Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan.
First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
J Hepatobiliary Pancreat Sci. 2023 Sep;30(9):1152-1160. doi: 10.1002/jhbp.1344. Epub 2023 Jun 19.
Endoscopic transpapillary naso-gallbladder drainage (ENGBD) has been reported to be an effective treatment option for acute cholecystitis. At our institution, ENGBD was first placed for external fistula management, and endoscopic internalization by cutting was performed, shifting to endoscopic transpapillary gallbladder stenting (EGBS) after improvement of cholecystitis. However, there has been no comparative study to define which preoperative management is better: converting ENGBD to EGBS or removing ENGBD. The study aimed to compare the incidence rate of the late adverse events (AEs) related to biliary system between shifting from ENGBD to EGBS and removal of ENGBD.
We retrospectively studied 122 patients who underwent ENGBD for acute cholecystitis between January 2010 and October 2022. The patients were divided into two groups: the cutting group (converting ENGBD to EGBS) and the removal group (removal of ENGBD). The short and late clinical outcomes were compared between groups.
Endoscopic transpapillary naso-gallbladder drainage was successfully placed in 78.6% (96/122), and elective cholecystectomy was performed in 31 and 36 patients in the cutting and removal groups, respectively. The cumulative late-AE rates were 6.4% and 33.3% (p = .007), with a median waiting period for elective cholecystectomy of 58 and 33 days (p = .390) in the cutting and removal groups, respectively. In the multivariate analysis, only endoscopic internalization by cutting was an independent factor affecting late AEs.
Endoscopic internalization by cutting ENGBD after the resolution of acute cholecystitis was considered effective in reducing the risk of late AEs during the waiting period for an elective cholecystectomy.
经内镜经乳头鼻胆囊引流术（ENGBD）已被报道为治疗急性胆囊炎的有效治疗选择。在我们的机构中，ENGBD 最初用于外部瘘管管理，并通过切开进行内镜内部化，在胆囊炎改善后转为内镜经乳头胆囊支架置入术（EGBS）。然而，尚无比较研究来定义哪种术前管理更好：将 ENGBD 转为 EGBS 或移除 ENGBD。本研究旨在比较从 ENGBD 转为 EGBS 和移除 ENGBD 之间与胆道系统相关的晚期不良事件（AE）发生率。
我们回顾性研究了 2010 年 1 月至 2022 年 10 月期间因急性胆囊炎接受 ENGBD 的 122 例患者。患者分为两组：切开组（将 ENGBD 转为 EGBS）和移除组（移除 ENGBD）。比较两组之间的短期和晚期临床结局。
ENGBD 成功放置 78.6%（96/122），在切开和移除组分别有 31 例和 36 例患者进行了择期胆囊切除术。累积晚期 AE 发生率分别为 6.4%和 33.3%（p = .007），切开和移除组的择期胆囊切除术等待期中位数分别为 58 天和 33 天（p = .390）。多变量分析显示，只有内镜内部化是影响晚期 AE 的独立因素。
在急性胆囊炎缓解后，切开 ENGBD 进行内镜内部化被认为可以降低择期胆囊切除术前等待期间晚期 AE 的风险。
