UTILITY OF TRANSPAPILLARY CHOLECYSTODUODENAL DRAINAGE AS A METHOD FOR PREVENTION OF NEW COMPLICATIONS IN PATIENTS WITH CHOLELITHIASIS ASSOCIATED WITH CHOLEDOCHOLITHIASIS AND HIGH SURGICAL RISK

Aims:

Surgery for biliary disease has changed with the progress of endoscopic techniques. To date, the treatment of choice for symptomatic cholelithiasis and acute cholecystitis is surgical, whereas choledocholithiasis is ERCP. However, in older patients with high surgical risk, cholecystectomy, implies high morbidity and mortality, so other alternatives should be studied.

Methods:

Descriptive, retrospective study of historical cohorts.

Group I: biliary tract was cleaned through ERCP and transpapillary cholecystoduodenal drainage was placed.

Group II: bile duct cleaning is performed through ERCP only.

Results:

Group I: 31 patients, 48% female, mean age 85 ± 7 with a follow-up period of 19 ± 17 months. 8 (27%) patients were re-admitted, 3 (38%) for acute cholecystitis, 2 (25%) for acute cholangitis and 3 (38%) for scheduled cholecystectomy.

Group II: 65 patients, 52% female sex, mean age 82 ± 9 years, with a follow-up period of 25 ± 19 months. 22 (36%) patients were re-admitted, 6 (27%) due to acute cholecystitis, 3 (14%) due to acute cholangitis and 13 (59%) to programmed cholecystectomy.

Complications of the endoscopic procedure:

Group I: none.

Group II: 5 (7%) and 1 (2%) patients presented with upper gastrointestinal bleeding and acute pancreatitis, respectively. In no group there was mortality.

Conclusions:

Our study showed that transpapillary cholecystoduodenal drainage reduces the number of readmissions, mainly for performing scheduled cholecystectomies. So, we believe that it should be considered as an alternative in elderly patients and/or with high surgical risk.