Background

Endoscopic transpapillary gallbladder stenting (ETGBS) has been used as an alternative to percutaneous cholecystostomy in patients with acute cholecystitis who are considered unfit for surgery. However, there are few data on the efficacy and safety of ETGBS replacement of percutaneous cholecystostomy in high-risk surgical patients. This study aimed to evaluate the feasibility, efficacy, and safety of ETGBS to replace percutaneous cholecystostomy in high-risk surgical patients.

Methods

This single center retrospective study reviewed the data of patients who attempted ETGBS to replace percutaneous cholecystostomy between January 2017 and September 2019. The technical success, clinical success, adverse events, and stent patency were evaluated.

Results

ETGBS was performed in 43 patients (24 male, mean age 80.7 ± 7.4 years) to replace percutaneous cholecystostomy due to high surgical risk. The technical success rate and clinical success rate were 97.7% (42/43) and 90.5% (38/42), respectively. Procedure-related adverse events and stent-related late adverse events occurred in 7.0% (3/43) and 11.6% (5/43), respectively. Of the patients who successfully underwent ETGBS (n = 42), only one had recurrent acute cholecystitis during follow-up. The median stent patency was 415 days (interquartile range 240–528 days).

Conclusions

ETGBS, as a secondary intervention for the purpose of internalizing gallbladder drainage in patients following placement of a percutaneous cholecystostomy, is safe, effective, and technically feasible. Thus, conversion of percutaneous cholecystostomy to ETGBS may be considered as a viable option in high-risk surgical patients.

中文翻译：

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经皮胆囊造口术中转内镜经乳头胆囊支架置入术治疗高危手术患者的疗效和安全性

背景

内镜下经乳头胆囊支架置入术 (ETGBS) 已被用作不适合手术的急性胆囊炎患者的经皮胆囊造口术的替代方法。然而，关于 ETGBS 替代经皮胆囊造口术在高危手术患者中的有效性和安全性的数据很少。本研究旨在评估 ETGBS 在高危手术患者中替代经皮胆囊造口术的可行性、有效性和安全性。

方法

这项单中心回顾性研究回顾了 2017 年 1 月至 2019 年 9 月期间尝试 ETGBS 替代经皮胆囊造口术的患者的数据。评估了技术成功、临床成功、不良事件和支架通畅率。

结果

由于手术风险高，43 名患者（24 名男性，平均年龄 80.7 ± 7.4 岁）进行了 ETGBS 以替代经皮胆囊造口术。技术成功率和临床成功率分别为97.7%（42/43）和90.5%（38/42）。与手术相关的不良事件和与支架相关的晚期不良事件分别发生在 7.0% (3/43) 和 11.6% (5/43)。在成功接受 ETGBS 的患者（n  = 42）中，只有 1 人在随访期间出现复发性急性胆囊炎。中位支架通畅率为 415 天（四分位距为 240-528 天）。

结论

ETGBS 作为一种辅助干预措施，目的是在经皮胆囊造口术后患者胆囊引流内化，是安全、有效且技术上可行的。因此，经皮胆囊造口术转换为 ETGBS 可能被认为是高风险手术患者的可行选择。