Department of Gastroenterology, Aichi Medical University, Yazakokarimata, Nagakute, Aichi, Japan.
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.
Gastrointest Endosc. 2023 Sep;98(3):362-370. doi: 10.1016/j.gie.2023.04.002. Epub 2023 Apr 12.
Although long-term stent placement using endoscopic transpapillary gallbladder drainage (ETGBD) and EUS-guided gallbladder drainage (EUS-GBD) reportedly reduces cholecystitis recurrence, comparative evidence of their safety and efficacy is scarce. This study aimed to examine and compare the long-term utility of EUS-GBD versus that of ETGBD in poor surgical candidates.
A total of 379 high-risk surgical patients with acute calculous cholecystitis met the eligibility criteria for enrollment in this study. The technical success and adverse events (AEs) were compared between the EUS-GBD and ETGBD groups, and propensity score matching was performed to adjust for differences between the groups. Both groups underwent plastic stent placement, and scheduled stent exchange and removal were not performed in either group.
The technical success rate of EUS-GBD was significantly higher than that of ETGBD (96.7% vs 78.9%, P < .001), whereas the early AE rate did not differ significantly between the 2 methods (7.8% vs 8.9%, P = 1.000). The rate of recurrent cholecystitis did not differ significantly (3.8% vs 3.0%, P = 1.000), but the rate of symptomatic late AEs, in addition to cholecystitis, was significantly lower with EUS-GBD than with ETGBD (1.3% vs 13.4%, P = .006). Consequently, the overall late AE rate was significantly lower with EUS-GBD (5.0% vs 16.4%, P = .029). Multivariate analysis revealed that EUS-GBD was associated with a significantly longer time to late AE (hazard ratio, .26; 95% confidence interval, .10-.67; P = .005).
Long-term stent placement via EUS-GBD is a promising potential option for limiting late AEs, including recurrence, in poor surgical candidates with calculous cholecystitis.
虽然内镜经乳头胆囊引流术（ETGBD）和超声内镜引导下胆囊引流术（EUS-GBD）长期放置支架可降低胆囊炎复发率，但关于其安全性和有效性的比较证据很少。本研究旨在检查和比较 EUS-GBD 与 ETGBD 在手术高危患者中的长期应用。
共 379 例符合急性胆石性胆囊炎入选标准的高危手术患者纳入本研究。比较 EUS-GBD 组和 ETGBD 组的技术成功率和不良事件（AE），并进行倾向评分匹配以调整组间差异。两组均行塑料支架置入，均不进行支架更换和取出。
EUS-GBD 的技术成功率显著高于 ETGBD（96.7% vs 78.9%，P <.001），而两种方法的早期 AE 发生率无显著差异（7.8% vs 8.9%，P = 1.000）。胆囊炎复发率无显著差异（3.8% vs 3.0%，P = 1.000），但 EUS-GBD 组除胆囊炎外，症状性晚期 AE 发生率显著低于 ETGBD 组（1.3% vs 13.4%，P =.006）。因此，EUS-GBD 组的总体晚期 AE 发生率显著较低（5.0% vs 16.4%，P =.029）。多变量分析显示，EUS-GBD 与晚期 AE 发生时间显著延长相关（风险比，0.26；95%置信区间，0.10-0.67；P =.005）。
对于有症状的高危手术患者，EUS-GBD 长期放置支架可能是一种很有前途的选择，可以减少包括复发在内的晚期 AE。
