Feasibility of endoscopic transpapillary gallbladder drainage for acute gangrenous cholecystitis in poor surgical candidates

IF 4.7 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy Pub Date : 2025-05-20 DOI:10.1111/den.15050

Kazunari Nakahara, Shinjiro Kobayashi, Tsuyoshi Morimoto, Yosuke Igarashi, Akihiro Sekine, Yusuke Satta, Haruka Niwa, Junya Sato, Tomoko Norose, Nobuyuki Ohike, Keisuke Tateishi

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引用次数: 0

Abstract

Objectives

Surgery is generally the first choice of treatment for gangrenous cholecystitis (GC). However, some patients are not fit for surgery because of their comorbidities. We evaluated the feasibility of endoscopic transpapillary gallbladder drainage (ETGBD) for GC in poor surgical candidates.

Methods

This retrospective study compared the outcomes of ETGBD for acute cholecystitis (AC) with and without complicated GC. Of the 136 patients who underwent ETGBD for AC at a single tertiary referral center between January 2019 and July 2023, 91 who underwent contrast-enhanced computed tomography (CT) before ETGBD were included in the analysis.

Results

Patients were assigned to the GC (n = 29) and non-GC (n = 62) groups based on CT findings. The technical success rate of ETGBD, clinical success rate for AC, and rate of early adverse events (AEs) in the GC and non-GC groups were 86.2% vs. 91.9% (P = 0.63), 79.3% vs. 91.9% (P = 0.17), and 27.6% vs. 16.1% (P = 0.32), respectively. The technical and clinical success rates were slightly lower, while the early AE rate was higher in the GC group. However, the differences were not significant. The incidence of late AEs was 15.8% in the GC group and 17.9% in the non-GC group, with no significant difference (P = 0.87). Elective cholecystectomy was significantly less frequent in the GC group (P = 0.023).

Conclusion

ETGBD is a feasible treatment option for GC in patients contraindicated for surgery.

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内镜下经乳头胆囊引流治疗急性坏疽性胆囊炎的可行性。

目的：手术通常是坏疽性胆囊炎（GC）的首选治疗方法。然而，有些患者由于其合并症而不适合手术。我们评估了内镜下经乳头胆囊引流术（ETGBD）治疗胃癌的可行性。方法：本回顾性研究比较了急性胆囊炎（AC）合并和不合并GC的ETGBD的结果。在2019年1月至2023年7月期间在单一三级转诊中心接受ETGBD治疗的136例AC患者中，91例患者在ETGBD之前接受了对比增强计算机断层扫描（CT）。结果：根据CT表现将患者分为GC组（n = 29）和非GC组（n = 62）。GC组与非GC组ETGBD的技术成功率、AC的临床成功率、早期不良事件（ae）率分别为86.2%∶91.9% （P = 0.63）、79.3%∶91.9% （P = 0.17）、27.6%∶16.1% （P = 0.32）。技术和临床成功率略低，而早期AE发生率在GC组较高。然而，差异并不显著。GC组晚期ae发生率为15.8%，非GC组为17.9%，差异无统计学意义（P = 0.87）。GC组择期胆囊切除术发生率明显低于对照组（P = 0.023）。结论：ETGBD是胃癌手术禁忌患者可行的治疗方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Endoscopy 医学-外科

CiteScore

10.10

自引率

15.10%

发文量

291

审稿时长

6-12 weeks

期刊介绍： Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.