Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.
Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan; Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Gastrointest Endosc. 2023 Jul;98(1):36-42.e1. doi: 10.1016/j.gie.2023.01.009. Epub 2023 Jan 14.
Acute cholecystitis is occasionally observed after biliary drainage using a covered self-expandable metal stent (CSEMS) for distal biliary obstruction (DBO). Gallbladder drainage before CSEMS placement may reduce cholecystitis. This study aimed to examine the preventive effect of endoscopic gallbladder stent placement (EGBS) on cholecystitis with CSEMSs.
We retrospectively analyzed patients with DBO who underwent CSEMS placement across the orifice of the cystic duct between November 2014 and October 2021 and were negative for cholecystitis on biliary drainage. Prophylactic EGBS was attempted before CSEMS placement. The incidence of cholecystitis was compared between patients with and without EGBS.
In total, 286 patients (128 men; median age, 75 years) were included in this study. EGBS was attempted in 32 patients before CSEMS placement, and technical success was achieved in 24 patients (75%). Adverse events were noted in 3 patients (9.4%; penetration of cystic duct in 1 and acute pancreatitis in 2). The cumulative incidence of cholecystitis was significantly lower in patients with EGBS than in those without EGBS (1 [4.2%] vs 56 [21.4%], P = .045). In multivariable analysis, EGBS was a significant protective factor against cholecystitis (hazard ratio, .11; 95% confidence interval, .01-.79; P = .028).
Although the transpapillary approach to the gallbladder is not easy for patients with DBO, EGBS is effective in preventing cholecystitis associated with CSEMS placement.
胆道引流术后偶尔会发生急性胆囊炎，尤其是在使用覆膜自膨式金属支架（CSEMS）治疗远端胆道梗阻（DBO）时。在放置 CSEMS 之前进行胆囊引流可能会降低胆囊炎的发生率。本研究旨在探讨内镜下胆囊支架置入术（EGBS）对 CSEMS 相关胆囊炎的预防作用。
我们回顾性分析了 2014 年 11 月至 2021 年 10 月期间接受 CSEMS 放置术的 DBO 患者，这些患者在胆道引流时无胆囊炎，且 CSEMS 位于胆囊管开口处。在放置 CSEMS 之前尝试进行预防性 EGBS。比较有和无 EGBS 的患者胆囊炎的发生率。
本研究共纳入 286 例患者（男 128 例；中位年龄 75 岁）。32 例患者在放置 CSEMS 之前尝试了 EGBS，其中 24 例（75%）技术成功。3 例患者出现不良事件（9.4%；1 例穿透胆囊管，2 例急性胰腺炎）。有 EGBS 的患者胆囊炎的累积发生率明显低于无 EGBS 的患者（1 [4.2%] vs 56 [21.4%]，P =.045）。多变量分析显示，EGBS 是胆囊炎的保护因素（危险比，0.11；95%置信区间，0.01-0.79；P =.028）。
尽管经乳头途径进入胆囊对 DBO 患者来说并不容易，但 EGBS 可有效预防 CSEMS 放置相关的胆囊炎。
