Chan Joey Ho Yi, Teoh Anthony Yuen Bun
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR China.
Clin Endosc. 2018 Mar;51(2):150-155. doi: 10.5946/ce.2017.125. Epub 2017 Nov 17.
The gold standard for treatment of acute cholecystitis is laparoscopic cholecystectomy. However, cholecystectomy is often not suitable for surgically unfit patients who are too frail due to various co-morbidities. As such, several less invasive endoscopic treatment modalities have been developed to control sepsis, either as a definitive treatment or as a temporizing modality until the patient is stable enough to undergo cholecystectomy at a later stage. Recent developments in endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with endoscopic ultrasound EUS-specific stents having lumen-apposing properties have demonstrated potential as a definitive treatment modality. Furthermore, advanced gallbladder procedures can be performed using the stents as a portal. With similar effectiveness as percutaneous transhepatic cholecystostomy and lower rates of adverse events reported in some studies, EUS-GBD has opened exciting possibilities in becoming the next best alternative in treating acute cholecystitis in surgically unfit patients. The aim of this review article is to provide a summary of the various methods of gallbladder drainage GBD with particular focus on EUS-GBD and the many new prospects it allows.
急性胆囊炎治疗的金标准是腹腔镜胆囊切除术。然而，胆囊切除术通常不适用于因各种合并症而身体过于虚弱、无法耐受手术的患者。因此，人们开发了几种侵入性较小的内镜治疗方法来控制感染，这些方法既可以作为确定性治疗，也可以作为一种临时措施，直到患者身体足够稳定，能够在后期接受胆囊切除术。内镜超声引导下胆囊引流术（EUS-GBD）以及具有管腔贴壁特性的内镜超声（EUS）专用支架的最新进展已显示出作为一种确定性治疗方式的潜力。此外，使用这些支架作为通道可以进行更高级的胆囊手术。在一些研究中，EUS-GBD与经皮经肝胆囊造瘘术效果相似，且不良事件发生率较低，这为其成为手术不适合患者急性胆囊炎的下一个最佳替代治疗方法带来了令人兴奋的可能性。这篇综述文章的目的是总结胆囊引流（GBD）的各种方法，特别关注EUS-GBD及其带来的众多新前景。
