EUS-guided gallbladder drainage with a lumen-apposing metal stent versus endoscopic transpapillary gallbladder drainage for the treatment of acute cholecystitis

被引:61
作者
Higa, Jennifer T. [1 ]
Sahar, Nadav [1 ]
Kozarek, Richard A. [1 ]
La Selva, Danielle [1 ]
Larsen, Michael C. [1 ]
Gan, Seng-Ian [1 ]
Ross, Andrew S. [1 ]
Irani, Shayan S. [1 ]
机构
[1] Virginia Mason Med Ctr, Div Gastroenterol & Hepatol, 1100 Ninth Ave,Mailstop C3 GAS, Seattle, WA 98101 USA
关键词
PERCUTANEOUS CHOLECYSTOSTOMY; MANAGEMENT; RISK; GUIDELINES; OUTCOMES;
D O I
10.1016/j.gie.2019.04.238
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Aims: There is an evolving role for EUS-guided transmural gallbladder (GB) drainage. Endoscopic transpapillary GB drainage is a well-established, nonoperative treatment for acute cholecystitis. We compared the outcomes of 78 cases of EUS-guided versus transpapillary GB drainage at a single, U.S.-based, high-volume endoscopy center. Methods: This was a retrospective analysis performed from May 2013 to January 2018, identified from a database of nonoperative patients with acute cholecystitis. Both electrocautery-enhanced and nonelectrocautery-enhanced lumen-apposing metal stents were used. For transpapillary drainage, guidewire access was obtained and then a transpapillary 7F x 15-cm double-pigtail plastic stent was placed. Results: In patients who had successful transpapillary or transmural drainage, demographics data were similar. Technical success was observed in 39 of 40 patients (97.5%) who underwent first attempt at EUS-guided drainage versus 32 of 38 patients (84.2%) for first-attempt transpapillary drainage (adjusted odds ratio, 9.83; 95% confidence interval,.93-103.86). Clinical success was significantly higher with EUS drainage in 38 of 40 patients (95.0%) versus transpapillary drainage in 29 of 38 patients (76.3%) (adjusted odds ratio, 7.14; 95% confidence interval, 1.32-38.52). Recurrent cholecystitis was lower in the EUS-guided drainage group (2.6% vs 18.8%, respectively; P = .023) on univariate analysis but only trended to significance in a multiple regression model. Duration of follow-up, reintervention rates, hospital length of stay, and overall adverse event rates were similar between groups. Conclusions: EUS-guided GB drainage results in a higher clinical success rate compared with transpapillary drainage and may be associated with a lower recurrence rate of cholecystitis. However, transpapillary drainage should be considered as the first-line treatment for patients who are surgical candidates but require temporizing measures or require an ERCP for alternative reasons.
引用
收藏
页码:483 / 492
页数:10
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