2026 Volume 68 Issue 7 Pages 1339-1349
Objectives: Surgery is generally the first choice of treatment for gangrenous cholecystitis (GC). However, some patients are not fit for surgery because of their comorbidities. We evaluated the feasibility of endoscopic transpapillary gallbladder drainage (ETGBD) for GC in poor surgical candidates.
Methods: This retrospective study compared the outcomes of ETGBD for acute cholecystitis (AC) with and without complicated GC. Of the 136 patients who underwent ETGBD for AC at a single tertiary referral center between January 2019 and July 2023, 91 who underwent contrast-enhanced computed tomography (CT) before ETGBD were included in the analysis.
Results: Patients were assigned to the GC (n=29) and non-GC (n=62) groups based on CT findings. The technical success rate of ETGBD, clinical success rate for AC, and rate of early adverse events (AEs) in the GC and non-GC groups were 86.2% vs. 91.9% (P=0.63), 79.3% vs. 91.9% (P=0.17), and 27.6% vs. 16.1% (P=0.32), respectively. The technical and clinical success rates were slightly lower, while the early AE rate was higher in the GC group. However, the differences were not significant. The incidence of late AEs was 15.8% in the GC group and 17.9% in the non-GC group, with no significant difference (P= 0.87). Elective cholecystectomy was significantly less frequent in the GC group (P=0.023).
Conclusion: ETGBD is a feasible treatment option for GC in patients contraindicated for surgery
