Prevention of Cholecystitis in Patients Undergoing ERCP for Malignant Distal Biliary Obstruction Involving the Cystic Duct: A Novel Technique

Cholecystitis following biliary drainage with a self-expandable metallic stent (SEMS) in patients with distal malignant biliary obstruction (MBO) and cystic duct orifice involvement is significant. Interventions such as placing a cystic duct stent during ERCP can decrease the risk. This single-center, randomized, controlled trial investigated whether the placement of an endoscopic ultrasound (EUS)-guided gallbladder drain prevents the occurrence of acute cholecystitis in patients undergoing SEMS biliary decompression for MBO involving the cystic duct. The secondary outcomes were the length of hospitalization and median survival time.

Forty-four patients with MBO and cystic duct involvement were enrolled from July 2018 to July 2020. Twenty-two patients were randomized to the intervention group and were treated with conventional ERCP biliary drainage with SEMS placement, followed by primary EUS-guided gallbladder drainage (EUS-GBD). The other 22 patients (control group) were treated with only conventional biliary drainage. 

No patients in the intervention group versus 5 (22.7%) in the control group developed acute cholecystitis (P=.049). The median hospitalization time was significantly lower in the intervention group than in the control group (1 day vs 2 days; P=.017). There was no difference in the median survival rates between the 2 groups (2.9 months in the intervention group vs 2.8 months in the control group; P=.580).