Ridtitid Wiriyaporn, Faknak Natee, Piyachaturawat Panida, Teeratorn Nicha, Sritunyarat Yingluk, Angsuwatcharakon Phonthep, Mekaroonkamol Parit, Kongkam Pradermchai, Rerknimitr Rungsun
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Endoscopy. 2023 May;55(5):469-475. doi: 10.1055/a-1962-7305. Epub 2022 Oct 18.
Endoscopic transpapillary gallbladder stenting (ETGS) can be a bridging therapy to elective cholecystectomy or a permanent gallbladder drainage method in patients with symptomatic gallbladder disease who are awaiting cholecystectomy or are unfit for surgery, respectively. We evaluated the intermediate- to long-term outcomes of ETGS in these groups.
We retrospectively reviewed 234 patients (acute cholecystitis = 147), who were unfit for surgery (n = 50) or had deferred cholecystectomy (n = 184) and who underwent ETGS between 2012 and 2021. A 7-Fr, 15-cm, double-pigtail plastic stent was placed for ETGS without scheduled stent exchange. Biliary event-free rates (i. e. cholecystitis and cholangitis) were determined at 6 months, 1 year, and ≥ 2 years.
Technical and clinical success rates were 84.6 % (198/234) and 97.4 % (193/198), respectively. Kaplan-Meier analysis (n = 193) showed a biliary event-free rate of 99 % (95 %CI 0.95-1.00) at 6 months, 92 % (95 %CI 0.87-0.97) at 1 year, and 76 % (95 %CI 0.65-0.93) at ≥ 2 years, during a median follow-up period of 564 days (range 200-3001 days).
ETGS is an effective biliary drainage method that should be considered in selected cases with common bile duct stone where cholecystectomy could not be performed or was deferred. The biliary event-free rates of ≥ 76 % up to ≥ 2 years further support the use of ETGS in these patient groups.
内镜下经乳头胆囊支架置入术（ETGS）可作为一种过渡性治疗方法，用于择期胆囊切除术，或分别用于患有症状性胆囊疾病且正在等待胆囊切除术或不适合手术的患者的永久性胆囊引流方法。我们评估了这些患者群体中ETGS的中长期结果。
我们回顾性分析了2012年至2021年间接受ETGS的234例患者（急性胆囊炎患者147例），这些患者不适合手术（50例）或推迟了胆囊切除术（184例）。放置一根7Fr、15cm的双猪尾塑料支架进行ETGS，无需定期更换支架。在6个月、1年和≥2年时确定无胆道事件发生率（即胆囊炎和胆管炎）。
技术成功率和临床成功率分别为84.6%（198/234）和97.4%（193/198）。Kaplan-Meier分析（n=193）显示，在中位随访期564天（范围200-3001天）内，6个月时无胆道事件发生率为99%（95%CI 0.95-1.00），1年时为92%（95%CI 0.87-0.97），≥2年时为76%（95%CI 0.65-0.93）。
ETGS是一种有效的胆道引流方法，在无法进行胆囊切除术或推迟手术的胆总管结石特定病例中应予以考虑。长达≥2年的无胆道事件发生率≥76%进一步支持在这些患者群体中使用ETGS。
