Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand.
Gastrointest Endosc. 2020 Sep;92(3):634-644. doi: 10.1016/j.gie.2020.03.3866. Epub 2020 Apr 21.
One of the main reasons for failed endoscopic transpapillary gallbladder stenting (ETGS) under fluoroscopic guidance is the inability to cannulate the cystic duct. Single-operator peroral cholangioscopy (SOC)-assisted ETGS is an adjunct technique to facilitate ETGS. We aimed to demonstrate its efficacy.
Between 2015 and 2019, 104 patients with acute cholecystitis at moderate to high surgical risk underwent ETGS, which involved 3 steps: (1) cystic duct cannulation under fluoroscopic guidance with or without additional SOC guidance; (2) guidewire placement; and (3) stent placement in the gallbladder. The technical success rate was determined when stent placement was confirmed endoscopically and radiographically.
Of 104 patients, 55 (53%) patients had successful ETGS under fluoroscopic guidance. Of 49 patients who had failed fluoroscopy-guided ETGS, 41 patients underwent additional SOC-assisted ETGS and 5 patients proceeded to other interventions. Of patients who underwent SOC-assisted ETGS (n = 41), 23 (56%) cystic cannulation followed by stent placement were successful; cystic duct cannulations, guidewire, and stent placement failed in 8, 9, and 1 patients, respectively. The overall technical success rate of ETGS increased from 53% (55 of 104) to 75% (78 of 104) after additional SOC assistance. Adverse events and recurrence were not different between patients who underwent ETGS under fluoroscopic guidance and those who underwent SOC-assisted ETGS.
In patients with acute cholecystitis who are not surgical candidates, SOC-assisted ETGS can increase the technical success rate after failed fluoroscopic guidance. SOC can help for the cystic duct cannulation and guidewire placement steps but not for the stent placement step.
在荧光透视引导下经内镜经胆囊管胆囊支架置入术（ETGS）失败的主要原因之一是无法进行胆囊管插管。单操作孔经口胆管镜（SOC）辅助 ETGS 是一种辅助技术，可促进 ETGS 的进行。我们旨在证明其疗效。
2015 年至 2019 年间，104 例中度至高度手术风险的急性胆囊炎患者接受了 ETGS，该手术包括 3 个步骤：（1）在荧光透视引导下或在 SOC 引导下进行胆囊管插管；（2）导丝放置；（3）在胆囊内放置支架。当支架放置在内镜和放射学上均得到确认时，确定技术成功率。
104 例患者中，55 例（53%）患者在荧光透视引导下成功进行了 ETGS。在 49 例未能进行荧光透视引导下 ETGS 的患者中，41 例患者进行了 SOC 辅助下的 ETGS，5 例患者进行了其他干预。在接受 SOC 辅助 ETGS（n=41）的患者中，23 例（56%）的胆囊插管后支架放置成功；胆囊管插管、导丝和支架放置分别在 8、9 和 1 例患者中失败。在接受 SOC 辅助 ETGS 的患者中，技术成功率从 53%（55 例/104 例）增加到 75%（78 例/104 例）。在接受荧光透视引导下 ETGS 的患者和接受 SOC 辅助 ETGS 的患者之间，不良事件和复发没有差异。
在不适合手术的急性胆囊炎患者中，SOC 辅助 ETGS 可在荧光透视引导失败后提高技术成功率。SOC 可帮助进行胆囊管插管和导丝放置步骤，但不能进行支架放置步骤。
