Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
PLoS One. 2023 Feb 9;18(2):e0281605. doi: 10.1371/journal.pone.0281605. eCollection 2023.
Endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an alternative procedure for acute cholecystitis but remains a challenging procedure.
To elucidate the efficacy of a strategic approach for ETGBD that utilizes a four-step classification system and the optional use of 'Three-pillar' assistance with the following devices: cholangioscopy (SpyGlass DS, SG), a flex-type guidewire (Flex-GW), and a 3-Fr microcatheter (3-Fr Micro).
A total of 115 patients undergoing ETGBD were studied retrospectively. Characteristics and technical outcomes were compared between conventional ETGBD technique (Classical ETGBD, N = 50) and strategic ETGBD with optional Three-pillar assistance (Strategic ETGBD, N = 65).
SG-assistance (15/65, 23.1%) was as an excellent troubleshooter in Category 1 (failure to identify the cystic duct [CD] orifice) and Category 2 (failure to advance the GW across the CD takeoff due to unfavorable angle). Flex-GW (19/65, 29.2%) worked for Category 3b (failure of GW access to the GB due to multiple tortuosities). 3-Fr Micro (11/65, 16.9%) was effective for Category 3a (failure of GW access to the GB due to CD obstruction) and Category 4 (failure of drainage stent insertion to the GB). The overall technical success rate was significantly higher for Strategic ETGBD (63/65, 96.9%) compared with Classical ETGBD (36/50, 72.0%) (p = 0.0001).
Strategic ETGBD, which includes the Three-pillar assistance options of SG in the initial steps, Flex-GW for tortuous CD, and 3-Fr Micro for stenotic CD, achieved a significantly higher success rate than for Classical ETGBD.
经内镜逆行胰胆管造影（ERCP）下胆囊引流术（ETGBD）已被报道为急性胆囊炎的替代治疗方法，但仍是一种具有挑战性的操作。
阐明一种采用四步分类系统的 ETGBD 策略性方法的疗效，并在以下设备中选择性使用“三支柱”辅助方法：胆管镜（SpyGlass DS，SG）、可弯曲导丝（Flex-GW）和 3Fr 微导管（3Fr Micro）。
回顾性研究了 115 例行 ETGBD 的患者。比较了传统 ETGBD 技术（经典 ETGBD，N=50）和选择性使用三支柱辅助的策略性 ETGBD（策略性 ETGBD，N=65）的患者特征和技术结果。
SG 辅助（15/65，23.1%）在 1 类（无法识别胆囊管（CD）口）和 2 类（由于角度不利，GW 无法穿过 CD 起始部）中是一种出色的故障排除器。Flex-GW（19/65，29.2%）适用于 3b 类（由于多次迂曲，GW 无法进入胆囊）。3Fr Micro（11/65，16.9%）对 3a 类（由于 CD 阻塞，GW 无法进入胆囊）和 4 类（引流支架无法插入胆囊）有效。与经典 ETGBD（36/50，72.0%）相比，策略性 ETGBD 的总体技术成功率（63/65，96.9%）显著更高（p=0.0001）。
与经典 ETGBD 相比，包括初始步骤中 SG 的三支柱辅助、用于迂曲 CD 的 Flex-GW 和用于狭窄 CD 的 3Fr Micro 的策略性 ETGBD，其成功率显著更高。
