Ridtitid Wiriyaporn, Luangsukrerk Thanawat, Piyachaturawat Panida, Teeratorn Nicha, Angsuwatcharakon Phonthep, Kongkam Pradermchai, Rerknimitr Rungsun
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.
Ann Hepatobiliary Pancreat Surg. 2022 Feb 28;26(1):104-112. doi: 10.14701/ahbps.21-098.
BACKGROUNDS/AIMS: In moderate and high-surgical risk patients with acute cholecystitis, studies comparing percutaneous cholecystostomy (PC) vs. endoscopic transpapillary gallbladder stenting (ETGS) vs. endoscopic ultrasound-guided transmural gallbladder stenting (EUGS) are limited. Thus, the aim of this study was to compare efficacy and recurrence of cholecystitis after PC, ETGS, or EUGS during follow-up.
We reviewed 143 moderate and high-surgical risk patients with acute cholecystitis with or without concomitant common bile duct stones who underwent PC, ETGS, or EUGS at our hospital. Technical success rate (TSR), clinical success rate (CSR), and recurrence were compared.
TSR in PC or EUGS group was higher than that in the ETGS group for those with concomitant common bile duct stones (100% vs. 100% vs. 73.2%; = 0.07) and for those without concomitant common bile duct stones (100% vs. 100% vs. 77.3%; < 0.001). CSR in ETGS or EUGS group was higher than that in the PC group for those with concomitant common bile duct stones (96.2% vs. 100% vs. 87.5%; = 0.41) and for those without concomitant common bile duct stones (94.1% vs. 100% vs. 63.0%; = 0.006). Using Kaplan-Meier analysis, the overall recurrent risk was the highest in the PC group ( = 0.004).
In moderate and high-surgical risk patients with acute cholecystitis, EUGS provides significantly higher CSR with comparable TSR to PC. Thus, ETGS should be the first choice in those with concomitant common bile duct stones. Among the three patient groups, those who received PC had the highest rate of recurrence.
背景/目的：在具有中度和高度手术风险的急性胆囊炎患者中，比较经皮胆囊造瘘术（PC）、内镜经乳头胆囊支架置入术（ETGS）和内镜超声引导下经壁胆囊支架置入术（EUGS）的研究有限。因此，本研究的目的是比较随访期间PC、ETGS或EUGS后胆囊炎的疗效和复发情况。
我们回顾了我院143例具有中度和高度手术风险的急性胆囊炎患者，这些患者伴有或不伴有胆总管结石，接受了PC、ETGS或EUGS治疗。比较了技术成功率（TSR）、临床成功率（CSR）和复发情况。
对于伴有胆总管结石的患者（100%对100%对73.2%；P = 0.07）以及不伴有胆总管结石的患者（100%对100%对77.3%；P < 0.001），PC组或EUGS组的TSR高于ETGS组。对于伴有胆总管结石的患者（96.2%对100%对87.5%；P = 0.41）以及不伴有胆总管结石的患者（94.1%对100%对63.0%；P = 0.006），ETGS组或EUGS组的CSR高于PC组。使用Kaplan-Meier分析，PC组的总体复发风险最高（P = 0.004）。
在具有中度和高度手术风险的急性胆囊炎患者中，EUGS提供了显著更高的CSR，且TSR与PC相当。因此，对于伴有胆总管结石的患者，ETGS应作为首选。在这三组患者中，接受PC治疗的患者复发率最高。
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