Garg Rajat, Baron Todd H, Trieu Judy A, Martínez-Moreno Belén, Aparicio Tormo José Ramón, Akiki Karl, Storm Andrew C, Kumar Prabhat, Singh Amandeep, Simons-Linares C Roberto, Chahal Prabhleen
Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, United States.
Department of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, United States.
Endoscopy. 2025 Jun;57(6):593-601. doi: 10.1055/a-2517-0927. Epub 2025 Jan 15.
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for symptomatic gallbladder disease has been shown to be safe and effective in patients with high surgical risk, but data are lacking for patients with cirrhosis. We investigated the safety and effectiveness of EUS-GBD in patients with and without cirrhosis.This retrospective review included patients who underwent EUS-GBD at four (three US and one Spanish) international tertiary care centers. Outcomes, including technical success, clinical success, and procedure-related adverse events, were compared between patients with and without cirrhosis.170 patients (47 with cirrhosis, 123 without cirrhosis) were included. There was no difference in age, sex, race, comorbidities, antiplatelet use, hemoglobin, or international normalized ratio between the two groups ( > 0.05 for all). The most common etiology of cirrhosis was alcohol (42.6%) with mean Model of End-stage Liver Disease-Sodium (MELD-Na) score of 16.2 (SD 8.8). Acute cholecystitis was more common in patients with cirrhosis (74.5% vs. 56.9%; = 0.02). Technical (cirrhosis 97.9% vs. no cirrhosis 95.1%; = 0.67) and clinical (93.6% vs. 94.9%; = 0.71) success rates were similar in the two groups. Adverse events were infrequent and similar between groups, the most common being stent maldeployment (cirrhosis 4.3% vs. no cirrhosis 5.7%; = 0.99). Survival rates were similar at the end of follow-up.EUS-GBD was safe and effective in patients with cirrhosis, with outcomes similar to patients without cirrhosis when performed by experienced echoendoscopists. Patients with cirrhosis and symptomatic gallbladder disease can be considered for EUS-GBD.
内镜超声引导下胆囊引流术（EUS - GBD）治疗有症状的胆囊疾病，已被证明在手术风险高的患者中是安全有效的，但肝硬化患者的数据尚缺。我们调查了EUS - GBD在有和没有肝硬化患者中的安全性和有效性。
这项回顾性研究纳入了在四个（三个美国和一个西班牙）国际三级医疗中心接受EUS - GBD的患者。比较了有和没有肝硬化患者的结局，包括技术成功率、临床成功率和与操作相关的不良事件。
共纳入170例患者（47例有肝硬化，123例无肝硬化）。两组在年龄、性别、种族、合并症、抗血小板药物使用、血红蛋白或国际标准化比值方面无差异（均>0.05）。肝硬化最常见的病因是酒精性（42.6%），终末期肝病 - 钠（MELD - Na）评分均值为16.2（标准差8.8）。急性胆囊炎在肝硬化患者中更常见（74.5%对56.9%；P = 0.02）。两组的技术成功率（肝硬化组97.9%对无肝硬化组95.1%；P = 0.67）和临床成功率（93.6%对94.9%；P = 0.71）相似。不良事件发生率低且组间相似，最常见的是支架放置不当（肝硬化组4.3%对无肝硬化组5.7%；P = 0.99）。随访结束时生存率相似。
EUS - GBD在肝硬化患者中是安全有效的，由经验丰富的超声内镜医师操作时，其结局与无肝硬化患者相似。有肝硬化和有症状胆囊疾病的患者可考虑行EUS - GBD。
