Late onset pancreatitis 6 months after endoscopic transpapillary gallbladder stenting for acute cholecystitis

Recently, endoscopic transpapillary gallbladder stenting (ETGS) has been proposed as an alternative to percutaneous transhepatic gallbladder drainage in patients with severe critical illness, particularly in the presence of coagulopathy or thrombocytopenia. Although ETGS is reported to be a safe and effective procedure, little information is available regarding its long-term follow-up results and delayed adverse events. Herein, we report the case of a patient who developed late onset pancreatitis following ETGS for acute cholecystitis. A 57-year-old woman with acute cholecystitis was admitted to our department. She underwent long-term anticoagulant therapy owing to a history of severe pulmonary hypertension and pulmonary infarction. We carried out ETGS using a 7-Fr 7-cm-long double pigtail stent (Olympus Medical Systems, Tokyo, Japan) without sphincterotomy (Video S1). The stenting was successful with no adverse events and the symptoms disappeared after the procedure. Although there was no recurrence of cholecystitis following the procedure, the patient was readmitted to our department for acute pancreatitis 6 months later. Computed tomography showed peripancreatic fluid collection. In addition, spontaneous stent distal migration had occurred. From the endoscopic findings, the distally migrated stent was embedded in the mucosa of the anal side of the papilla and induced acute pancreatitis by obstructing the orifice of the papilla (Figs 1,2; Video S2). We immediately removed the gallbladder stent. The patient was admitted to the intensive care unit for 12 days. Thereafter, her pancreatitis improved. To the best of our knowledge, this is the first case of late onset pancreatitis after ETGS. In this case, the pancreatitis was possibly caused by obstruction of the pancreatic duct orifice as a result of stent migration from improvement of gallbladder enlargement after ETGS. Careful long-term follow up must be provided after ETGS. Moreover, the advantages and disadvantages of carrying out sphincterotomy during ETGS must be examined.