Division of Biliopancreas, Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea.
Institute of Wonkwang Medical Science, Iksan, Republic of Korea.
Sci Rep. 2024 Jun 5;14(1):12893. doi: 10.1038/s41598-024-63608-5.
This study retrospectively evaluated the outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using novel electrocautery-enhanced lumen-apposing metal stents (LAMS) in high-risk patients with acute cholecystitis (AC). Between January 1, 2021, and November 30, 2022, 58 high-risk surgical patients with AC underwent EUS-GBD with the novel electrocautery-enhanced LAMS. The technical success rate was 94.8% (55/58), with one case of duodenal perforation requiring surgery with complete stent migration and two of partial stent migration into the gallbladder. However, the clinical success rate was 100% (55/55). Recurrent AC occurred in 3.6% of the cases (2/55), managed with double pigtail plastic stents through the LAMS. Early AEs observed in 1.8% (1/55) due to stent obstruction. Late AEs occurred in 5.4% (3/55), including two cases of cholangitis and one of stent obstruction. For 33 patients followed over 6 months, LAMS maintenance was sustained in 30 cases. Two patients underwent double-pigtail plastic stent replacement after LAMS removal, and one underwent LAMS removal during surgery following tumor stage regression after chemotherapy for cholangiocarcinoma. The novel electrocautery-enhanced LAMS demonstrated high technical and clinical success rates in high-risk surgical patients with AC, maintaining effective gallbladder drainage with minimal AEs during long-term follow-up, thus highlighting its efficacy and safety in challenging patients.
本研究回顾性评估了新型电烧灼增强型 lumen-apposing 金属支架（LAMS）在急性胆囊炎（AC）高危手术患者中行内镜超声引导下胆囊引流（EUS-GBD）的疗效。2021 年 1 月 1 日至 2022 年 11 月 30 日，58 例高危手术 AC 患者接受了新型电烧灼增强型 LAMS 的 EUS-GBD。技术成功率为 94.8%（55/58），其中 1 例发生十二指肠穿孔，需要手术治疗，支架完全迁移，2 例部分支架迁移至胆囊。然而，临床成功率为 100%（55/55）。3.6%（2/55）的病例发生复发性 AC，通过 LAMS 置入双猪尾塑料支架进行治疗。1.8%（1/55）的病例出现早期不良反应，原因是支架阻塞。5.4%（3/55）的病例出现晚期不良反应，包括 2 例胆管炎和 1 例支架阻塞。在 33 例随访超过 6 个月的患者中，30 例 LAMS 维持通畅。2 例患者在 LAMS 取出后更换双猪尾塑料支架，1 例患者在化疗后胆管癌肿瘤分期消退行手术时取出 LAMS。新型电烧灼增强型 LAMS 用于 AC 高危手术患者，具有较高的技术和临床成功率，在长期随访中保持有效的胆囊引流，且不良反应最小，这突出了其在具有挑战性的患者中的疗效和安全性。
