Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Centre, New York, NY, USA.
Gastrointest Endosc Clin N Am. 2022 Jul;32(3):527-543. doi: 10.1016/j.giec.2022.02.004. Epub 2022 May 11.
Endoscopic drainage of the gallbladder for acute cholecystitis can be performed with the transpapillary method or endoscopic ultrasound (EUS)-guided method. EUS-guided gallbladder drainage (EUS-GBD) is gaining popularity as the treatment of choice for acute cholecystitis in patients who are deemed high-risk for cholecystectomy (CCY). It provides an alternative to percutaneous drainage and laparoscopic CCY in these patients. With the development of lumen-apposing metal stents (LAMS), the procedure is associated with high rates of technical and clinical success with low rates of adverse events (AEs). The aim of this article is to provide an overview of the current status of EUS-GBD including the indications, techniques, stent systems in-use, and how the procedure compares to conventional techniques are outlined. Furthermore, the feasibility of cholecystoscopy and advanced gallbladder interventions is explored. Finally, a comparison in outcomes of EUS-GBD versus laparoscopic CCY is provided giving some initial data in support of the procedure as an alternative to surgery in a selected group of patients.
内镜下胆囊引流术可通过经乳头途径或内镜超声（EUS）引导途径进行。EUS 引导下胆囊引流术（EUS-GBD）作为胆囊切除术（CCY）高危患者急性胆囊炎的治疗选择越来越受到关注。它为这些患者提供了经皮引流和腹腔镜 CCY 的替代方案。随着 lumen-apposing 金属支架（LAMS）的发展，该手术具有较高的技术和临床成功率，不良事件（AE）发生率较低。本文旨在概述 EUS-GBD 的现状，包括适应证、技术、使用的支架系统，以及与传统技术的比较。此外，还探讨了胆囊镜和高级胆囊介入的可行性。最后，提供了 EUS-GBD 与腹腔镜 CCY 结果的比较，为该手术在选定患者群体中替代手术提供了一些初步数据支持。
