Tumor invasion to the arteries feeding the gallbladder as a novel risk factor for cholecystitis after metallic stent placement in distal malignant biliary obstruction

Dig Endosc. 2018 May;30(3):380-387. doi: 10.1111/den.12991. Epub 2017 Dec 21.

Abstract

Background and aim: Cholecystitis is a major complication after self-expandable metallic stent (SEMS) placement for malignant biliary obstruction. Ischemia is one of the risk factors for cholecystitis, but little is known about the influence of tumor invasion to the feeding artery of the gallbladder on the onset of cholecystitis after SEMS placement. The aim of the present study was to identify risk factors for cholecystitis after SEMS placement.

Methods: Incidence and nine predictive factors of cholecystitis were retrospectively evaluated in 107 patients who underwent SEMS placement for unresectable distal malignant biliary obstruction at Kyoto University Hospital and Otsu Red Cross Hospital between January 2012 and June 2016.

Results: Cholecystitis occurred in 13 of 107 patients (12.1%) after SEMS placement during the median follow-up period of 262 days. Univariate analyses showed that tumor invasion to the feeding artery of the gallbladder and tumor involvement to the orifice of the cystic duct were significant predictors of cholecystitis (P = 0.001 and P < 0.001). Multivariate analysis confirmed that these two factors were significant and independent risks for cholecystitis with odds ratios of 22.13 (95% CI, 3.57-137.18; P = 0.001) and 25.26 (95% CI, 4.12-154.98; P < 0.001), respectively.

Conclusions: This study showed for the first time that tumor invasion to the feeding artery of the gallbladder as well as tumor involvement to the orifice of the cystic duct are independent risk factors for cholecystitis after SEMS placement.

Keywords: cholecystitis; distal malignant bile duct obstruction; ischemia; self-expandable metallic stent; tumor invasion to the feeding artery of the gallbladder.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cholecystitis / epidemiology*
  • Cholestasis / etiology
  • Cholestasis / surgery*
  • Female
  • Gallbladder / blood supply*
  • Gallbladder / pathology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Pancreatic Neoplasms / pathology*
  • Pancreatic Neoplasms / surgery
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Risk Factors
  • Self Expandable Metallic Stents / adverse effects*