Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Gastrointest Endosc. 2019 Feb;89(2):289-298. doi: 10.1016/j.gie.2018.08.052. Epub 2018 Sep 10.
Endoscopic gallbladder drainage (GBD) has been performed as an alternative to percutaneous drainage for acute cholecystitis. To date, there has been no comparative study between EUS-guided cholecystostomy (EUSC) and endoscopic transpapillary cholecystostomy (ETC). The aim of this study was to compare the outcomes of EUSC and ETC.
A retrospective review of an endoscopic GBD database prospectively collected at the Asan Medical Center (between July 2010 and December 2014) was performed to identify consecutive patients with acute cholecystitis who underwent attempted endoscopic GBD. Procedural and long-term outcomes were evaluated using inverse probability of treatment weighting (IPTW).
A total of 172 patients (76 in the EUSC group and 96 in the ETC group) were included in this study. Seven patients who failed to undergo ETC crossed over to the EUSC group. After adjustment with the IPTW method, technical success (99.3% vs 86.6%, P < .01) and clinical success (99.3% vs 86%, P < .01) rates were significantly higher in the EUSC group than in the ETC group. The procedure-related adverse event rate was significantly higher in the ETC group (7.1% vs 19.3%, P = .02). The cholecystitis or cholangitis recurrence rate (12.4% vs 3.2%) was also higher in the ETC group than in the EUSC group, as identified using Cox analysis (hazard ratio, 3.01; 95% confidence interval, .73-12.9; P = .04).
In patients with acute cholecystitis who are unfit for surgery, EUSC may be a more suitable treatment method than ETC.
内镜下胆囊引流（GBD）已作为急性胆囊炎的替代方法进行经皮引流。迄今为止，尚未有关于超声内镜引导下胆囊造口术（EUSC）和内镜经乳头胆囊造口术（ETC）的比较研究。本研究旨在比较 EUSC 和 ETC 的结果。
对 2010 年 7 月至 2014 年 12 月期间在 Asan 医疗中心前瞻性收集的内镜 GBD 数据库进行回顾性分析，以确定接受内镜 GBD 的急性胆囊炎连续患者。使用逆概率治疗加权（IPTW）评估程序和长期结果。
本研究共纳入 172 例患者（EUSC 组 76 例，ETC 组 96 例）。7 例未能进行 ETC 的患者交叉到 EUSC 组。经 IPTW 方法调整后，EUSC 组的技术成功率（99.3% vs 86.6%，P <.01）和临床成功率（99.3% vs 86%，P <.01）均显著高于 ETC 组。ETC 组的与操作相关的不良事件发生率显著较高（7.1% vs 19.3%，P =.02）。Cox 分析显示，ETC 组的胆囊炎或胆管炎复发率（12.4% vs 3.2%）也高于 EUSC 组（危险比，3.01；95%置信区间，.73-12.9；P =.04）。
对于不适合手术的急性胆囊炎患者，EUSC 可能是比 ETC 更合适的治疗方法。
