Choi Jun-Ho, Lee Sang Soo, Choi Joon Hyuk, Park Do Hyun, Seo Dong-Wan, Lee Sung Koo, Kim Myung-Hwan
Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Endoscopy. 2014 Aug;46(8):656-61. doi: 10.1055/s-0034-1365720. Epub 2014 Jun 30.
Endoscopic ultrasonography-guided transmural gallbladder drainage (EUS-GBD) has been proposed for the management of acute cholecystitis in high risk patients; however, little is known about the long-term outcomes of this treatment. The aim of this study was to evaluate the procedural and long-term outcomes of EUS-GBD with self-expandable metallic stent (SEMS).
Data for this retrospective study were obtained from a prospectively collected EUS database. Patients with acute cholecystitis who were deemed unsuitable for cholecystectomy were included. Study outcomes were technical and clinical success, adverse events, and stent patency.
EUS-GBD was technically and clinically successful in 62/63 patients (98.4 %; 95 % confidence interval [CI] 94.9 % - 100 %). Procedural adverse events included duodenal perforation (n = 1, 1.6 %) and self-limiting pneumoperitoneum (n = 2, 3.2 %), all of which resolved with conservative treatment. Long-term outcomes of EUS-GBD were evaluated in 56 patients who were followed for a median of 275 days (range 40 - 1185 days). Late adverse events developed in four patients (7.1 %; 95 %CI 5.7 % - 8.4 %), including asymptomatic distal stent migration (n = 2), and acute cholecystitis due to stent occlusion (n = 2). Two patients with occluded stent were successfully treated endoscopically (reintervention rate of 3.6 %). A total of 54 patients (96.4 %) had no recurrence of acute cholecystitis during follow-up. Median stent patency time was 190 days overall (range 15 - 1185 days) and 458 days (range 151 - 1185 days) for the 28 patients who were alive at the study end. The cumulative stent patency rate was 86 % at 3 years.
EUS-GBD with an SEMS for acute cholecystitis showed excellent long-term outcomes and may be a definitive treatment in patients who are unsuitable for cholecystectomy because of advanced malignancy or high surgical risk.
内镜超声引导下经壁胆囊引流术（EUS-GBD）已被推荐用于高危患者急性胆囊炎的治疗；然而，关于该治疗的长期疗效知之甚少。本研究旨在评估使用自膨式金属支架（SEMS）进行EUS-GBD的操作及长期疗效。
本回顾性研究的数据来自前瞻性收集的EUS数据库。纳入被认为不适合行胆囊切除术的急性胆囊炎患者。研究结局包括技术成功与临床成功、不良事件及支架通畅情况。
63例患者中有62例EUS-GBD在技术和临床方面成功（98.4%；95%置信区间[CI] 94.9% - 100%）。操作相关不良事件包括十二指肠穿孔（n = 1，1.6%）和自限性气腹（n = 2，3.2%），所有这些均经保守治疗后缓解。对56例患者进行了EUS-GBD长期疗效评估，这些患者的中位随访时间为275天（范围40 - 1185天）。4例患者（7.1%；95%CI 5.7% - 8.4%）出现晚期不良事件，包括无症状的支架远端移位（n = 2）以及因支架堵塞导致的急性胆囊炎（n = 2）。2例支架堵塞患者经内镜成功治疗（再次干预率为3.6%）。共有54例患者（96.4%）在随访期间急性胆囊炎未复发。总体中位支架通畅时间为190天（范围15 - 1185天），研究结束时存活的28例患者的中位支架通畅时间为458天（范围151 - 1185天）。3年时支架累积通畅率为86%。
使用SEMS进行EUS-GBD治疗急性胆囊炎显示出优异的长期疗效，对于因晚期恶性肿瘤或手术风险高而不适合行胆囊切除术的患者可能是一种确定性治疗方法。
