Thailand: Endoscopic transpapillary gallbladder stenting (ETGS) effectively prevents recurrent cholecystitis in patients whose cholecystectomy was deferred for three months, a randomized trial revealed. The findings were published online in the Gastroenterology journal on February 13, 2024.
"ETGS could prevent recurrent cholecystitis in acute cholecystitis patients with common bile duct stone whose cholecystectomy was deferred for three months," Wiriyaporn Ridtitid, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, and colleagues wrote.
"The majority of recurrences occurred within 3 months in patients who did not receive ETGS."
Apart from antibiotics, endoscopic transpapillary gallbladder stenting has been proposed as one of the adjunctive treatments before surgery in patients with acute cholecystitis whose cholecystectomy could not be performed or was deferred. Currently, no comparative data exists on the outcomes of ETGS in those who receive and do not receive ETGS.
Against the above background, the researchers aimed to compare the rates of recurrent cholecystitis at 3 and 6 months in these two groups.
The study included patients with acute calculous cholecystitis having a high probability of common bile duct stones, who were candidates for surgery but could not have an early cholecystectomy during the COVID-19 surgical lockdown. One hundred and twenty eligible patients were randomized into groups A (received ETGS; n=60) and B (did not receive ETGS; n=60). In both groups, a definitive cholecystectomy was performed at 3 months or later.
The following were the study’s main findings:
In group A, technical and clinical success rates were 90% and 100%, respectively.
Based on intention-to-treat analysis, group A had a significantly lower recurrence rate than group B at 3 months (0% versus 18.3%).
At 3-6 months, group A showed a nonsignificantly lower rate of recurrent cholecystitis compared to group B (0% vs 10%).
In conclusion, endoscopic transpapillary gallbladder stenting could prevent recurrent cholecystitis in acute cholecystitis patients with common bile duct stones whose cholecystectomy was deferred for three months.
Reference:
Ridtitid W, Karuehardsuwan J, Faknak N, Piyachaturawat P, Vongwattanakit P, Kulpatcharapong S, Angsuwatcharakon P, Mekaroonkamol P, Kongkam P, Rerknimitr R. Endoscopic Gallbladder Stenting to Prevent Recurrent Cholecystitis in Deferred Cholecystectomy: A Randomized Trial. Gastroenterology. 2024 Feb 14:S0016-5085(24)00169-0. doi: 10.1053/j.gastro.2024.02.007. Epub ahead of print. PMID: 38360274.