Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea.
Gastrointest Endosc. 2011 Jul;74(1):176-81. doi: 10.1016/j.gie.2011.03.1120.
Although early laparoscopic cholecystectomy is the treatment of choice for patients with acute cholecystitis, percutaneous cholecystostomy has been performed in patients unsuitable for cholecystectomy. EUS-guided transgastric/transduodenal gallbladder drainage by using a plastic stent and/or nasobiliary drainage may be an alternative effective treatment for these patients, but bile leakage into the peritoneal space causing bile peritonitis is not uncommon during placement of a plastic stent.
To evaluate the technical feasibility and safety of EUS-guided transgastric/transduodenal gallbladder drainage with single-step placement of a modified covered self-expandable metal stent (CSEMS) in patients with acute cholecystitis who are unsuitable for cholecystectomy.
Prospective feasibility study.
Tertiary-care referral center.
This study involved 15 patients with acute cholecystitis who did not respond to initial medical treatment and were unsuitable for cholecystectomy.
EUS-guided transgastric/transduodenal gallbladder drainage with single-step placement of a modified CSEMS.
Technical success, functional success, complications associated with the placement of a metal stent, and recurrence of acute cholecystitis.
Modified CSEMSs were successfully placed in all patients through the stomach (n = 10) or duodenum (n = 5). All patients achieved functional success within 3 days of metal stent placement. Pneumoperitoneum occurred in two patients during or after the procedure, but both patients improved with conservative management. During follow-up (median 145 days, range 60-297 days), no patient experienced recurrent cholecystitis.
Small patient population without long-term follow-up.
Placement of a modified CSEMS after EUS-guided transgastric/transduodenal gallbladder drainage may be a feasible and safe alternative to treatments such as percutaneous cholecystostomy in patients with acute cholecystitis who are unsuitable for cholecystectomy.
尽管早期腹腔镜胆囊切除术是治疗急性胆囊炎的首选方法，但对于不适合胆囊切除术的患者，已进行经皮胆囊造口术。EUS 引导下经胃/经十二指肠胆囊引流术，使用塑料支架和/或鼻胆管引流，可能是这些患者的另一种有效治疗方法，但在放置塑料支架时，胆汁常会漏入腹腔引起胆汁性腹膜炎。
评估 EUS 引导下经胃/经十二指肠胆囊引流术，使用改良型全覆膜自膨式金属支架（CSEMS）一步法治疗不适合胆囊切除术的急性胆囊炎患者的技术可行性和安全性。
前瞻性可行性研究。
三级转诊中心。
本研究纳入了 15 例经初始药物治疗无反应且不适合胆囊切除术的急性胆囊炎患者。
EUS 引导下经胃/经十二指肠胆囊引流术，使用改良型 CSEMS 一步法放置。
技术成功率、功能成功率、金属支架置入相关并发症以及急性胆囊炎复发。
改良型 CSEMS 均通过胃（n = 10）或十二指肠（n = 5）成功放置于所有患者。所有患者在金属支架放置后 3 天内均获得功能成功。2 例患者在操作过程中或之后发生气腹，但均经保守治疗后好转。在随访期间（中位数 145 天，范围 60-297 天），无患者出现复发性胆囊炎。
患者人群数量少，无长期随访。
EUS 引导下经胃/经十二指肠胆囊引流术后放置改良型 CSEMS 可能是不适合胆囊切除术的急性胆囊炎患者的一种可行且安全的替代治疗方法，优于经皮胆囊造口术等治疗方法。
