Endoscopic gallbladder stenting to prevent recurrent cholecystitis in deferred cholecystectomy: a randomized trial

Abstract

Background and aims

Endoscopic transpapillary gallbladder stenting (ETGS) has been proposed as one of the adjunctive treatments, apart from antibiotics, before surgery in patients with acute cholecystitis whose cholecystectomy could not be performed or deferred. Currently, there are no comparative data on the outcomes of ETGS in those who receive and do not receive ETGS. We aimed to compare the rates of recurrent cholecystitis at 3 and 6 months in these two groups.

Methods

Between 2020-2023, eligible acute-calculous-cholecystitis patients with a high probability of common bile duct (CBD) stone, who were surgical candidates but could not have an early cholecystectomy during COVID-19 surgical lockdown, were randomized into groups A (received ETGS) and B (did not receive ETGS). A definitive cholecystectomy was performed at 3 months or later in both groups.

Results

A total of 120 eligible patients were randomized into group A (n=60) and group B (n=60). In group A, technical and clinical success rates were 90% (54/60) and 100% (54/54), respectively. Based on intention-to-treat analysis, group A had a significantly lower rate of recurrence than group B at 3 months [0% (0/60) vs. 18.3% (11/60); p=0.001]. At 3-6 months, group A showed a non-significantly lower rate of recurrent cholecystitis compared to group B [0% (0/32) vs. 10% (3/30); p=0.11].

Conclusions

ETGS could prevent recurrent cholecystitis in acute cholecystitis patients with CBD stone whose cholecystectomy was deferred for 3 months. In those who did not receive ETGS, the majority of recurrences occurred within 3 months. (Thaiclinicaltrials.org, number: TCTR20200913001)