Endoscopic Transpapillary Gallbladder Drainage Reduces the Frequency of Biliopancreatic Events in the Waiting Period for Surgery, Even in Patients without Comorbid Diseases.

Abstract

Introduction: In patients with acute cholecystitis and choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography (ERCP) followed by interval cholecystectomy (6 weeks-3 months), preoperative biliopancreatic events are reported in 18.3-41.8%. Endoscopic transpapillary gallbladder drainage (ET-GBD) is indicated in this patient group if there are comorbidities preventing surgery. This study compared biliopancreatic events during the interval to cholecystectomy in patients who underwent ET-GBD despite being surgically fit versus those treated with ERCP alone.

Methods: In this retrospective study conducted between 2018 and 2023, 121 patients with cholecystitis secondary to choledocholithiasis underwent ERCP. Surgical candidates expected to undergo delayed cholecystectomy were divided into two groups: those who received ET-GBD (study group) and those who did not (control group, from the first half of the study period).

Results: The ET-GBD group had a mean age of 54.54 (56.7% female), while the non-ET-GBD group had a mean age of 63.18 (50% female). During the waiting period, biliopancreatic events occurred in 1/34 (2.9%) of ET-GBD patients versus 18/34 (52.9%) of controls (absolute risk reduction: 50.0%, 95% confidence interval [CI]: 21.8-68.0; relative risk: 0.056, 95% CI: 0.0079-0.39; p < 0.001). Specifically, biliary colic (2.9% vs. 47.1%; p < 0.001), cholecystitis (0% vs. 17.6%; p = 0.009), and choledocholithiasis (0% vs. 26.4%; p = 0.001) were significantly less frequent in the ET-GBD group.

Conclusion: ET-GBD was associated with significantly lower biliopancreatic complications during the interval to surgery in operable patients with acute cholecystitis and choledocholithiasis.