Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent.
Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent.
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DOI：
10.3748/wjg.v23.i4.661
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发表时间：
2017-01-28
影响因子：
4.3
通讯作者：
Kudo M
中科院分区：
文献类型：
--
作者：
Kamata K;Takenaka M;Kitano M;Omoto S;Miyata T;Minaga K;Yamao K;Imai H;Sakurai T;Watanabe T;Nishida N;Kudo M
评估自膨式金属支架（SEMS）取出后该手术的长期结局。还评估了SEMS内镜超声引导胆囊引流（EUS-GBD）的有效性和安全性。2010年1月至2015年4月期间，12例被认为不适合胆囊切除术的急性结石性胆囊炎患者接受了SEMS EUS-GBD。EUS-GBD是在EUS和透视的引导下，通过用针穿刺胆囊，插入导丝，扩张穿刺孔，并放置SEMS来进行的。胆囊炎改善后，取出SEMS和/或更换为7 Fr塑料猪尾支架。技术和临床成功率，不良事件发生率和复发率都进行了测量。技术成功率、临床成功率和不良事件发生率分别为100%、100%和0%。胆囊炎改善后，8例患者的SEMS被移除而未进行置换，而4例患者的SEMS被置换为7 Fr猪尾支架。1例未接受猪尾支架置换的患者（8.3%）出现复发。EUS-GBD术后中位随访时间为304 d（78-1492）。EUS-GBD联合SEMS是急性胆囊炎的一种可能的替代治疗方法。取出SEMS后的长期结局非常好。在SEMS放置后4周取出SEMS并改善症状可能会避免支架移位和由于食物嵌塞引起的胆囊炎复发。
To assess the long-term outcomes of this procedure after removal of self-expandable metal stent (SEMS). The efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with SEMS were also assessed. Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUS-GBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. The SEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured. The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient (8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d (78-1492). EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.