Inoue Tadahisa, Suzuki Yuta, Yoshida Michihiro, Naitoh Itaru, Okumura Fumihiro, Kitano Rena, Haneda Kenichi, Hayashi Kazuki, Yoneda Masashi
Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, 5-161 Maehata-cho, Tajimi, Gifu, 507-8522, Japan.
Dig Dis Sci. 2023 Apr;68(4):1529-1538. doi: 10.1007/s10620-022-07651-0. Epub 2022 Aug 22.
Although long-term stent placement using endoscopic gallbladder stenting (EGBS) reportedly reduces cholecystitis recurrence in patients unfit to undergo cholecystectomy, its efficacy and safety remain uncertain.
This study aimed to examine the long-term effect of EGBS in poor surgical candidates of cholecystectomy.
A total of 528 high-risk surgical patients with acute calculous cholecystitis met this study's eligibility criteria. The technical success and adverse events (AE) were compared between patients who underwent EGBS and those who underwent percutaneous transhepatic gallbladder drainage (PTGBD). Elective stent exchange and removal were not performed after EGBS. The external tube was removed after improvement of cholecystitis following PTGBD.
The technical success rate was significantly lower with EGBS compared to PTGBD (75.4% versus 98.7%, P < 0.001), while the early-AE rate did not differ significantly between the two methods (7.7% versus 4.3%, P = 0.146). The 1-, 3-, and 5-year cumulative incidence rates of cholecystitis were 3.8%, 7.2%, and 7.2% with EGBS, and 11.7%, 17.6%, and 30.2% with PTGBD, respectively (P = 0.001). Conversely, those of symptomatic late-AE (except cholecystitis) were 8.2%, 22.7%, and 31.4% with EGBS, and 7.5%, 10.9%, and 13.1% with PTGBD, respectively (P = 0.035). Thus, the 1-, 3-, and 5-year cumulative incidence of overall late-AE was 12.0%, 30.4%, and 40.4% with EGBS, and 19.2%, 28.3%, and 42.5% with PTGBD, respectively (P = 0.649).
Long-term stent placement via EGBS is useful for preventing the recurrence of cholecystitis, but the success rate is low and the frequency of other late-AE increases with the prolongation of the indwelling period.
尽管据报道，采用内镜下胆囊支架置入术（EGBS）进行长期支架置入可降低不适于接受胆囊切除术患者的胆囊炎复发率，但其疗效和安全性仍不确定。
本研究旨在探讨EGBS在胆囊切除术手术条件较差的患者中的长期效果。
共有528例急性结石性胆囊炎高危手术患者符合本研究的纳入标准。比较接受EGBS和经皮经肝胆囊引流术（PTGBD）的患者的技术成功率和不良事件（AE）。EGBS术后不进行择期支架更换和取出。PTGBD术后胆囊炎改善后拔除外引流管。
与PTGBD相比，EGBS的技术成功率显著较低（75.4%对98.7%，P＜0.001），而两种方法的早期AE发生率无显著差异（7.7%对4.3%，P = 0.146）。EGBS组胆囊炎的1年、3年和5年累积发病率分别为3.8%、7.2%和7.2%，PTGBD组分别为11.7%、17.6%和30.2%（P = 0.001）。相反，EGBS组有症状的晚期AE（除胆囊炎外）的累积发病率分别为8.2%、22.7%和31.4%，PTGBD组分别为7.5%、10.9%和13.1%（P = 0.035）。因此，EGBS组总体晚期AE的1年、3年和5年累积发病率分别为12.0%、30.4%和40.4%，PTGBD组分别为19.2%、28.3%和42.5%（P = 0.649）。
通过EGBS进行长期支架置入术对预防胆囊炎复发有效，但成功率较低，且随着留置时间的延长，其他晚期AE的发生率增加。
