内镜超声引导引流术与内镜经胆囊引流术治疗急性胆囊炎的辐射量对比分析

IF 0.3 Q4 GASTROENTEROLOGY & HEPATOLOGY

Advances in Digestive Medicine Pub Date : 2024-07-25 DOI:10.1002/aid2.13400

Koichiro Mandai, Takato Inoue, Shiho Nakamura, Takaaki Yoshimoto, Tomoya Ogawa, K. Uno, K. Yasuda

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引用次数: 0

摘要

目前，比较内镜下胆囊经皮下胆囊引流术（ETGBD）和内镜超声引导胆囊引流术（EUS-GBD）治疗急性胆囊炎相关辐射暴露的报告还很缺乏。因此，我们旨在评估 ETGBD 和 EUS-GBD 期间的辐射暴露。我们对 2020 年 1 月至 2023 年 9 月期间接受 ETGBD 或 EUS-GBD 的急性胆囊炎患者进行了回顾性调查。所有手术均使用同一台带有过囊X射线管的透视设备进行。对透视时间、射线照片数量和估计入口表面剂量等参数进行了辐射暴露评估。在排除胆总管结石或急性胆管炎患者后，对 ETGBD 组和 EUS-GBD 组的患者特征和手术结果进行了比较分析。共评估了 44 例患者（ETGBD 组和 EUS-GBD 组分别为 21 例和 23 例）。虽然两组患者中美国麻醉医师协会体能状况≥3级的患者没有明显差异，但EUS-GBD组老年患者的比例高于ETGBD组。与 ETGBD 组相比，EUS-GBD 组的手术时间更短（38 分钟 vs. 59 分钟，p < .001），透视时间更短（964 秒 vs. 1829 秒，p < .001），拍片更少（22.9 张 vs. 28.4 张，p < .001），估计入口表面剂量更低（85.2 mGy vs. 149.3 mGy，p < .001）。EUS-GBD 组的手术成功率高于 ETGBD 组（100% vs. 57.1%，p < .001），早期不良事件发生率无显著差异（17.4% vs. 9.5%，p = .67）。在接受永久性支架植入术的患者中，EUS-GBD 组的症状性晚期不良事件（急性胆囊炎复发和其他不良事件）的 1 年累积发生率明显低于 ETGBD 组（p = .045）。在没有并发胆管结石或胆管炎的患者中，EUS-GBD 的手术时间和透视时间更短，所需的射线照相次数更少，手术成功率明显高于 ETGBD。

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A comparative analysis of radiation exposure in endoscopic ultrasound‐guided drainage versus endoscopic transpapillary drainage for acute cholecystitis

Currently, reports comparing radiation exposure associated with endoscopic transpapillary gallbladder drainage (ETGBD) and endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) for acute cholecystitis are lacking. Therefore, we aimed to evaluate the radiation exposure during ETGBD and EUS‐GBD. We retrospectively investigated patients with acute cholecystitis who underwent ETGBD or EUS‐GBD between January 2020 and September 2023. All procedures were performed using the same fluoroscopy device with an overcouch x‐ray tube. Parameters such as fluoroscopy time, number of radiographs, and estimated entrance surface dose were assessed for radiation exposure. After excluding patients with choledocholithiasis or acute cholangitis, a comparative analysis of patient characteristics and procedural outcomes was performed between the ETGBD and EUS‐GBD groups. Forty‐four patients (21 and 23 in the ETGBD and EUS‐GBD groups, respectively) were assessed. Although there was no significant difference in patients with an American Society of Anesthesiologists physical status ≥3 between the groups, the EUS‐GBD group had a higher proportion of older patients than the ETGBD group. The EUS‐GBD group demonstrated a shorter procedure time (38 vs. 59 min, p < .001), shorter fluoroscopy time (964 vs. 1829 s, p < .001), fewer radiographs (22.9 vs. 28.4 images, p < .001), and lower estimated entrance surface dose (85.2 vs. 149.3 mGy, p < .001) compared to the ETGBD group. The EUS‐GBD group had a higher procedural success rate than the ETGBD group (100% vs. 57.1%, p < .001), with no significant difference in the incidence of early adverse events (17.4% vs. 9.5%, p = .67). In patients with permanent stenting, the 1‐year cumulative incidence of symptomatic late adverse events (recurrence of acute cholecystitis and other adverse events) was significantly lower in the EUS‐GBD group than in the ETGBD group (p = .045). In patients without concurrent bile duct stones or cholangitis, EUS‐GBD demonstrated shorter procedure and fluoroscopy times, required fewer radiographs, and had a significantly higher procedural success rate than ETGBD.

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来源期刊

Advances in Digestive Medicine GASTROENTEROLOGY & HEPATOLOGY-

自引率

33.30%

发文量

期刊介绍： Advances in Digestive Medicine is the official peer-reviewed journal of GEST, DEST and TASL. Missions of AIDM are to enhance the quality of patient care, to promote researches in gastroenterology, endoscopy and hepatology related fields, and to develop platforms for digestive science. Specific areas of interest are included, but not limited to: • Acid-related disease • Small intestinal disease • Digestive cancer • Diagnostic & therapeutic endoscopy • Enteral nutrition • Innovation in endoscopic technology • Functional GI • Hepatitis • GI images • Liver cirrhosis • Gut hormone • NASH • Helicobacter pylori • Cancer screening • IBD • Laparoscopic surgery • Infectious disease of digestive tract • Genetics and metabolic disorder • Microbiota • Regenerative medicine • Pancreaticobiliary disease • Guideline & consensus.