Treatment of acute cholecystitis in high-risk surgical patients. Systematic review of the literature according to the levels of evidence.
Treatment of acute cholecystitis in high-risk surgical patients. Systematic review of the literature according to the levels of evidence.
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高危手术患者急性胆囊炎的治疗。
DOI：
10.23736/s2724-5985.21.02854-3
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
P. Fusaroli
中科院分区：
文献类型：
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作者：
A. Lisotti;B. Napoléon;C. Fabbri;A. Anderloni;R. Linguerri;I. Bacchilega;P. Fusaroli
急性胆囊炎（AC）是最常见的胆系结石疾病并发症。虽然对于AC的胆囊切除术存在共识，但胆囊引流适用于老年或高风险手术患者。我们系统地回顾了EUS引导下胆囊引流（EUS-GBD）治疗高风险手术患者AC的现有证据。这些研究根据牛津循证医学中心的证据等级（LE）进行分类。文献检索检索到175篇手稿;其中大多数是专家意见（LE V，编号53）或病例系列（LE IV，编号29）。没有RCT的荟萃分析（LE Ia），而两项随机对照试验（LE Ib）证明EUS-GBD在长期结局（不良事件、复发性胆囊炎和再次介入）方面上级经皮经肝GBD（PT-GBD）。队列研究的几项荟萃分析（LE IIa，编号11）旨在比较三种可用的引流策略（内镜、超声内镜和经皮），并评估不良事件的汇总风险。采用倾向评分分析（LE III）在一项回顾性研究中比较了手术和EUS-GBD。少数回顾性研究（LE III）涵盖了从PT-GBD转换为EUS-GBD的结局。在EUS-GBD上发表了几篇文章（第69篇），作为恶性胆道梗阻的抢救策略。文献中EUS-GBD的证据水平已经从最初的描述性研究发展到最近的随机对照试验和队列研究的荟萃分析。虽然有几篇文章讨论了GBD不同技术之间的比较，但我们认为一些主题和问题尚未得到充分研究。仍在争论中。
Acute cholecystitis (AC) is the most common biliary stone disease complication. While there is consensus regarding cholecystectomy for AC, gallbladder drainage is indicated in elderly or high-risk surgical patients. We systematically reviewed available evidence in the field of EUS-guided gallbladder drainage (EUS-GBD) for AC in high-risk surgical patients. The studies were classified according to their level of evidence (LE) according to the Oxford Centre for Evidence Based Medicine classification. Literature search retrieved 175 manuscripts; most of them were expert opinions (LE V, no. 53) or caseseries (LE IV, no. 29). There was no meta-analysis of RCT (LE Ia), while two randomized controlled trials (LE Ib) demonstrated that EUS-GBD was superior to percutaneous trans-hepatic-GBD (PT-GBD) regarding longterm outcomes (adverse events, recurrent cholecystitis, and reintervention). Several meta-analyses of cohort studies (LE IIa, no. 11) were designed to compare the three available drainage strategies (endoscopic, echoendoscopic and percutaneous) and to assess the pooled risk of adverse events. Comparison between surgery and EUS-GBD was done in a single retrospective study with a propensity score analysis (LE III). The outcomes of conversion from PT-GBD to EUS-GBD were covered by few retrospective studies (LE III). Several manuscripts (no. 69) were published on EUS-GBD as a rescue strategy in case of malignant biliary obstruction. The levels of evidence of EUS-GBD in the literature have evolved from initial descriptive studies to recent randomized controlled trials and meta-analysis of cohort studies. While several articles addressed the comparison among different techniques for GBD, in our opinion some topics and questions have not been adequately investigated. are still debated.