Stenting of the cystic duct: a possible bridge to laparoscopic cholecystectomy?

Purpose There have been very few case reports describing cystic duct stent insertion in the management of acute cholecystitis secondary to benign disease with no case series published to date. Both Gatenby et al and Comin et al describe only a single case. We present our series demonstrating the role of cystic duct stents in managing gallbladder disease in those patients unfit for surgery. Materials and Methods 14 patients in our institution underwent cystic duct stent insertion for the management of acute cholecystitis in the period June 2008 to June 2012. Patients underwent a mixture of direct and transhepatic gallbladder puncture. The cystic duct was cannulated with a hydrophilic guidewire which was subsequently passed through the common bile duct and into the duodenum. An 8Fr double pigtail stent was placed with the distal end lying within the duodenum and the proximal end within the gallbladder. Results 6 patients presented with gallbladder perforation, 7 patients presented with gallbladder empyema/severe cholecystitis and 1 with necrotsing pancreatitis. We experienced a 93% technical success rate. Clinical follow up revealed all technical successes did well post procedure with symptom resolution. 1 patient developed acute pancreatitis post procedure. None have experienced any subsequent episodes of acute cholecystitis (follow-up 14 days - 48 months). Conclusion Cystic duct stent insertion can be successfully used to manage acute cholecystitis/gallbladder empyema or gallbladder perforation in those unfit for surgery and should be considered alongside external gallbladder drainage. We hope to further refine this technique for use in patients fit for surgery as a bridge to laparoscopic cholecystectomy.