前沿关注（31）：经乳头胆囊支架治疗急性胆囊炎的长期疗效

（来源：GIE 2021; 94(4): 742-748）

背景及目的：对于不适宜手术的部分急性胆囊炎（AC）患者，ERCP介导的经乳头胆囊引流（ERGD）提供了一种非手术治疗的方法。本研究的主要目的的评估ERGD的长期效果，次要目的是评估技术/临床成功率、不良事件及胆囊炎复发的危险因素。

Background and Aims: Select patients with acute cholecystitis (AC) are poor candidates for cholecystectomy. ERCP-guided transpapillary gallbladder (GB) drainage (ERGD) is one modality for nonoperative management of AC in these patients. Our primary aim was to evaluate long-term success of destination ERGD. Secondary aims were the rate of technical and clinical success, number of repeat procedures, rate of adverse events, and risk factors for recurrent AC.

方法：2008年-2019年期间选择不适宜手术的AC患者尝试进行经乳头胆囊塑料双猪尾支架植入。长期有效定义为ERGD后6个月未再发AC、死亡或再次介入治疗；技术成功为至少一次成功植入支架；临床成功为AC症状解除并出院。

Methods: Consecutive patients with AC who were not candidates for cholecystectomy underwent ERGD with attempted transpapillary GB plastic double-pigtail stent placement at a tertiary hospital from January 2008 to December 2019. Long-term success was defined as no AC after ERGD until 6 months, death, or reintervention. Technical success was defined as placement of at least 1 transpapillary stent into the GB and clinical success as resolution of AC symptoms with discharge from the hospital.

结果：长期有效率为95.9%(47/49)，技术成功率96%(49/51)，临床成功率100%。轻度的不良事件发生率5.9%(n=3)。ERGD后平均随访453天（18-1879天）。植入2根支架者似乎较1根支架复发AC的时间更长（P=0.13），单根支架者重复操作的可能也更大（p=0.045）。

Results: Long-term success was achieved in 95.9% of patients (47/49), technical success in 96% (49/51), and clinical success 100% in those with technical success. Mild adverse events occurred in 5.9% (n = 3). Mean follow-up was 453 days after ERGD (range, 18-1879). A trend toward longer time to recurrence of AC was seen in patients with 2 rather than 1 GB stent placed (P = .13), and more repeat procedures were performed when a single stent was placed (P = .045).

结论：经乳头胆囊双支架植入是安全有效的方法，可用于全身情况很差的AC患者长期治疗。病情复发的危险因素包括支架移位及单根支架植入。双支架植入虽然技术上有难度，但可以挽救单支架的失败，因此推荐为首选方案。

Conclusions: ERGD with transpapillary GB double-pigtail stent placement is a safe and effective long-term therapy for poor surgical candidates with AC. Risk factors for recurrence include stent removal and single-stent therapy. Double-stent therapy is not always technically feasible but may salvage failed single-stent therapy or recurrence after elective stent removal and may therefore be the preferred treatment modality.

上一期：前沿关注（30）：AGA更新结肠癌筛查指导意见 - 消化内科 - 专业医生社区，医学、药学、生命科学、科研学术交流 (dxy.cn)