Takasawa Osamu, Fujita Naotaka, Noda Yutaka, Kobayashi Go, Ito Kei, Horaguchi Jun, Obana Takashi
Department of Gastroenterology, Sendai City Medical Center, Miyagino-ku, Sendai, Japan.
Dig Endosc. 2009 Jan;21(1):43-7. doi: 10.1111/j.1443-1661.2008.00822.x.
Endosonography-guided biliary drainage (ESBD) is gaining acceptance as an effective treatment for obstructive jaundice. Only a few reports on the application of this technique to the gallbladder (endosonography-guided gallbladder drainage [ESGBD]) have been published in the literature. In order to relieve acute cholecystitis which developed in a patient with unresectable malignant biliary obstruction after deployment of a covered metal stent (CMS), we applied this technique. ESGBD was carried out by using an electronic curved linear array echoendoscope. After visualization of the gallbladder and determination of the puncture route, a needle knife papillotome was advanced with electrocautery to pierce the gastric and gallbladder walls. Under the guidance of a guidewire inserted through the needle sheath into the gallbladder, a 7.2 Fr, 30 cm-long, single pigtail plastic tube was placed to bridge the gallbladder and the stomach. No complications relevant to the procedure were encountered. ESGBD was quite effective in ameliorating the patient's acute cholecystitis and the drainage tube was removed after 10 days without sequelae. Acute cholecystitis following CMS deployment is considered to be a good indication for ESGBD.
内镜超声引导下胆道引流术（ESBD）作为一种治疗梗阻性黄疸的有效方法正逐渐被认可。关于该技术应用于胆囊（内镜超声引导下胆囊引流术[ESGBD]）的报道在文献中仅有少数几篇。为缓解一名不可切除恶性胆道梗阻患者在置入覆膜金属支架（CMS）后发生的急性胆囊炎，我们应用了该技术。ESGBD通过使用电子弯曲线阵超声内镜进行。在观察到胆囊并确定穿刺路径后，用针刀乳头切开器通电推进以穿透胃壁和胆囊壁。在通过针鞘插入胆囊的导丝引导下，置入一根7.2 Fr、30 cm长的单猪尾塑料引流管以连接胆囊和胃。未遇到与该操作相关的并发症。ESGBD在改善患者急性胆囊炎方面相当有效，引流管在10天后拔除，无后遗症。CMS置入后发生的急性胆囊炎被认为是ESGBD的良好适应证。
