McDonagh Padraic, Awadelkarim Bidour, Leeds John S, Nayar Manu K, Oppong Kofi W
HPB Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK.
Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK.
Cancers (Basel). 2023 May 30;15(11):2988. doi: 10.3390/cancers15112988.
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a rescue technique for patients with malignant biliary obstruction who fail conventional treatment with ERCP or EUS-guided biliary drainage. The technique has been successfully employed in the management of acute cholecystitis in patients not fit for surgery. However, the evidence for its use in malignant obstruction is less robust. This review article aims to evaluate the data available at present to better understand the safety and efficacy of EUS-guided gallbladder drainage.
A detailed literature review was conducted and several databases were searched for any studies relating to EUS-GBD in malignant biliary obstruction. Pooled rates with 95% confidence intervals were calculated for clinical success and adverse events.
Our search identified 298 studies related to EUS-GBD. The final analysis included 7 studies with 136 patients. The pooled rate of clinical success (95% CI) was 85% (78-90%, I: 0%). The pooled rate of adverse events (95% CI) was 13% (7-19%, I: 0%). Adverse events included: peritonitis, bleeding, bile leakage, stent migration, and stent occlusion. No deaths directly related to the procedure were reported; however, in some of the studies, deaths occurred due to disease progression.
This review supports the use of EUS-guided gallbladder drainage as a rescue option for patients who have failed conventional measures.
内镜超声引导下胆囊引流术（EUS-GBD）是一种针对恶性胆道梗阻患者的挽救性技术，这些患者常规的内镜逆行胰胆管造影术（ERCP）或内镜超声引导下胆道引流治疗失败。该技术已成功用于不适宜手术的急性胆囊炎患者的治疗。然而，其在恶性梗阻治疗中的应用证据尚不充分。这篇综述文章旨在评估目前可用的数据，以更好地了解内镜超声引导下胆囊引流术的安全性和有效性。
进行了详细的文献综述，并检索了多个数据库，以查找与恶性胆道梗阻中EUS-GBD相关的任何研究。计算了临床成功率和不良事件的合并率及95%置信区间。
我们的检索共识别出298项与EUS-GBD相关的研究。最终分析纳入了7项研究中的136例患者。临床成功率的合并率（95%CI）为85%（78-90%，I²：0%）。不良事件的合并率（95%CI）为13%（7-19%，I²：0%）。不良事件包括：腹膜炎、出血、胆漏、支架移位和支架堵塞。未报告与该操作直接相关的死亡病例；然而，在一些研究中，患者因疾病进展而死亡。
本综述支持将内镜超声引导下胆囊引流术作为常规措施失败患者的挽救性选择。
