Weill Cornell Medical Center, New York, NY.
Rutgers Robert Wood Johnson, New Brunswick, NJ.
J Clin Gastroenterol. 2019 Mar;53(3):231-235. doi: 10.1097/MCG.0000000000001036.
Endoscopic ultrasound-guided gallbladder drainage (EGBD) with a lumen apposing metal stent is becoming a widely accepted alternative to percutaneous gallbladder drainage (PTGD) for patients who are not candidates for cholecystectomy (CCY). In some patients, medical comorbidites can improve, allowing them to undergo CCY. We compare feasibility and outcomes of interval CCY after EGBD versus PTGD.
We conducted a multicentered international cohort study of patients who underwent EGBD or PTGD and then underwent interval CCY. Baseline patient demographics, procedural details, and follow-up data were recorded and compared.
In total, 34 patients were included. Thirteen patients underwent EGBD followed by CCY (mean age, 53.77±17.27, 46.15% male), and 21 patients underwent PTGD followed by CCY (mean age, 62.14±13.06, 61.9% male). There was no statistically significant difference in mean Charlson Comorbidity Index (P=0.12) or etiology of cholecystitis (P=0.85) between the 2 groups. All patients had a technically successful CCY. There was no difference between rates of open versus laparoscopic CCY (P=1). In addition, there was no difference in postsurgical adverse events (P=0.23).
Surgical CCY after EGBD with lumen apposing metal stent is safe and feasible for the management of cholecystitis. If patient's underlying medical conditions improve, previous EUS-GLB drainage should not preclude patients from undergoing CCY as part of standard of care.
内镜超声引导下胆囊引流（EGBD）联合使用腔内置入金属支架，正在成为不能接受胆囊切除术（CCY）的患者的另一种替代经皮胆囊引流（PTGD）的方法。在一些患者中，合并症可能会改善，使他们能够接受 CCY。我们比较了 EGBD 与 PTGD 后间隔期行 CCY 的可行性和结果。
我们进行了一项多中心国际队列研究，纳入了接受 EGBD 或 PTGD 后行间隔期 CCY 的患者。记录并比较了患者的基线人口统计学特征、操作细节和随访数据。
共纳入 34 例患者。13 例患者行 EGBD 后行 CCY（平均年龄 53.77±17.27 岁，46.15%为男性），21 例患者行 PTGD 后行 CCY（平均年龄 62.14±13.06 岁，61.9%为男性）。两组间平均 Charlson 合并症指数（P=0.12）或胆囊炎病因（P=0.85）无统计学差异。所有患者的 CCY 均成功实施。开腹与腹腔镜 CCY 率无差异（P=1）。此外，术后不良事件无差异（P=0.23）。
对于胆囊炎的治疗，EGBD 联合使用腔内置入金属支架行 CCY 是安全可行的。如果患者的基础疾病得到改善，先前的 EUS-GLB 引流不应阻止患者接受 CCY 作为标准治疗的一部分。
