Sagami Ryota, Hayasaka Kenji, Ujihara Tetsuro, Nakahara Ryotaro, Murakami Daisuke, Iwaki Tomoyuki, Katsuyama Yasushi, Harada Hideaki, Tsuji Hiroaki, Sato Takao, Nishikiori Hidefumi, Murakami Kazunari, Amano Yuji
Department of Gastroenterology, Oita San-ai Medical Center, Oita (Ryota Sagami Hiroaki Tsuji, Takao Sato, Hidefumi Nishikiori).
Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada).
Ann Gastroenterol. 2020 Jul-Aug;33(4):391-397. doi: 10.20524/aog.2020.0496. Epub 2020 May 15.
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) as a treatment for patients with acute cholecystitis has been shown to obtain high technical and clinical success rates and a low recurrence rate. However, the safety of EUS-GBD for patients receiving antithrombotic therapy (ATT) has not been proven. The aim was to evaluate the safety and efficacy of EUS-GBD in patients receiving ATT.
Twelve patients with acute cholecystitis associated with gallstones who were receiving antithrombotic therapy and underwent EUS-GBD were enrolled in this retrospective study. Patients with grade II or III cholecystitis who had failed endoscopic transpapillary GBD (ETGBD) or developed recurrence after multiple ETGBD procedures underwent urgent drainage by EUS-GBD. The primary outcome was the rate of bleeding complications after the procedure and the secondary outcomes were the technical and clinical success rates, complications, and recurrence.
Eleven (91.6%) patients underwent EUS-GBD with continuation of ATT (at least 1 agent). Five of 12 patients (41.7%) were receiving more than 1 agent for ATT. The rate of bleeding complications was 0% and the technical success rate was 100%, even though some patients had high-grade (severe) cholecystitis and/or several underlying diseases. Early complications were found in 2 (16.7%) patients. The clinical success rate was 91.7% (11/12). There were no recurrences of cholecystitis during the follow-up period (mean 261 [range 5-650] days).
EUS-GBD yielded high technical and clinical success rates and a low recurrence rate. No patients receiving ATT developed bleeding complications. EUS-GBD might be a good option for patients on ATT.
内镜超声引导下胆囊引流术（EUS-GBD）作为急性胆囊炎患者的一种治疗方法，已显示出较高的技术成功率和临床成功率以及较低的复发率。然而，EUS-GBD 对接受抗血栓治疗（ATT）患者的安全性尚未得到证实。本研究旨在评估 EUS-GBD 对接受 ATT 患者的安全性和有效性。
本回顾性研究纳入了 12 例接受抗血栓治疗且患有急性胆囊炎合并胆结石并接受 EUS-GBD 的患者。患有 II 级或 III 级胆囊炎且内镜经乳头胆囊引流术（ETGBD）失败或在多次 ETGBD 手术后复发的患者接受了 EUS-GBD 紧急引流。主要结局是术后出血并发症的发生率，次要结局是技术成功率、临床成功率、并发症及复发情况。
11 例（91.6%）患者在继续接受 ATT（至少 1 种药物）的情况下接受了 EUS-GBD。12 例患者中有 5 例（41.7%）接受了不止 1 种 ATT 药物。出血并发症发生率为 0%，技术成功率为 100%，尽管一些患者患有重度（严重）胆囊炎和/或多种基础疾病。2 例（16.7%）患者出现早期并发症。临床成功率为 91.7%（11/12）。随访期间（平均 261 天[范围 5 - 650 天]）无胆囊炎复发。
EUS-GBD 具有较高的技术成功率和临床成功率以及较低的复发率。接受 ATT 的患者未发生出血并发症。EUS-GBD 可能是接受 ATT 患者的一个良好选择。
