Binda Cecilia, Anderloni Andrea, Forti Edoardo, Fusaroli Pietro, Macchiarelli Raffaele, Manno Mauro, Fugazza Alessandro, Redaelli Alessandro, Aragona Giovanni, Lovera Mauro, Togliani Thomas, Armellini Elia, Amato Arnaldo, Brancaccio Mario Luciano, Badas Roberta, Leone Nicola, de Nucci Germana, Mangiavillano Benedetto, Sbrancia Monica, Pollino Valeria, Lisotti Andrea, Maida Marcello, Sinagra Emanuele, Ventimiglia Marco, Repici Alessandro, Fabbri Carlo, Tarantino Ilaria
Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì-Cesena, Italy.
Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S., Policlinico San Matteo Viale, 27100 Pavia, Italy.
Diagnostics (Basel). 2024 Feb 13;14(4):413. doi: 10.3390/diagnostics14040413.
Although endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) has become one of the treatments of choice for acute cholecystitis (AC) in fragile patients, scant data are available on real-life settings and long-term outcomes.
We performed a multicenter retrospective study including EUS-guided GBD using LAMS for AC in 19 Italian centers from June 2014 to July 2020. The primary outcomes were technical and clinical success, and the secondary outcomes were the rate of adverse events (AE) and long-term follow-up.
In total, 116 patients (48.3% female) were included, with a mean age of 82.7 ± 11 years. LAMS were placed, transgastric in 44.8% of cases, transduodenal in 53.3% and transjejunal in 1.7%, in patients with altered anatomy. Technical success was achieved in 94% and clinical success in 87.1% of cases. The mean follow-up was 309 days. AEs occurred in 12/116 pts (10.3%); 8/12 were intraprocedural, while 1 was classified as early (<15 days) and 3 as delayed (>15 days). According to the ASGE lexicon, two (16.7%) were mild, three (25%) were moderate, and seven (58.3%) were severe. No fatal AEs occurred. In subgroup analysis of 40 patients with a follow-up longer than one year, no recurrence of AC was observed.
EUS-GBD had high technical and clinical success rates, despite the non-negligible rate of AEs, thus representing an effective treatment option for fragile patients.
尽管使用管腔贴附金属支架（LAMS）的内镜超声引导下胆囊引流术（EUS-GBD）已成为脆弱患者急性胆囊炎（AC）的首选治疗方法之一，但关于实际临床情况和长期预后的数据却很少。
我们进行了一项多中心回顾性研究，纳入了2014年6月至2020年7月期间在意大利19个中心接受EUS引导下使用LAMS治疗AC的患者。主要结局指标为技术成功率和临床成功率，次要结局指标为不良事件（AE）发生率和长期随访情况。
共纳入116例患者（48.3%为女性），平均年龄82.7±11岁。在解剖结构改变的患者中，44.8%的病例通过经胃途径放置LAMS，53.3%经十二指肠途径，1.7%经空肠途径。94%的病例实现了技术成功，87.1%的病例实现了临床成功。平均随访时间为309天。12/116例患者（10.3%）发生了AE；12例中有8例发生在术中，1例为早期（<15天），3例为延迟性（>15天）。根据美国胃肠内镜学会（ASGE）词汇表，2例（16.7%）为轻度，3例（25%）为中度，7例（58.3%）为重度。未发生致命性AE。在40例随访时间超过1年的亚组分析中，未观察到AC复发。
EUS-GBD具有较高的技术成功率和临床成功率，尽管AE发生率不可忽视，但仍是脆弱患者的一种有效治疗选择。
