Analysis of Technical Success and Clinical Outcomes in Percutaneous Transpapillary Cystic Duct Stent (PTCDS)

Following placement of percutaneous cholecystostomy tubes for cholecystitis and other causes of biliary obstruction in patients ineligible for surgery, management involves tube removal and risking recurrence, or chronic tube exchanges, which limits patients' quality of life. More recent options include percutaneous or endoscopic cystic duct stent placement, cholelithotomy, Axios stenting, or chemical ablation. This study systemically analyzes the outcomes and causes of technical success rates in PTCDS placements for all causes of cholecystitis in a population larger than previously published.


Materials and Methods:

IRB approved single-institution analysis of 118 pt following PTCDS attempts between September 2018 and September 2024. Patient characteristics, including gender, age, vitals, relevant laboratory values, cystic duct patency, presence of cholelithiasis, anesthesia requirement, and patient outcomes were analyzed.



Results:

At the time of procedure, a total of 86 patients had patent cystic ducts (CD) and normal CD anatomy. In this group, internalization was successful in 82 out of 86 patients (95.3%). In patients with completely obstructed cystic ducts (n = 17), the primary technical success rate was 5.9%, and the secondary success rate upon re-intervention was 28.5%.  In patients with aberrant or complex CD anatomy, the technical success rate was 34.4%.  Given our patient mix, a total of 94 out of 118 final attempts (79.7%) were technically successful. In 45 out of 118 attempts, pre- and post-procedural metabolic panels were obtained. There was a transient increase in AST (p = 0.004), ALT (p = 0.003), alkaline phosphatase (p < 0.001), total bilirubin (p = 0.005), and direct bilirubin (p = 0.002) levels ≤ 72 hours after cystic duct internalization compared to pre-procedure baseline values, which normalized over time. The overall complication rate following technically successful PTCDS was 7.4% including sepsis (5.3%), need for additional intervention (3.2%) or death related to complications within 30 days (1.1%). External drain removal without subsequent recurrent infection or complications was successful in 91.5% of patients.



Conclusion:

Cholecystostomy internalization or PTCDS placement is a technically feasible, safe, and effective treatment for patients who need interval cholecystectomy or are unable to undergo surgical cholecystectomy. The success rates are directly related to CD patency and demonstration of normal anatomy. PTCDS is a viable and increasingly common procedure to avoid long term percutaneous drain thereby improving patients' quality of life.