Maruta Akinori, Iwashita Takuji, Iwata Keisuke, Yoshida Kensaku, Uemura Shinya, Mukai Tsuyoshi, Yasuda Ichiro, Shimizu Masahito
Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan.
First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
J Hepatobiliary Pancreat Sci. 2021 Dec;28(12):1138-1146. doi: 10.1002/jhbp.967. Epub 2021 Apr 28.
Endoscopic transpapillary gallbladder drainage (EGBD) has been reported as an effective gallbladder drainage treatment option for acute cholecystitis in high-risk surgical patients. However, the long-term outcomes such as cholecystitis' recurrence rate after placement of EGB stenting (EGBS) have not been well studied yet.
The aim of the present study was to compare the long-term outcome of EGBS and removal of gallbladder drainage after percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic nasogallbladder drainage (ENGBD) for acute cholecystitis in high-risk surgical patients and clarify the usefulness of long-term placement of EGBS.
We retrospectively studied 180 high-risk surgical patients with acute cholecystitis between January 2010 and December 2018. The patients were divided into two groups: EGBS group (long-term placement of EGBS) or Removal group (removal of drainage tube after PTGBD or ENGBD). Clinical outcomes, including long-term results, were compared between the groups.
The cumulative late adverse event (AE) rates were 5.0% and 22.1% in the EGBS and Removal group (P = .002), with a median follow-up period of 375 and 307 days in the two groups, respectively. The cumulative cholecystitis recurrence rate was 5.0% (2/40) in the EGBS group and 16% (21/131) in the Removal group (P = .024), respectively. In the multivariate analysis for late AE, only EGBS was an independent risk factor with a decreasing value.
The permanent EGBS in high-risk surgical patients with acute cholecystitis was considered effective in reducing the risk of late AE.
内镜经乳头胆囊引流术（EGBD）已被报道为高危手术患者急性胆囊炎的一种有效胆囊引流治疗选择。然而，放置内镜下胆囊支架（EGBS）后胆囊炎复发率等长期结局尚未得到充分研究。
本研究旨在比较高危手术患者急性胆囊炎经皮经肝胆囊引流术（PTGBD）或内镜鼻胆管引流术（ENGBD）后EGBS与拔除胆囊引流管的长期结局，并阐明长期放置EGBS的有效性。
我们回顾性研究了2010年1月至2018年12月期间180例高危手术的急性胆囊炎患者。患者分为两组：EGBS组（长期放置EGBS）或拔除组（PTGBD或ENGBD后拔除引流管）。比较两组的临床结局，包括长期结果。
EGBS组和拔除组的累积晚期不良事件（AE）发生率分别为5.0%和22.1%（P = 0.002），两组的中位随访期分别为375天和307天。EGBS组胆囊炎累积复发率为5.0%（2/40），拔除组为16%（21/131）（P = 0.024）。在晚期AE的多因素分析中，只有EGBS是一个具有降低值的独立危险因素。
高危手术的急性胆囊炎患者长期放置EGBS被认为可有效降低晚期AE风险。
