Departments of, Department of, Gastroenterology, New Tokyo Hospital, Chiba, Japan.
Department of Gastroenterology, Oita San-ai Medical Center, Oita, Japan.
Dig Endosc. 2020 Nov;32(7):1092-1099. doi: 10.1111/den.13650. Epub 2020 Apr 1.
Patients with acute cholecystitis receiving antithrombotic therapy (ATT) have an increased risk of bleeding complications during surgery and percutaneous drainage. Endoscopic transpapillary gallbladder drainage (ETGBD) is recommended for such cases; however, evidence is limited. To investigate this issue further, we performed a retrospective multicenter study.
One hundred thirty patients with acute cholecystitis who underwent ETGBD were enrolled. They were divided into an ATT group (continuation of ATT on the day of the procedure and/or heparin substitution) and a Non-ATT group (discontinuation or no use of ATT). The primary outcome was bleeding complication rate, and the secondary outcomes were technical success rate, clinical success rate and total complication rate.
Eighty-three patients were enrolled in the ATT group, and 47 were enrolled in the Non-ATT group. In the ATT group, 42.2% continued multi-agent ATT. No bleeding complications occurred in either group. There were no significant differences between the ATT and Non-ATT groups in the technical success rate (84.3% vs 89.4%, P = 0.426 respectively) or the clinical success rate (97.1% vs 100%, P = 0.259, respectively). The overall early complication rate was 3.1% (4/130): mild pancreatitis (n = 3) and cholangitis (n = 1). Stent dysfunction was found in 10.9% of patients (at 196 days on average), and the 12-month stent patency rate was 69.0%.
No significant difference was found in the bleeding complication rate between ETGBD with and without ATT. ETGBD may be an ideal drainage method for patients with acute cholecystitis receiving ATT.
接受抗血栓治疗（ATT）的急性胆囊炎患者在手术和经皮引流期间有出血并发症的风险增加。对于此类病例，建议进行内镜经乳头胆囊引流（ETGBD）；然而，证据有限。为了进一步研究这个问题，我们进行了一项回顾性多中心研究。
共纳入 130 例接受 ETGBD 的急性胆囊炎患者。他们被分为 ATT 组（手术当天继续 ATT 和/或肝素替代）和非 ATT 组（停药或不使用 ATT）。主要结局是出血并发症发生率，次要结局是技术成功率、临床成功率和总并发症发生率。
83 例患者入组 ATT 组，47 例患者入组非 ATT 组。在 ATT 组中，42.2%的患者继续使用多药物 ATT。两组均未发生出血并发症。ATT 组和非 ATT 组在技术成功率（分别为 84.3%和 89.4%，P=0.426）或临床成功率（分别为 97.1%和 100%，P=0.259）方面无显著差异。总的早期并发症发生率为 3.1%（4/130）：轻度胰腺炎（n=3）和胆管炎（n=1）。支架功能障碍在 10.9%的患者中发现（平均 196 天），12 个月的支架通畅率为 69.0%。
ETGBD 联合和不联合 ATT 的出血并发症发生率无显著差异。ETGBD 可能是接受 ATT 的急性胆囊炎患者的一种理想引流方法。
