Liao Yi-Jun, Lin Wan-Tzu, Tsai Hsin-Ju, Chen Chia-Chang, Tung Chun-Fang, Yang Sheng-Shun, Peng Yen-Chun
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
J Clin Med. 2022 Mar 28;11(7):1869. doi: 10.3390/jcm11071869.
Severe acute cholangitis is a life-threatening medical emergency. Endoscopic biliary drainage (EBD) or percutaneous transhepatic biliary drainage (PTBD) is usually used for biliary decompression. However, it can be risky to transport a critical patient to the radiology unit. We aimed to compare clinical outcomes between bedside, radiation-free EBD and fluoroscopic-guided PTBD in patients under critical care.
A retrospective study was conducted on critically ill patients admitted to the intensive care unit with biliary obstruction and cholangitis from January 2011 to April 2020.
A total of 16 patients receiving EBD and 31 patients receiving PTBD due to severe acute cholangitis were analyzed. In the EBD group, biliary drainage was successfully conducted in 15 (93.8%) patients. Only one patient (6.25%) encountered post-procedure pancreatitis. The 30-day mortality rate was no difference between the 2 groups (32.72% vs. 31.25%, = 0.96). Based on multivariate analysis, independent prognostic factors for the 30-day mortality were a medical history of malignancy other than pancreatobiliary origin (HR: 5.27, 95% confidence interval [CI]: 1.01-27.57) and emergent dialysis (HR: 7.30, 95% CI: 2.20-24.24).
Bedside EBD is safe and as effective as percutaneous drainage in critically ill patients. It provides lower risks in patient transportation but does require experienced endoscopists to perform the procedure.
严重急性胆管炎是一种危及生命的医疗急症。内镜下胆管引流（EBD）或经皮经肝胆管引流（PTBD）通常用于胆管减压。然而，将重症患者转运至放射科可能存在风险。我们旨在比较重症监护患者床旁、无辐射的EBD与透视引导下PTBD的临床结局。
对2011年1月至2020年4月入住重症监护病房、患有胆管梗阻和胆管炎的重症患者进行回顾性研究。
共分析了16例因严重急性胆管炎接受EBD的患者和31例接受PTBD的患者。在EBD组中，15例（93.8%）患者成功进行了胆管引流。仅1例患者（6.25%）术后发生胰腺炎。两组的30天死亡率无差异（32.72%对31.25%，P = 0.96）。基于多因素分析，30天死亡率的独立预后因素是除胰胆源性以外的恶性肿瘤病史（HR：5.27，95%置信区间[CI]：1.01 - 27.57）和紧急透析（HR：7.30，95%CI：2.20 - 24.24）。
床旁EBD在重症患者中是安全的，且与经皮引流效果相同。它在患者转运方面风险较低，但确实需要经验丰富的内镜医师来实施该操作。
