Background and Aims

Endoscopic gallbladder drainage (GBD) has been performed as an alternative to percutaneous drainage for acute cholecystitis. To date, there has been no comparative study between EUS-guided cholecystostomy (EUSC) and endoscopic transpapillary cholecystostomy (ETC). The aim of this study was to compare the outcomes of EUSC and ETC.

Methods

A retrospective review of an endoscopic GBD database prospectively collected at the Asan Medical Center (between July 2010 and December 2014) was performed to identify consecutive patients with acute cholecystitis who underwent attempted endoscopic GBD. Procedural and long-term outcomes were evaluated using inverse probability of treatment weighting (IPTW).

Results

A total of 172 patients (76 in the EUSC group and 96 in the ETC group) were included in this study. Seven patients who failed to undergo ETC crossed over to the EUSC group. After adjustment with the IPTW method, technical success (99.3% vs 86.6%, P < .01) and clinical success (99.3% vs 86%, P < .01) rates were significantly higher in the EUSC group than in the ETC group. The procedure-related adverse event rate was significantly higher in the ETC group (7.1% vs 19.3%, P = .02). The cholecystitis or cholangitis recurrence rate (12.4% vs 3.2%) was also higher in the ETC group than in the EUSC group, as identified using Cox analysis (hazard ratio, 3.01; 95% confidence interval, .73-12.9; P = .04).

Conclusions

In patients with acute cholecystitis who are unfit for surgery, EUSC may be a more suitable treatment method than ETC.

中文翻译：

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EUS指导的胆囊造口术与内镜经乳头状胆囊造瘘术治疗高危手术患者的急性胆囊炎

背景和目标

内镜下胆囊引流术（GBD）已作为急性胆囊炎经皮引流术的替代方法。迄今为止，在EUS引导的胆囊造口术（EUSC）和内窥镜经乳头状胆囊造口术（ETC）之间尚无比较研究。这项研究的目的是比较EUSC和ETC的结果。

方法

回顾性分析了前瞻性地在Asan医疗中心（2010年7月至2014年12月）收集的内镜GBD数据库，以识别出连续尝试过内镜GBD的急性胆囊炎患者。程序和长期结果使用治疗加权比重（IPTW）进行评估。

结果

本研究共纳入172位患者（EUSC组为76位，ETC组为96位）。未能接受ETC的7名患者转入EUSC组。用IPTW方法进行调整后，EUSC组的技术成功率（99.3％vs. 86.6％，P  <.01）和临床成功率（99.3％vs 86％，P  <.01）显着高于ETC组。ETC组与手术相关的不良事件发生率显着更高（7.1％对19.3％，P  = .02）。Cox分析表明，ETC组的胆囊炎或胆管炎复发率（12.4％比3.2％）也高于EUSC组（危险比，3.01； 95％置信区间，.73-12.9；P  =。 04）。

结论

对于不适合手术的急性胆囊炎患者，EUSC可能是比ETC更合适的治疗方法。