Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan.
Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kanagawa, Japan.
Scand J Gastroenterol. 2023 Mar;58(3):286-290. doi: 10.1080/00365521.2022.2118554. Epub 2022 Sep 7.
Endoscopic transpapillary gallbladder drainage (ETGBD) has been performed as an alternative therapy against cholecystectomy in patients with acute cholecystitis. To date, few studies have reported the safety, efficacy, and factors affecting ETGBD. We evaluated the clinical outcomes and predictors of technical failure of ETGBD.
Patients with acute cholecystitis who underwent ETGBD were retrospectively reviewed, and consecutive patients were included in the study. The technical success rate, clinical success rate, adverse events, and the predictors associated with the technical failure of ETGBD were investigated.
A total of 242 patients were enrolled in the study. The technical success rate of ETGBD and clinical success rate of technically successful ETGBD cases were 87% and 93%, respectively. We experienced cystic duct injury in 24 patients as an ETGBD-related adverse event, and pancreatitis in 12 patients as an endoscopic retrograde cholangiopancreatography-related adverse event. Multivariate analysis indicated that cystic duct injury was the independent predictor associated with the technical failure of ETGBD (odds ratio, 11; 95% confidence interval, 3.9-29; < 0.001).
ETGBD was a safe and effective treatment method for acute cholecystitis with acceptable adverse events. There was no predictor based on the information from patient characteristics; however, cystic duct injury was associated with the technical failure of ETGBD.
内镜经乳头胆囊引流术（ETGBD）已作为一种替代疗法应用于急性胆囊炎患者，以避免胆囊切除术。迄今为止，鲜有研究报道 ETGBD 的安全性、疗效及影响因素。本研究评估了 ETGBD 的临床结果和技术失败的预测因素。
回顾性分析了接受 ETGBD 的急性胆囊炎患者的临床资料，连续纳入研究对象。研究调查了 ETGBD 的技术成功率、临床成功率、不良事件，以及与 ETGBD 技术失败相关的预测因素。
本研究共纳入 242 例患者。ETGBD 的技术成功率和技术成功病例的临床成功率分别为 87%和 93%。我们在 24 例患者中观察到 ETGBD 相关的胆囊管损伤，在 12 例患者中观察到内镜逆行胰胆管造影术相关的胰腺炎。多因素分析表明，胆囊管损伤是 ETGBD 技术失败的独立预测因素（比值比，11；95%置信区间，3.9-29； < 0.001）。
ETGBD 是一种安全有效的治疗急性胆囊炎的方法，不良事件发生率可接受。根据患者特征信息，不存在预测因素，但胆囊管损伤与 ETGBD 的技术失败有关。
