Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

Abstract

Background/Aims
Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement.
Methods
We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively.
Results
The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis.
Conclusions
The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.

Keyword

Cholecystitis; Endoscopic retrograde cholangiopancreatography; Malignant biliary obstruction; Risk factors; Self-expandable metallic stents

Figure

  • Fig. 1. Flow of contrast agent into the gallbladder. Flow of the contrast agent into the gallbladder was deemed positive when the contrast agent was observed flowing into the gallbladder or cystic duct on fluoroscopic imaging in endoscopic retrograde cholangiopancreatography.

  • Fig. 2. Tumor invasion to the cystic artery. Tumor invasion to the cystic artery (arrow) was visible on multidetector computed tomography.

  • Fig. 3. Tumor involvement to the orifice of cystic duct. Multidetector computed tomography (A) shows cholangiocarcinoma of the common bile duct (*) and contrast enhancement at the cystic duct (arrow). Infiltration of the tumor from the bile to the cystic duct was visible on intraductal ultrasonography (arrowheads) (B).


Reference

1. Soehendra N, Reynders-Frederix V. Palliative bile duct drainage - a new endoscopic method of introducing a transpapillary drain. Endoscopy. 1980; 12:8–11.
Article
2. Cotton PB. Duodenoscopic placement of biliary prostheses to relieve malignant obstructive jaundice. Br J Surg. 1982; 69:501–503.
Article
3. ASGE Technology Assessment Committee, Pfau PR, Pleskow DK, et al. Pancreatic and biliary stents. Gastrointest Endosc. 2013; 77:319–327.
Article
4. Leung JW. History of bile duct stenting: rigid prostheses. In : Kozarek R, Baron T, Song H-Y, editors. Self-expandable stents in the gastrointestinal tract. New York (NY): Springer;2013. p. 15–31.
5. Almadi MA, Barkun A, Martel M. Plastic vs. self-expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses. Am J Gastroenterol. 2017; 112:260–273.
Article
6. Kitano M, Yamashita Y, Tanaka K, et al. Covered self-expandable metal stents with an anti-migration system improve patency duration without increased complications compared with uncovered stents for distal biliary obstruction caused by pancreatic carcinoma: a randomized multicenter trial. Am J Gastroenterol. 2013; 108:1713–1722.
Article
7. Saleem A, Leggett CL, Murad MH, Baron TH. Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction. Gastrointest Endosc. 2011; 74:321–327.e1-e3.
Article
8. Sogabe Y, Kodama Y, Honjo H, et al. Tumor invasion to the arteries feeding the gallbladder as a novel risk factor for cholecystitis after metallic stent placement in distal malignant biliary obstruction. Dig Endosc. 2018; 30:380–387.
Article
9. Shimizu S, Naitoh I, Nakazawa T, et al. Predictive factors for pancreatitis and cholecystitis in endoscopic covered metal stenting for distal malignant biliary obstruction. J Gastroenterol Hepatol. 2013; 28:68–72.
Article
10. Nakai Y, Isayama H, Kawakubo K, et al. Metallic stent with high axial force as a risk factor for cholecystitis in distal malignant biliary obstruction. J Gastroenterol Hepatol. 2014; 29:1557–1562.
Article
11. 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.
Article
12. 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.
Article
13. Nakai Y, Isayama H, Tsujino T, et al. Intraductal US in the assessment of tumor involvement to the orifice of the cystic duct by malignant biliary obstruction. Gastrointest Endosc. 2008; 68:78–83.
Article
14. Isayama H, Hamada T, Yasuda I, et al. TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc. 2015; 27:259–264.
Article
15. Isayama H, Nakai Y, Toyokawa Y, et al. Measurement of radial and axial forces of biliary self-expandable metallic stents. Gastrointest Endosc. 2009; 70:37–44.
Article
16. Isayama H, Nakai Y, Hamada T, Matsubara S, Kogure H, Koike K. Understanding the mechanical forces of self-expandable metal stents in the biliary ducts. Curr Gastroenterol Rep. 2016; 18:64.
Article
17. Li DF, Zhou CH, Wang LS, Yao J, Zou DW. Is ERCP-BD or EUS-BD the preferred decompression modality for malignant distal biliary obstruction? A meta-analysis of randomized controlled trials. Rev Esp Enferm Dig. 2019; 111:953–960.
Article
18. Kim GH, Ryoo SK, Park JK, et al. Risk factors for pancreatitis and cholecystitis after endoscopic biliary stenting in patients with malignant extrahepatic bile duct obstruction. Clin Endosc. 2019; 52:598–605.
Article
19. Klimczak T, Kaczka K, Klimczak J, Tyczkowska-Sieroń E, Tyczkowska A. Primary bacterial culture of bile and pancreatic juice in tumor related jaundice (TROJ) - is ascending cholangitis always our fault? Scand J Gastroenterol. 2018; 53:1569–1574.
Article
20. Gregg JA, De Girolami P, Carr-Locke DL. Effects of sphincteroplasty and endoscopic sphincterotomy on the bacteriologic characteristics of the common bile duct. Am J Surg. 1985; 149:668–671.
Article
21. Ainley CC, Williams SJ, Smith AC, Hatfield AR, Russell RC, Lees WR. Gallbladder sepsis after stent insertion for bile duct obstruction: management by percutaneous cholecystostomy. Br J Surg. 1991; 78:961–963.
Article
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr