Giri Suprabhat, Afzalpurkar Shivaraj, Gore Prasanna, Khatana Gaurav, Sahu Saroj Kanta, Praharaj Dibya Lochan, Mallick Bipadabhanjan, Nath Preetam, Sundaram Sridhar, Sahu Manoj Kumar
Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, Odisha, India.
Department of Gastroenterology, Nanjappa Multispecialty Hospital, Davangere 577005, Karnataka, India.
World J Gastrointest Endosc. 2025 Jul 16;17(7):108030. doi: 10.4253/wjge.v17.i7.108030.
Post-endoscopic retrograde cholangiopancreatography (ERCP) cholecystitis (PEC) is a recognized adverse event associated with ERCP. The incidence of PEC is low in patients undergoing ERCP, but is high in specific subgroups, such as those receiving fully-covered self-expandable metallic stents (SEMS). Several risk factors contribute to PEC, including gallbladder (GB)-related factors like tumor involvement of the orifice of the cystic duct (OCD) or feeding artery, and associated gallstones. Stent-related factors, such as covered stent placement and high axial force stents, and procedure-related factors, including stent placement across the OCD and contrast injection into the GB, further elevate the risk. Prevention strategies focus on modifying techniques, such as careful contrast administration and stent selection (uncovered or low axial force SEMS), and considering prophylactic GB drainage through endoscopic transpapillary GB drainage (ETGBD) or endoscopic ultrasound-guided GB drainage (EUS-GBD), especially in high-risk patients. Treatment options for PEC range from conservative management with antibiotics to more invasive interventions like percutaneous transhepatic GB aspiration or drainage, endoscopic techniques (ETGBD, EUS-GBD), and cholecystectomy. The choice of treatment depends on the severity of cholecystitis, the patient's condition, and other factors. The present review summarizes the currently available literature on the incidence, predictors, prevention, and management of PEC.
内镜逆行胰胆管造影（ERCP）术后胆囊炎（PEC）是一种与ERCP相关的公认不良事件。接受ERCP的患者中PEC的发生率较低，但在特定亚组中发生率较高，例如接受全覆膜自膨式金属支架（SEMS）的患者。多种危险因素促成PEC，包括胆囊（GB）相关因素，如胆囊管开口（OCD）或供血动脉的肿瘤累及以及相关胆结石。支架相关因素，如覆膜支架置入和高轴向力支架，以及操作相关因素，包括支架穿过OCD置入和向GB内注入造影剂，会进一步增加风险。预防策略侧重于改进技术，如谨慎给予造影剂和选择支架（无覆膜或低轴向力SEMS），并考虑通过内镜经乳头胆囊引流（ETGBD）或内镜超声引导下胆囊引流（EUS - GBD）进行预防性GB引流，尤其是在高危患者中。PEC的治疗选择范围从使用抗生素的保守治疗到更具侵入性的干预措施，如经皮经肝胆囊抽吸或引流、内镜技术（ETGBD、EUS - GBD）以及胆囊切除术。治疗方法的选择取决于胆囊炎的严重程度、患者状况及其他因素。本综述总结了目前关于PEC的发生率、预测因素、预防和管理的现有文献。
