Division of Biliopancreas, Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University Medical School, Iksan, Korea.
Institute of Wonkwang Medical Science, Iksan, Korea.
Gut Liver. 2024 Mar 15;18(2):348-357. doi: 10.5009/gnl230019. Epub 2023 Jul 17.
BACKGROUND/AIMS: There are no consensus guidelines for patients with acute cholecystitis undergoing percutaneous cholecystostomy who are unfit for interval cholecystectomy. The current study aimed to compare the clinical outcomes of endoscopic gallbladder drainage, i.e. conversion from percutaneous cholecystostomy (including endoscopic transpapillary gallbladder stenting and endoscopic ultrasound-guided gallbladder drainage), and conservative treatment after percutaneous cholecystostomy tube removal.
This retrospective review included patients who underwent percutaneous cholecystostomy for acute cholecystitis between January 2017 and December 2020. Consecutive patients who underwent endoscopic gallbladder drainage or percutaneous cholecystostomy tube removal without interval cholecystectomy were included. Outcome measures included recurrent acute cholecystitis and unplanned readmission due to gallstone-related diseases.
During the study period, 238 patients were selected (63 underwent endoscopic gallbladder drainage conversion and 175 underwent conservative treatment). Patients who underwent endoscopic gallbladder drainage conversion had lower rates of recurrent acute cholecystitis (3 [4.76%] vs 31 [17.71%], p=0.012) and unplanned readmission due to gallstone-related diseases (6 [9.52%] vs 40 [22.86%], p=0.022) than those who underwent conservative treatment following percutaneous cholecystostomy tube removal. In the univariate and multivariate analyses, calculus cholecystitis (odds ratio, 13.75; 95% confidence interval, 1.83 to 102.83; p=0.011) and conversion of endoscopic gallbladder drainage (odds ratio, 0.23; 95% confidence interval, 0.06 to 0.78; p=0.019) were significant predictive factors for recurrent acute cholecystitis.
Endoscopic gallbladder drainage conversion led to more favorable outcomes than conservative treatment after percutaneous cholecystostomy tube removal. Therefore, endoscopic gallbladder drainage conversion may be considered a promising treatment option for patients undergoing percutaneous cholecystostomy who are at a high surgical risk.
背景/目的：对于因身体状况不适合行间隔性胆囊切除术而行经皮胆囊造口术的急性胆囊炎患者，目前尚无共识指南。本研究旨在比较经皮胆囊造口术后行内镜胆囊引流（包括经皮经胆囊管胆囊支架置入术和内镜超声引导下胆囊引流）和经皮胆囊造口管拔除后的保守治疗的临床结果。
本回顾性研究纳入了 2017 年 1 月至 2020 年 12 月期间因急性胆囊炎而行经皮胆囊造口术的患者。连续纳入了行内镜胆囊引流或经皮胆囊造口管拔除而未行间隔性胆囊切除术的患者。主要观察指标包括复发性急性胆囊炎和因胆石相关疾病而计划外再入院。
在研究期间，共选择了 238 例患者（63 例行内镜胆囊引流转化，175 例行保守治疗）。与经皮胆囊造口管拔除后的保守治疗相比，行内镜胆囊引流转化的患者复发性急性胆囊炎的发生率较低（3[4.76%]比 31[17.71%]，p=0.012），因胆石相关疾病而计划外再入院的发生率也较低（6[9.52%]比 40[22.86%]，p=0.022）。在单因素和多因素分析中，胆石性胆囊炎（比值比，13.75；95%置信区间，1.83 至 102.83；p=0.011）和内镜胆囊引流的转化（比值比，0.23；95%置信区间，0.06 至 0.78；p=0.019）是复发性急性胆囊炎的显著预测因素。
与经皮胆囊造口管拔除后的保守治疗相比，内镜胆囊引流转化可获得更好的结果。因此，对于行经皮胆囊造口术且手术风险较高的患者，内镜胆囊引流转化可能是一种有前途的治疗选择。
