P2281 - Cystic Duct Stenting vs Other Treatment Modalities for Management of Acute Cholecystitis in Patients With Decompensated Cirrhosis

Award: Presidential Poster Award

Muhammad Salman Faisal, MD¹, Taha Ashraf, MD¹, Kevin Harris, MD², Muhammad Zarrar Khan, MD², Ammad Chaudhary, MD², Andrew Watson, MD², Duyen Dang, MD², Robert Pompa, MD², Mazen Elatrache, MD², Cyrus Piraka, MD², Sumit Singla, MD², Tobias Zuchelli, MD^2
1Henry Ford Health System, Detroit, MI; ²Henry Ford Hospital, Detroit, MI

Introduction: Acute cholecystitis in the setting of decompensated cirrhosis is a feared complication with high morbidity and mortality. We compared outcomes of cystic duct stenting via ERCP to other modalities including percutaneous cholecystostomy, cholecystectomy, and medical management in this setting.

Methods: We performed a retrospective cohort study. After obtaining IRB approval, we used ICD-10 codes to identify patients who presented with acute cholecystitis and had an underlying diagnosis of cirrhosis with MELD-Na of at least 15 or higher from Jan 2015 to Dec 2022 at our center. Primary outcome was 30-day mortality. Our secondary outcomes were 1-year mortality, 30-day readmission and worsening of liver disease as characterized by increasing MELD-Na or new onset ascites or encephalopathy following acute cholecystitis.

Results: 368 charts were reviewed to identify 67 patients who met inclusion criteria (clinical evidence and documentation that supported acute cholecystitis in the setting of a MELD-Na ≥15). 19 (28.3%) patients underwent ERCP with cystic duct stenting and were compared to 48 (71.6%) patients who were managed by other modalities: cholecystectomy (n=12), percutaneous cholecystostomy (n=17), supportive care (n=19). The median follow up was 21 months for both groups. There was no major difference in demographics, etiology of cirrhosis, hepatocellular cancer(p=0.37) presence of ascites (p=0.67) and encephalopathy (p=0.54) between the two groups. Mean MELD-Na is similar at 22.0 and 22.4 between the two groups (p=0.84). 2 (10.5%) patients died in the cystic duct stent group due to complications of cirrhosis within 30 days compared to 9 (18.8%) in the control group with a RR 0.91 (CI: 0.8-1.1, p= 0.71). We found a significant difference in the protective effect of cystic duct stenting compared to other modalities on one month readmission rate and decline in liver function with RR of 0.56 (0.4-0.9, P= 0.038) and RR 0.49 (CI 0.3-0.8, P= 0.01) respectively. The only complication in the cystic duct stent group was pancreatitis (n=1, 5.2%) that was managed supportively. Percutaneous cholecystostomy had the highest rates of 30-day readmission (73.3%) and worsening liver function (85.7%).

Discussion: In our cohort, cystic duct stenting via ERCP appears safe and prevents readmissions and further decompensation of liver disease in patients with decompensated cirrhosis who present with acute cholecystitis.


Disclosures:


Muhammad Salman Faisal, MD¹, Taha Ashraf, MD¹, Kevin Harris, MD², Muhammad Zarrar Khan, MD², Ammad Chaudhary, MD², Andrew Watson, MD², Duyen Dang, MD², Robert Pompa, MD², Mazen Elatrache, MD², Cyrus Piraka, MD², Sumit Singla, MD², Tobias Zuchelli, MD². P2281 - Cystic Duct Stenting vs Other Treatment Modalities for Management of Acute Cholecystitis in Patients With Decompensated Cirrhosis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.