Yamamiya Akira, Kitamura Katsuya, Ishii Yu, Mitsui Yuta, Nomoto Tomohiro, Yoshida Hitoshi
Akira Yamamiya, Katsuya Kitamura, Yu Ishii, Yuta Mitsui, Tomohiro Nomoto, Hitoshi Yoshida, Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan.
World J Clin Cases. 2017 Jul 16;5(7):280-285. doi: 10.12998/wjcc.v5.i7.280.
To investigate the feasibility of initial endoscopic common bile duct (CBD) stone removal in patients with acute cholangitis (AC).
A single-center, retrospective study was conducted between April 2013 and December 2014 and was approved by the Medical Ethics Committee at our institution. Written informed consent was obtained from each patient prior to the procedure. The cohort comprised 31 AC patients with CBD stones who underwent endoscopic biliary drainage (EBD) for naïve papilla within 48 h after AC onset. We retrospectively divided the participants into two groups: 19 patients with initial endoscopic CBD stone removal (initial group) and 12 patients with delayed endoscopic CBD stone removal (delayed group). We evaluated the feasibility of initial endoscopic CBD stone removal in patients with AC.
We observed no significant differences between the groups regarding patient characteristics. According to the assessments based on the Tokyo Guidelines, the AC severity of patients with initial endoscopic CBD stone removal was mild to moderate. The use of antithrombotic agents before EBD was less frequent in the initial group than in the delayed group (11% 58%, respectively; = 0.004). All the patients underwent successful endoscopic CBD stone removal and adverse events did not differ significantly between the groups. The number of endoscopic retrograde cholangiopancreatography procedures was significantly lower in the initial group than in the delayed group [median (interquartile range) 1 (1-1) 2 (2-2), respectively; < 0.001]. The length of hospital stay was significantly shorter for the initial group than for the delayed group [10 (9-15) 17 (14-20), respectively; = 0.010].
Initial endoscopic CBD stone removal in patients with AC may be feasible when AC severity and the use of antithrombotic agents are carefully considered.
探讨急性胆管炎（AC）患者早期内镜下胆总管（CBD）取石的可行性。
于2013年4月至2014年12月开展了一项单中心回顾性研究，该研究获得了本机构医学伦理委员会的批准。在手术前，每位患者均签署了书面知情同意书。该队列包括31例患有CBD结石的AC患者，他们在AC发作后48小时内接受了内镜下胆管引流（EBD）以处理单纯乳头病变。我们将参与者回顾性地分为两组：19例早期内镜下CBD取石患者（早期组）和12例延迟内镜下CBD取石患者（延迟组）。我们评估了AC患者早期内镜下CBD取石的可行性。
两组患者的特征无显著差异。根据基于东京指南的评估，早期内镜下CBD取石患者的AC严重程度为轻度至中度。早期组在EBD前使用抗血栓药物的频率低于延迟组（分别为11%和58%；P = 0.004）。所有患者均成功进行了内镜下CBD取石，两组间不良事件无显著差异。早期组的内镜逆行胰胆管造影术次数明显低于延迟组[中位数（四分位间距）分别为1（1 - 1）和2（2 - 2）；P < 0.001]。早期组的住院时间明显短于延迟组[分别为10（9 - 15）和17（14 - 20）；P = 0.010]。
当仔细考虑AC严重程度和抗血栓药物的使用情况时，AC患者早期内镜下CBD取石可能是可行的。
