Endoscopic transpapillary gallbladder drainage is associated with favorable long-term outcomes in patients with advanced liver disease

Abstract

Background: Endoscopic gallbladder therapy is increasingly used in high-risk surgical patients, but data in advanced liver disease are lacking. Methods: We performed a single center retrospective analysis of patients with cirrhosis undergoing endoscopic transpapillary gallbladder drainage (ET-GBD) with cystic duct stenting (n=55). Short term outcomes were assessed at day 30. Long term outcomes were assessed at 6 months, 1 year, and 3 years or last known follow up. Subgroup analyses were completed by location (inpatient vs. outpatient). Results: A total of 52 patients, mean MELD-Na 16, underwent successful ET-GBD (38 inpatient, 14 outpatient). Most patients (n=48) experienced immediate symptomatic relief. Short-term adverse event rate was 7.7% and 30-day mortality was 1.9%. At 6 months, 86.5% of patients had a favorable outcome; unfavorable outcomes included death (n=2), recurrent cholecystitis and/or need for urgent cholecystectomy (n=5). At the end of the study, 80% of patients experienced a favorable outcome including 5 patients bridged to liver transplant and 20 who had their stent in place with adequate symptom control. Of those with imaging, 65% of patients experienced resolution of cholelithiasis. Recurrent cholecystitis (p=1.00) and stone resolution (p=0.35) did not differ in patients with one or two cystic duct stents in place. Conclusions: Transpapillary gallbladder stenting is technically feasible and associated with high rates of clinical success in patients with decompensated liver disease. Stone resolution is common after transpapillary gallbladder stenting and may portend favorable patient outcomes.