Posner Hannah, Widmer Jessica
Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, NY, USA.
Transl Gastroenterol Hepatol. 2020 Jul 5;5:41. doi: 10.21037/tgh.2019.12.20. eCollection 2020.
Cholecystectomy is the gold standard treatment for acute cholecystitis, but it may not be appropriate for patients with significant comorbidities. Percutaneous gallbladder drainage (PT-GBD) and endoscopic transpapillary gallbladder drainage (ET-GBD) are alternatives with good technical and clinical success rates, but are limited by technical challenges and the need for definitive therapy. EUS-guided gallbladder drainage (EUS-GBD) is quickly becoming the preferred modality of treatment at expert centers in this cohort of patients due to increased efficacy and minimal adverse events. Technicalities of the procedure, including selection of access site, should be informed by the ultimate needs and anatomy of each patient. With the evolution of new stents and accessories, including a cautery-enhanced lumen apposing metal stent deployment system, success rates and adverse events are favorable. A review of published case series demonstrates an overall clinical success rate of approximately 97% for EUS-GBD. The most common complication is pneumoperitoneum, so the evolution of self-expanding LAMS is promising. EUS-GBD has been successfully described in cases where definitive therapy or a bridge to cholecystectomy is needed. As the procedure's applications continue to evolve, there should be greater discussion about specific details including access site and stent selection.
胆囊切除术是急性胆囊炎的金标准治疗方法，但对于有严重合并症的患者可能并不适用。经皮胆囊引流术（PT-GBD）和内镜经乳头胆囊引流术（ET-GBD）是技术成功率和临床成功率较高的替代方法，但受到技术挑战和确定性治疗需求的限制。由于疗效提高且不良事件最少，超声内镜引导下胆囊引流术（EUS-GBD）正迅速成为这类患者专家中心首选的治疗方式。该手术的技术细节，包括穿刺部位的选择，应根据每个患者的最终需求和解剖结构来确定。随着新型支架及配件的发展，包括一种带有烧灼增强的管腔贴壁金属支架置入系统，成功率和不良事件情况良好。对已发表病例系列的回顾显示，EUS-GBD的总体临床成功率约为97%。最常见的并发症是气腹，因此自膨式全覆膜金属支架的发展前景广阔。在需要确定性治疗或作为胆囊切除术桥梁的病例中，EUS-GBD已被成功应用。随着该手术应用的不断发展，应就包括穿刺部位和支架选择在内的具体细节进行更多讨论。
