GALLBLADDER COMPLICATIONS OF FULLY COVERED SELF-EXPANDING METAL STENTS FOR MALIGNANT BILIARY STRICTURES IN A UK TEACHING HOSPITAL

Aims:

To evaluate cholecystitis and other related complications post-procedure in patients who have a fully covered self-expanding metal stent (fcSEMS) inserted for malignant biliary strictures at ERCP.

Methods:

Retrospective data collection from the ERCP database at Norfolk and Norwich University Hospital from March 2014 to April 2017. Age, indication, aetiology, length of fcSEMS, complications and days post-procedure to complications were recorded, with a maximum of 6 months follow-up post-procedure.

Results:

103 patients had a fcSEMS inserted. Median age was 73 years old (range 41 – 96). ERCP was performed as an elective procedure (71/103) or as an emergency (32/103). Most common aetiology was pancreatic cancer (80/103). Length of stent used was 6 cm (76/103) and 8 cm (27/103).

Excluding 9 patients who had a previous cholecystectomy, 8.51% (8/94) of patients developed cholecystitis, developing this in a median of 16.5 days post-procedure. 3/9 of these patients developed gallbladder empyema which were drained percutaneously. 4/9 patients developed gallbladder perforation which were all managed conservatively. 1 patient suffered acute demise due to complications despite active management.

There was no statistically significant increase in cholecystitis rates regardless of age, aetiology, length of stent or presence or absence of gallstones.

Conclusions:

Caution needs to be exercised when placing fcSEMS for malignant strictures due to a significant risk of cholecystitis and its associated complications. Previous studies have suggested tumour involvement of the cystic duct orifice increases rates of cholecystitis post fcSEMS insertion; we do not routinely review this on radiological imaging or cholangiogram. This should be considered in the future prior to placing a fcSEMS. Other options include placement of a 10 Fr plastic stent instead of a metal stent.