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Title: Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell

Abstract

PurposeThere have been 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. We present our series demonstrating the role of cystic duct stents in managing benign gallbladder disease in those patients unfit for surgery.Materials and MethodsThirty three patients unfit for surgery in our institution underwent cystic duct stent insertion for the management of acute cholecystitis in the period June 2008 to June 2013. Patients underwent a mixture of transperitoneal 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 12-cm double-pigtail stent was placed with the distal end lying within the duodenum and the proximal end within the gallbladder.ResultsTen patients presented with gallbladder perforation, 21 patients with acute cholecystitis, 1 with acute cholangitis and 1 with necrotising pancreatitis. The technical success rate was 91 %. We experienced a 13 % complication rate with 3 % mortality rate at 30 days.ConclusionCystic duct stent insertion can be successfully used to manage acute cholecystitis, gallbladder empyema or gallbladder perforations in those unfit for surgery and should be considered alongside external gallbladder drainage asmore » a definitive mid-term treatment option.« less

Authors:
 [1];  [2]; ;  [1]
  1. Sheffield Teaching Hospitals NHS Trust, Department of Radiology, Northern General Hospital (United Kingdom)
  2. Sheffield Teaching Hospitals NHS Trust, Sheffield Vascular Institute (United Kingdom)
Publication Date:
OSTI Identifier:
22469884
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 38; Journal Issue: 4; Other Information: Copyright (c) 2015 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BILIARY TRACT; DIGESTIVE SYSTEM DISEASES; DUCTS; MORTALITY; PANCREAS; PATIENTS; PERFORATION; SMALL INTESTINE; SURGERY

Citation Formats

Hersey, N., E-mail: naomi.hersey@sth.nhs.uk, Goode, S. D., E-mail: s.goode@sheffield.sc.uk, Peck, R. J., E-mail: robert.peck@sth.nhs.uk, and Lee, F., E-mail: fred.lee@sth.nhs.uk. Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell. United States: N. p., 2015. Web. doi:10.1007/S00270-014-1014-Y.
Hersey, N., E-mail: naomi.hersey@sth.nhs.uk, Goode, S. D., E-mail: s.goode@sheffield.sc.uk, Peck, R. J., E-mail: robert.peck@sth.nhs.uk, & Lee, F., E-mail: fred.lee@sth.nhs.uk. Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell. United States. doi:10.1007/S00270-014-1014-Y.
Hersey, N., E-mail: naomi.hersey@sth.nhs.uk, Goode, S. D., E-mail: s.goode@sheffield.sc.uk, Peck, R. J., E-mail: robert.peck@sth.nhs.uk, and Lee, F., E-mail: fred.lee@sth.nhs.uk. Sat . "Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell". United States. doi:10.1007/S00270-014-1014-Y.
@article{osti_22469884,
title = {Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell},
author = {Hersey, N., E-mail: naomi.hersey@sth.nhs.uk and Goode, S. D., E-mail: s.goode@sheffield.sc.uk and Peck, R. J., E-mail: robert.peck@sth.nhs.uk and Lee, F., E-mail: fred.lee@sth.nhs.uk},
abstractNote = {PurposeThere have been 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. We present our series demonstrating the role of cystic duct stents in managing benign gallbladder disease in those patients unfit for surgery.Materials and MethodsThirty three patients unfit for surgery in our institution underwent cystic duct stent insertion for the management of acute cholecystitis in the period June 2008 to June 2013. Patients underwent a mixture of transperitoneal 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 12-cm double-pigtail stent was placed with the distal end lying within the duodenum and the proximal end within the gallbladder.ResultsTen patients presented with gallbladder perforation, 21 patients with acute cholecystitis, 1 with acute cholangitis and 1 with necrotising pancreatitis. The technical success rate was 91 %. We experienced a 13 % complication rate with 3 % mortality rate at 30 days.ConclusionCystic duct stent insertion can be successfully used to manage acute cholecystitis, gallbladder empyema or gallbladder perforations in those unfit for surgery and should be considered alongside external gallbladder drainage as a definitive mid-term treatment option.},
doi = {10.1007/S00270-014-1014-Y},
journal = {Cardiovascular and Interventional Radiology},
number = 4,
volume = 38,
place = {United States},
year = {Sat Aug 15 00:00:00 EDT 2015},
month = {Sat Aug 15 00:00:00 EDT 2015}
}
  • We present a patient with hepatocellular carcinoma accompanied by portal vein and bile duct tumor thrombi. The patient was treated with a spiral Z-stent covered by a polyethylene sheet placed in the bile duct, a Wallstent placed in the portal vein, chemoembolization, and external radiation therapy. The patient is alive with patency of both endoprostheses 18 months later.
  • We report the successful management of acute cholecystitis using cystic duct stent placement in 3 patients with inoperable malignant cystic duct obstruction (2 cholangiocarcinoma and 1 pancreatic carcinoma). All patients underwent stent placement in the bile duct, using an uncovered stent in 2 and a covered stent in 1, to relieve jaundice occurring 8-184 days (mean 120 days) before the development of acute cholecystitis. The occluded cystic duct was traversed by a microcatheter and a stent was implanted 4-17 days (mean 12 days) after cholecystostomy. Acute cholecystitis was improved after the procedure in all patients. Two patients died 3 andmore » 10 months later, while 1 has survived without cholecystitis for 22 months after the procedure to date.« less
  • No abstract prepared.
  • Benign biliary strictures (BBS) are difficult to treat. The majority of them are treated either endoscopically or using percutaneous techniques either with stents or conventional angioplasty balloons. To our knowledge we present the first case of use of a cutting balloon in the treatment of BBS through a percutaneous approach.
  • Purpose: More than 70% of Ewing tumors occur in the extremities and pelvis. This study identified factors influencing local control and functional outcomes after management with definitive radiotherapy (RT). Patients and Methods: A total of 75 patients with a localized Ewing tumor of the extremity or pelvis were treated with definitive RT at the University of Florida between 1970 and 2006 (lower extremity tumors in 30, pelvic tumors in 26, and upper extremity tumors in 19). RT was performed on a once-daily (40%) or twice-daily (60%) basis. The median dose was 55.2 Gy in 1.8-Gy daily fractions or 55.0 Gymore » in 1.2-Gy twice-daily fractions. The median observed follow-up was 4.7 years. Functional outcome was assessed using the Toronto Extremity Salvage Score. Results: The 10-year actuarial overall survival, cause-specific survival, freedom from relapse, and local control rate was 48%, 48%, 42%, and 71%, respectively. Of the 72 patients, 3 required salvage amputation. Inferior cause-specific survival was associated with larger tumors (81% for tumors <8 cm vs. 39% for tumors {>=}8 cm, p <0.05). No patient characteristics or treatment variables were predictive of local failure. No fractures occurred in patients treated with hyperfractionation or with tumors of the distal extremities. Severe late complications were more frequently associated with use of <8-MV photons and fields encompassing the entire bone or hemipelvis. A significantly better Toronto Extremity Salvage Score was associated with a late-effect biologically effective dose of <91.7 Gy{sub 3}. Conclusions: Limb preservation was effectively achieved through definitive RT. Treating limited field sizes with hyperfractionated high-energy RT could minimize long-term complications and provides superior functional outcomes.« less