Cystic Duct Stenting Versus Other Treatment Modalities for the Management of Acute Cholecystitis in Patients with Decompensated Cirrhosis.

Abstract

Background and aims: 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. We compared cystic duct stenting (CDS) to other modalities mainly percutaneous cholecystostomy (PC), cholecystectomy, and medical management.

Methodology: We performed a retrospective cohort study. After obtaining IRB approval, we gathered records of all patients at our health care system who had acute cholecystitis on presentation and an underlying diagnosis of cirrhosis with MELD-Na ≥ 15 from 2015 to 2022. Outcomes included 30-day mortality, 60-day mortality, 1-year mortality, 30-day readmission, and worsening liver disease as characterized by increasing MELD-Na by ≥ 3 or new onset ascites or encephalopathy following management.

Results: 67 patients met our inclusion criteria. 19 patients had CDS and were compared to 48 patients managed by other modalities, i.e., cholecystectomy (n = 12), PC (n = 17) and medical management (n = 19). There was no difference in demographics, etiology of cirrhosis, or mean MELD-Na between the two groups. We noticed a significant difference in the protective effect of CDS 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%).

Conclusion: For patients with decompensated cirrhosis who present with acute cholecystitis, CDS via ERCP prevents readmissions and further decompensation of liver disease when compared to other treatment modalities.