Clinical efficacy and safety of endoscopic ultrasound‐guided gallbladder drainage replacement of percutaneous drainage: A multicenter retrospective study
Clinical efficacy and safety of endoscopic ultrasound‐guided gallbladder drainage replacement of percutaneous drainage: A multicenter retrospective study
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超声内镜引导下胆囊引流术替代经皮引流术的临床疗效和安全性：多中心回顾性研究
DOI：
10.1111/den.13242
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发表时间：
2018
影响因子：
5.3
通讯作者：
Kitano M
中科院分区：
文献类型：
--
作者：
Minaga K;Yamashita Y;Ogura T;Takenaka M;Shimokawa Y;Hisa T;Itonaga M;Kato H;Nishikiori H;Okuda A;Matsumoto H;Uenoyama Y;Watanabe T;Chiba Y;Higuchi K;Kudo M;Kitano M
目的经皮肝穿刺胆囊引流术（PTGBD）广泛应用于急性胆囊炎患者。关于超声内镜引导下胆囊引流术 (EUS-GBD) 替代 PTBD 对无法接受胆囊切除术的患者的有效性和安全性的数据很少。方法日本的这项多中心回顾性研究回顾了 2010 年 1 月至 2017 年 12 月期间接受 EUS-GBD 替代 PTBD 的患者记录。评估的结果包括技术成功，定义为在胃肠道腔和胆囊之间成功放置支架；临床成功，定义为随后移除经皮导管；不良事件；结果对 21 名患者（14 名女性，平均年龄 77.5 ± 8.0 岁）进行了 EUS-GBD，以取代针对急性胆囊炎 (n = 19) 或梗阻性黄疸 (n = 2) 实施的 PTBD。 19 人（90.5%）取得了技术成功。从 PTBD 放置到 EUS-GBD 的中位时间为 11 天（范围为 6-68 天）。平均手术时间为 19.5 ± 5.1 分钟。没有观察到早期不良事件。发生了 3 起晚期不良事件，其中 2 例发生支架远端移位，1 例患者支架闭塞导致胆囊炎复发。两名患者需要重新干预。 17 名患者在 EUS-GBD 后平均 7 天（范围为 2-20 天）拔除经皮导管。支架通畅时间为 139 天（范围为 8-664 天）。 结论 对于需要持续胆囊引流的情况，对于无法接受胆囊切除术的患者，从 PTBD 转换为 EUS-GBD 是一种可行、有效且安全的技术。
ObjectivesPercutaneous transhepatic gallbladder drainage (PTGBD) is widely used for patients with acute cholecystitis. There are little data on the efficacy and safety of endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) replacement of PTGBD in patients who cannot undergo cholecystectomy.MethodsThis multicenter retrospective study in Japan reviewed records of patients who underwent EUS‐GBD to replace PTGBD between January 2010 and December 2017. Outcomes evaluated included technical success, defined as successful stent placement between the gastrointestinal lumen and the gallbladder; clinical success, defined as subsequent removal of the percutaneous catheter; adverse events; and stent patency.ResultsEUS‐GBD was performed in 21 patients (14 women, mean age 77.5 ± 8.0 years) to replace PTGBD that had been instituted for acute cholecystitis (n= 19) or obstructive jaundice (n= 2). Technical success was achieved in 19 (90.5%). The median period from PTGBD placement to EUS‐GBD was 11 days (range, 6–68 days). The mean procedure time was 19.5 ± 5.1 min. No early adverse events were observed. There were three late adverse events, distal stent migration in two cases and stent occlusion causing recurrent cholecystitis in one patient. Reintervention was required in two patients. The percutaneous catheter was removed after EUS‐GBD in 17 patients at a median of 7 days (range, 2–20 days). The duration of stent patency was 139 days (range, 8–664 days).ConclusionsWhere ongoing gallbladder drainage is required, conversion from PTGBD to EUS‐GBD is a feasible, effective, and safe technique for patients who cannot undergo cholecystectomy.