RISK OF CHOLECYSTITIS WITH PLACEMENT OF FULLY COVERED METAL BILIARY STENT: REAL WORLD EXPERIENCE FROM A TERTIARY CARE REFERRAL CENTER

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

Gastrointest Endosc

Abstract

Introduction: Fully covered self-expanding metal stents are indicated for management of benign and malignant biliary conditions including stone disease, biliary stricture, post sphincterotomy bleeding and others. There is often a concern for precipitating cholecystitis due to jailing off of cystic duct with placement of these stents. We aimed to assess the true rate of cholecystitis with placement of these stents and factors contributing to its development. Methods: After approval of local IRB, we used the relevant ICD-10 and billing codes to extract charts for all the patients who were diagnosed with acute cholecystitis within 12 months following ERCP with covered metal stent placement at our center. We excluded patients who had pre-existing diagnosis of cholecystitis, had prior partial or complete cholecystectomy or percutaneous cholecystostomy tube. Data regarding demographics, procedural characteristics, types of stents, and timing of cholecystitis were obtained. We then performed a binary logistic regression analysis to assess the impact of age, underlying pancreaticobiliary malignancy and stent size (40 mm versus longer stents) on rate of cholecystitis. Results: We reviewed 305 patient charts who met the inclusion criteria. Mean age was 65.44 +/- 13.4 years. Forty four percent of our population was female and 46.7% Caucasian. Indication for covered metal stent placement included: stone disease (12.4%), benign stricture (24.5%), malignant stricture (43.8%), post-sphincterotomy bleeding (7.8%). Bile duct was dilated in 77.6% of cases. Most common diameter of the stent deployed was 10 mm in 96.7% of procedures. Most common length of the stent was 60 mm in 60.8% and 40 mm in 31.0%. Anchoring plastic stents were placed in 21.9% of procedures. Main complications encountered were pancreatitis in 9.5%, bleeding in 5.2%, perforation in 0.3% and cholangitis in 8.2%. Cholecystitis was diagnosed in 9.2% of patients following covered metal stent placement mostly in the first three months following the procedure (6.2%). On logistic regression analysis, age (OR 1.02 CI 0.99-1.05), underlying pancreaticobiliary malignancy (OR 1.36 CI 0.58-3.15) and length of the covered metal stent, 40 mm versus longer stents (OR 0.77 CI 0.31-1.92), and dilated duct (OR 0.86 CI 0.23-3.18) were all not found to be significant contributors to development of cholecystitis following ERCP. Conclusion: Acute cholecystitis is a feared complication due to jailing of the cystic duct with placement of covered metal biliary stent and it can occur in 9.2% of the cases as shown in our study. Patient age, underlying malignancy, bile duct dilation and length of the stent do not appear to significantly impact the outcome.

Volume

99

Issue

6

First Page

AB696

Last Page

AB697

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