Cystic Duct Stenting vs Other Treatment Modalities for Management of Acute Cholecystitis in Patients With Decompensated Cirrhosis

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: Acute cholecystitis in the setting of decompensated cirrhosis is a feared complication with high morbidity and mortality. We compared outcomes of cystic duct stenting via ERCP to other modalities including percutaneous cholecystostomy, cholecystectomy, and medical management in this setting. Methods: We performed a retrospective cohort study. After obtaining IRB approval, we used International Classification of Diseases- 10th Edition codes to identify patients who presented with acute cholecystitis and had an underlying diagnosis of cirrhosis with MELD-Na of at least 15 or higher from Jan 2015 to Dec 2022 at our center. Primary outcome was 30-day mortality. Our secondary outcomes were 1-year mortality, 30-day readmission and worsening of liver disease as characterized by increasing MELD-Na or new onset ascites or encephalopathy following acute cholecystitis. Results: 368 charts were reviewed to identify 67 patients who met inclusion criteria (clinical evidence and documentation that supported acute cholecystitis in the setting of a MELD-Na ≥15). 19 (28.3%) patients underwent ERCP with cystic duct stenting and were compared to 48 (71.6%) patients who were managed by other modalities: cholecystectomy (n=12), percutaneous cholecystostomy (n=17), supportive care (n=19). The median follow up was 21 months for both groups. There was no major difference in demographics, etiology of cirrhosis, hepatocellular cancer (P=0.37) presence of ascites (P=0.67) and encephalopathy (P=0.54) between the 2 groups. Mean MELD-Na is similar at 22.0 and 22.4 between the 2 groups (P=0.84). Two (10.5%) patients died in the cystic duct stent group due to complications of cirrhosis within 30 days compared to 9 (18.8%) in the control group with a RR 0.91 (confidence interval [CI]: 0.8-1.1, P= 0.71). We found a significant difference in the protective effect of cystic duct stenting compared to other modalities on 1 month readmission rate and decline in liver function with RR of 0.56 (0.4-0.9, P= 0.038) and RR 0.49 (CI 0.3-0.8, P= 0.01) respectively. The only complication in the cystic duct stent group was pancreatitis (n=1, 5.2%) that was managed supportively. Percutaneous cholecystostomy had the highest rates of 30-day readmission (73.3%) and worsening liver function (85.7%) (Table 1). Conclusion: In our cohort, cystic duct stenting via ERCP appears safe and prevents readmissions and further decompensation of liver disease in patients with decompensated cirrhosis who present with acute cholecystitis.

Volume

118

Issue

10

First Page

S957

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