Transpapillary Gallbladder Stents Can Stabilize or Improve Decompensated Cirrhosis in Patients Awaiting Liver Transplantation. Issue 9 (October 2015)

• Record Type: Journal Article
• Authors: Tujios, Shannan R.; Rahnama-Moghadam, Sahand; Elmunzer, Joseph B.; Kwon, Richard; Singal, Amit G.; Anderson, Michelle A.; Wamsteker, Erik-Jan; Taylor, Jason R.; Scheiman, James; Elta, Grace; Fontana, Robert J.; Piraka, Cyrus R.
• Is Part Of: Journal of clinical gastroenterology. Volume 49:Issue 9(2015)
• Publication Date: 2015-10
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Digestive organs -- Diseases; Gastroenterology; Periodicals; Periodicals; 616.33005
• DOI: 10.1097/MCG.0000000000000269
• Languages: English
• ISSNs: 0192-0790

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Goals:</title> <p>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.</p> </sec> <sec> <title>Background:</title> <p>Endoscopic TGS placement is a minimally invasive means of treating symptomatic gallbladder disease in poor surgical candidates.</p> </sec> <sec> <title>Study:</title> <p>Between June 2005 and June 2011, 34 patients with cirrhosis and symptomatic gallbladder disease underwent attempted TGS placement.</p> </sec> <sec> <title>Results:</title> <p>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.</p> </sec> <sec> <title>Conclusions:</title> <p>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.</p> </sec> </abstract>