Abstract
BACKGROUND: Patients with cholecystitis and underlying cirrhosis represent a high-risk group for surgical intervention. In patients otherwise meriting an endoscopic retrograde cholangiopancreatography (ERCP), endoscopic transpapillary gallbladder stenting (ETGS) can serve as a bridge to cholecystectomy while awaiting liver transplant or provide long-term gallbladder (GB) drainage in those who are not surgical candidates. We evaluated the technical feasibility, clinical outcomes and safety of ETGS for complicated cholecystitis in patients with cirrhosis and high surgical risk. METHODS: Data of all adult cirrhotic patients with complicated cholecystitis who underwent ETGS between January 2021 and March 2025 were reviewed. Primary indication for ERCP was choledocholithiasis with or without cholangitis. Primary outcome was technical success of ETGS (successful deployment of at least one GB stent). Secondary outcomes included procedure time, safety, clinical success (symptom resolution with improvement in laboratory parameters within 72-h of stent insertion), symptom recurrence, 6-month and 12-month biliary event-free survival, and differences in outcomes among patients with one or two GB stents. RESULTS: Among 40 patients (age: 56.9 ± 14.3 years, 62.5% females, model for end-stage liver disease score: 16.4) with cirrhosis taken up for ETGS, technical success was achieved in 34 (85%) patients. Among those with technical success, clinical success was achieved in 33 (97%) patients. One and two 7-Fr double-pigtail plastic stents were deployed in 13 (38.2%) and 21 (61.8%) patients, respectively. Elective stent exchanges were not done. The median follow-up duration was 13.5 (11-18) months. One (2.9%) patient had recurrent cholecystitis at 5 months. The 6- and 12-month biliary event-free survival rates were 94% and 86.7%, respectively. No significant difference in clinical success, symptom recurrence, or 6- and 12-month survival was observed among patients with one or two stents. Mild (grade I as per the Adverse events GastRointEstinal Endoscopy classification) procedure-related adverse events occurred in two (5%) patients. CONCLUSION: ETGS is a technically feasible and safe, therapeutic option for complicated cholecystitis in cirrhotic patients with high clinical success and favourable intermediate-term outcomes.