Manta Raffaele, Zulli Claudio, Zullo Angelo, Forti Edoardo, Tringali Alberto, Dioscoridi Lorenzo, Zito Francesco, Bertani Helga, Conigliaro Rita, Mutignani Massimiliano
Gastroenterology Unit, Nuovo Ospedale Civile Sant' Agostino-Estense, Baggiovara-Modena, Italy.
Endoscopy Unit, AOUI San Giovanni di Dio e Ruggi d'Aragona, G. Fucito Center, Mercato San Severino (SA), Italy.
Endosc Int Open. 2017 Nov;5(11):E1111-E1115. doi: 10.1055/s-0043-118659. Epub 2017 Nov 8.
Gallbladder drainage in patients with cholecystitis who are unsuitable for surgery may be performed by endoscopic ultrasound (EUS)-guided placement of specifically designed fully covered metal stents. We describe the first case series of patients treated with a silicone-covered nitinol stent with bilateral anchor flanges.
Data from consecutive patients with acute cholecystitis who were deemed unsuitable candidates for surgery were collected. The stent placement procedure was performed in two tertiary endoscopy centers by four experienced endoscopists. Technical and clinical success rates, as well as adverse events and clinical outcome at follow-up, were assessed.
EUS-guided drainage for cholecystitis was performed in 16 patients (mean age 84 years; nine males). Technical and clinical success rates were 100 % (16/16) and 94 % (15/16), respectively; an early failure due to stone impaction occurred in the remaining case and required placement of a new stent. Symptom relief occurred in 11/15 cases (73 %) within 1 day, and within 2 days in the remaining 4 patients. Bleeding occurred in two patients (13 %): in one patient intraprocedural bleeding was successfully stopped during endoscopy; and delayed bleeding occurred in one patient requiring arterial embolization for catastrophic bleeding (patient died 10 days later). No cases of cholecystitis recurrence or biliary obstruction were observed during a median follow-up of 112 days (range 49 - 180 days).
Our data showed that EUS-guided gallbladder drainage with a specially designed stent is feasible and successful in patients with acute cholecystitis who are unfit for surgery.
对于不适宜手术的胆囊炎患者，可通过内镜超声（EUS）引导下放置专门设计的全覆膜金属支架进行胆囊引流。我们描述了首例使用带有双侧锚定翼缘的硅酮覆膜镍钛诺支架治疗的患者系列。
收集连续入选的被认为不适宜手术的急性胆囊炎患者的数据。支架置入手术由四个经验丰富的内镜医师在两个三级内镜中心进行。评估技术成功率、临床成功率以及随访时的不良事件和临床结局。
16例患者（平均年龄84岁；9例男性）接受了EUS引导下的胆囊炎引流术。技术成功率和临床成功率分别为100%（16/16）和94%（15/16）；其余1例因结石嵌顿导致早期失败，需要放置新的支架。11/15例（73%）患者在1天内症状缓解，其余4例在2天内症状缓解。2例患者（13%）发生出血：1例患者在内镜检查期间手术中出血成功停止；1例患者发生延迟出血，因严重出血需要进行动脉栓塞（患者于10天后死亡）。在中位随访112天（范围49 - 180天）期间，未观察到胆囊炎复发或胆道梗阻病例。
我们的数据表明，对于不适合手术的急性胆囊炎患者，使用专门设计的支架进行EUS引导下的胆囊引流是可行且成功的。
