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Received May 29, 2017; Revised Dec 19, 2017; Accepted Jan 14, 2018
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Laparoscopic cholecystectomy is currently the standard treatment for patients with early stage acute cholecystitis [1, 2]. Cholecystectomy is a commonly performed and safe procedure; however, invasive surgery is sometimes contraindicated in high-risk patients with complex comorbidities such as severe coagulopathy or poor performance status [3]. Moreover, although percutaneous transhepatic gallbladder aspiration/drainage (PTGBA/D) is considered a temporary therapy aimed at decompressing the gallbladder, the percutaneous transhepatic approach is controversial in patients at high risk of intra-abdominal bleeding or of removing their drainage tubes themselves [4–7]. Thus, endoscopic transpapillary gallbladder drainage (ETGBD) has recently been proposed as an alternative procedure for high-risk patients with acute cholecystitis [8–12]. ETGBD generally involves endoscopic nasotranspapillary gallbladder drainage and endoscopic transpapillary gallbladder stenting (ETGBS) without risks of tube self-withdrawal. In particular, ETGBS has been adopted as the initial approach in high-risk patients with acute cholecystitis or in patients with end-stage liver disease related to advanced cancer or those awaiting liver transplantation [13–19]. However, ETGBS has a mild risk of related pancreatitis due to the transpapillary approach, and conservative therapy may sometimes be curative for acute cholecystitis without the need for additional therapy. Accordingly, ETGBS may be a suitable option for recurrent cholecystitis (RC) after conservative treatment with antibiotics or PTGBA/D. Few studies have reported the long-term clinical outcomes of ETGBS for the prevention of RC. Hence, this retrospective study aimed to assess the clinical efficacy and long-term outcomes of ETGBS after initial conventional therapy in surgically high-risk patients with RC.
2. Methods
2.1. Patients
This retrospective study was conducted at a single center, Kagawa University Hospital. Data on 19 high-risk patients who had undergone ETGBS for RC after initial conservative therapy in our institution between June 2006 and May 2012 were retrospectively examined. Patient characteristics, including age, comorbidities (benign and malignant), physical status, presence of dementia, severity of cholecystitis, and therapy prior to ETGBS, were collected. The inclusion criteria were high-risk patients with RC within 2 months after conservative treatment with antibiotics or PTGBA/D for first episodes...