Sagami Ryota, Hayasaka Kenji, Ujihara Tetsuro, Nakahara Ryotaro, Murakami Daisuke, Iwaki Tomoyuki, Suehiro Satoshi, Katsuyama Yasushi, Harada Hideaki, Amano Yuji
Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan.
Department of Endoscopy, New Tokyo Hospital, Chiba, Japan.
Clin Endosc. 2020 Mar;53(2):221-229. doi: 10.5946/ce.2019.099. Epub 2019 Nov 5.
BACKGROUND/AIMS: Endoscopic transpapillary gallbladder drainage (ETGBD) is useful for the treatment of acute cholecystitis; however, the technique is difficult to perform. When intraductal ultrasonography (IDUS) is combined with ETGBD, the orifice of the cystic duct in the common bile duct may be more easily detected in the cannulation procedure. The aim of this study was to evaluate the efficacy of ETGBD with IDUS compared with that of ETGBD alone.
A total of 100 consecutive patients with acute cholecystitis requiring ETGBD were retrospectively recruited. The first 50 consecutive patients were treated using ETGBD without IDUS, and the next 50 patients were treated using ETGBD with IDUS. Through propensity score matching analysis, we compared the clinical outcomes between the groups. The primary outcome was the technical success rate.
The technical success rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (92.0% vs. 76.0%, p=0.044). There was no significant difference in procedure length between the two groups (74.0 min vs. 66.7 min, p=0.310). The complication rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (6.0% vs. 0%, p<0.001); however, only one case showed an IDUS technique-related complication (pancreatitis).
The assistance of IDUS may be useful in ETGBD.
背景/目的：内镜经乳头胆囊引流术（ETGBD）对急性胆囊炎的治疗很有用；然而，该技术操作困难。当将胆管内超声检查（IDUS）与ETGBD联合使用时，在插管过程中可能更容易检测到胆总管内的胆囊管开口。本研究的目的是评估与单纯ETGBD相比，联合IDUS的ETGBD的疗效。
回顾性纳入了连续100例需要进行ETGBD的急性胆囊炎患者。前50例连续患者采用不联合IDUS的ETGBD进行治疗，接下来的50例患者采用联合IDUS的ETGBD进行治疗。通过倾向评分匹配分析，我们比较了两组之间的临床结果。主要结局是技术成功率。
联合IDUS的ETGBD的技术成功率显著高于不联合IDUS的ETGBD（92.0%对76.0%，p = 0.044）。两组之间的操作时间无显著差异（74.0分钟对66.7分钟，p = 0.310）。联合IDUS的ETGBD的并发症发生率显著高于不联合IDUS的ETGBD（6.0%对0%，p<0.001）；然而，仅1例出现与IDUS技术相关的并发症（胰腺炎）。
IDUS的辅助可能对ETGBD有用。
