CYSTIC DUCT STENTING VERSUS OTHER TREATMENT MODALITIES FOR MANAGEMENT OF ACUTE CHOLECYSTITIS IN PATIENTS WITH DECOMPENSATED CIRRHOSIS

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

Gastrointest Endosc

Abstract

Introduction: The incidence of cholecystitis and cholelithiasis is higher in patients with cirrhosis. Decompensated liver disease places them at higher risk for morbidity and mortality from cholecystectomy and many providers prefer non-surgical approaches to management. We compared cystic duct stenting to other modalities mainly percutaneous cholecystostomy, cholecystectomy, and conservative medical management. Methodology: We performed a retrospective cohort study. After obtaining IRB approval, we pulled records of all the patients at our multicenter health care system who had acute cholecystitis on initial presentation and had an underlying diagnosis of cirrhosis with MELD-Na of at least 15 or higher from Jan 2015 to Dec 2022. Each chart was then individually reviewed. Our 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 management. Results: 368 patients had initial presentation concerning acute cholecystitis and underlying cirrhosis. Of them, n=67 met our inclusion criteria where all evidence and clinical documentation agreed upon acute cholecystitis and MELD-Na ≥15. 19 patients had cystic duct stenting and were compared to 48 patients who were managed by other modalities i.e. cholecystectomy (n=12), percutaneous cholecystostomy (n=17), antibiotics and other supportive care (n=19). No major difference in demographics or etiology of cirrhosis between the two groups. Hepatocellular cancer was present in 15.8% patients in the cystic duct stent group compared to 8.3% patients in the control group. Ascites and encephalopathy were present in 68.4% and 36.8% patients in the cystic duct stent group and a similar number in the control group. Mean MELD-Na is similar at 22.0 and 22.4 between the two groups. 52.6% cystic duct stenting patients were initially displaying signs of sepsis compared to 58.3% of control group. Roughly half the patients in both groups had acute cholecystitis corroborated by positive HIDA. 2 (10.5%) patients died in the cystic duct stent group within 30 days compared to 9 (18.8%) in the control group with a RR 0.91 (CI: 0.8-1.1, P= 0.71). We did notice a significant difference in the protective effect of cystic duct stenting compared to other modalities on one month readmission rate and 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 one case of pancreatitis (5.2%) that was managed supportively. Conclusion: For patients with decompensated cirrhosis who present with acute cholecystitis, cystic duct stenting via ERCP appears safer and prevents readmissions and further decompensation of liver disease when compared to other treatment modalities.

Volume

99

Issue

6

First Page

AB651

Last Page

AB652

Find It @ Sladen

Share

COinS