Kahaleh Michel, Perez-Miranda Manuel, Artifon Everson L, Sharaiha Reem Z, Kedia Prashant, Peñas Irene, De la Serna Carlos, Kumta Nikhil A, Marson Fernando, Gaidhane Monica, Boumitri Christine, Parra Viviana, Rondon Clavo Carlos M, Giovannini Marc
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
Hospital del Rio Hortega, Rio Hortega, Spain.
Dig Liver Dis. 2016 Sep;48(9):1054-7. doi: 10.1016/j.dld.2016.05.021. Epub 2016 Jun 3.
Cholecystectomy remains the gold standard treatment of cholecystitis. Endoscopic treatment of cholecystitis includes transpapillary gallbladder drainage. Recently, endoscopic ultrasound-guided transmural drainage of the gallbladder (EUS-GBD) has been reported. This study reports the cumulative experience of an international group performing EUS-GBD.
Cases of EUS-GBD from January 2012 to November 2013 from 3 tertiary-care institutions were captured in a registry. Patient demographics, disease characteristics, procedural and clinical outcomes were recorded.
35 patients (15 malignant, 20 benign) were included. Median age was 81 years (SD=13.76 years), sixteen (46%) were males. Median follow-up was 91.5 days (SD=157 days). Transmural access was obtained from the stomach (n=17) or duodenum (n=18). Stents placed included plastic (n=6), metal (n=20), or combination (n=7). Technical success was achieved in 91.4% (n=32). Immediate adverse events (14%) included: bleeding, stent migration, cholecystitis and hemoperitoneum. Delayed adverse events (11%) included abscess formation and recurrence of cholecystitis. Long-term clinical success rate was 89%. Stent type and puncture site were not associated with immediate (p=0.88, p=0.62), or long-term (p=0.47, p=0.27) success.
EUS-GBD appears to be feasible, safe, and effective. Prospective studies are needed to confirm these findings and identify the best technique to use.
NCT01522573.
胆囊切除术仍然是胆囊炎的金标准治疗方法。胆囊炎的内镜治疗包括经乳头胆囊引流术。最近，有报道称内镜超声引导下胆囊透壁引流术（EUS-GBD）。本研究报告了一个国际团队开展EUS-GBD的累积经验。
对2012年1月至2013年11月期间来自3家三级医疗机构的EUS-GBD病例进行登记。记录患者的人口统计学资料、疾病特征、手术及临床结果。
纳入35例患者（15例恶性，20例良性）。中位年龄为81岁（标准差=13.76岁），16例（46%）为男性。中位随访时间为91.5天（标准差=157天）。经胃（n=17）或十二指肠（n=18）获得透壁通路。置入的支架包括塑料支架（n=6）、金属支架（n=20）或联合支架（n=7）。技术成功率为91.4%（n=32）。即刻不良事件（14%）包括：出血、支架移位、胆囊炎和腹腔积血。延迟不良事件（11%）包括脓肿形成和胆囊炎复发。长期临床成功率为89%。支架类型和穿刺部位与即刻（p=0.88，p=0.62）或长期（p=0.47，p=0.27）成功率无关。
EUS-GBD似乎是可行、安全且有效的。需要进行前瞻性研究以证实这些发现并确定最佳使用技术。
NCT01522573。
