Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Gastrointest Endosc. 2010 Mar;71(3):634-40. doi: 10.1016/j.gie.2009.11.024.
Although the definitive therapy of acute cholecystitis is cholecystectomy, nonsurgical treatment such as percutaneous cholecystostomy could be indicated in patients who are unsuitable candidates for cholecystectomy. EUS-guided cholecystoenterostomy with a plastic stent and/or nasobiliary drainage has been proposed as an alternative effective treatment for these patients.
We conducted this study to evaluate the technical feasibility, safety, usefulness, and follow-up results of EUS-guided cholecystoenterostomy with single-step placement of a plastic stent for patients with acute cholecystitis who are unsuitable candidates for cholecystectomy.
A prospective feasibility study with a case series.
Tertiary teaching hospital.
Eight consecutive patients diagnosed with acute cholecystitis who were poor candidates for surgery.
EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent.
Technical success, clinical resolution of acute cholecystitis, procedure-related complications, and recurrence of cholecystitis.
Technical success and clinical resolution were achieved in all patients (100% [8/8] as intent to treat). A transduodenal approach was used for 7 patients and a transgastric approach for 1 patient. One patient showed self-limited pneumoperitoneum, and bile peritonitis occurred in 1 patient. One patient showed distal stent migration without bile leakage 3 weeks after stent insertion. During follow-up periods (median 186 days; range 22-300 days), cholecystitis did not recur in any patients.
Small number of patients.
EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent may be a feasible and useful alternative in patients with acute cholecystitis who are unsuitable candidates for cholecystectomy.
虽然急性胆囊炎的确定性治疗方法是胆囊切除术，但对于不适合胆囊切除术的患者，可以选择经皮胆囊造口术等非手术治疗。超声内镜引导下胆囊-肠吻合术（使用塑料支架和/或鼻胆管引流）已被提议作为这些患者的一种替代有效治疗方法。
我们进行这项研究是为了评估对不适合行胆囊切除术的急性胆囊炎患者行超声内镜引导下胆囊-肠吻合术、一步法置入单根 7F 双猪尾塑料支架的技术可行性、安全性、有效性和随访结果。
前瞻性可行性研究，病例系列。
三级教学医院。
连续 8 例诊断为急性胆囊炎且不适合手术的患者。
超声内镜引导下胆囊-肠吻合术，一步法置入 7F 双猪尾塑料支架。
技术成功率、急性胆囊炎的临床缓解、与操作相关的并发症和胆囊炎复发情况。
所有患者（按意向治疗分析，100%[8/8]）均获得技术成功和临床缓解。7 例患者采用经十二指肠入路，1 例患者采用经胃入路。1 例患者出现自限性气腹，1 例患者发生胆汁性腹膜炎。1 例患者在支架置入后 3 周出现远端支架迁移，但无胆汁漏。在随访期间（中位随访时间 186 天；范围 22-300 天），没有患者出现胆囊炎复发。
患者数量较少。
对于不适合行胆囊切除术的急性胆囊炎患者，超声内镜引导下胆囊-肠吻合术、一步法置入 7F 双猪尾塑料支架可能是一种可行且有效的替代治疗方法。
