Thomas Raj Jessica, Chatterjee Arjun, Abdallah Mohamed, Garg Rajat, Singh Amandeep, Chahal Prabhleen
Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA.
Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Scand J Gastroenterol. 2025 Jan;60(1):99-103. doi: 10.1080/00365521.2024.2434631. Epub 2024 Dec 2.
Cholecystectomy is the preferred treatment for acute cholecystitis in average surgical-risk patients. For those with high perioperative risk, percutaneous transhepatic gallbladder drainage (PT-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) are alternatives. However, PT-GBD is limited by contraindications such as large hepatic masses, significant ascites, and coagulopathy, and some critically ill patients cannot be transferred for PT-GBD or EUS-GBD. This case series demonstrates that bedside EUS-GBD in the ICU is technically feasible and safe for critically ill patients who are unsuitable for other interventions. Three cases involving severely ill patients successfully underwent bedside EUS-GBD with initial post-procedure improvement. Unfortunately, all patients eventually required comfort care due to their severe underlying conditions. These cases highlight EUS-GBD as an effective bedside option for gallbladder drainage in ICU patients when supported by multidisciplinary teams. Further research could confirm its expanded role in managing high-risk patients in intensive care.
胆囊切除术是普通手术风险患者急性胆囊炎的首选治疗方法。对于围手术期风险高的患者，经皮经肝胆囊引流术（PT-GBD）和内镜超声引导下胆囊引流术（EUS-GBD）是替代方案。然而，PT-GBD受到诸如大的肝脏肿块、大量腹水和凝血功能障碍等禁忌症的限制，一些重症患者无法转至进行PT-GBD或EUS-GBD。本病例系列表明，在重症监护病房（ICU）进行床旁EUS-GBD对不适合其他干预措施的重症患者在技术上是可行且安全的。三例重症患者成功接受了床旁EUS-GBD，术后初期病情有所改善。不幸的是，由于其严重的基础疾病，所有患者最终都需要姑息治疗。这些病例突出了在多学科团队支持下，EUS-GBD作为ICU患者胆囊引流的一种有效的床旁选择。进一步的研究可以证实其在重症监护中管理高危患者方面的扩展作用。
