PDF(Pubmed)
Abstract：
In recent years, therapeutic endoscopy has become a fundamental tool in the management of gallbladder diseases in light of its minimal invasiveness, high clinical efficacy, and good safety profile. Both endoscopic transpapillary gallbladder drainage (TGBD) and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) provide effective internal drainage in patients with acute cholecystitis unfit for cholecystectomy, avoiding the drawbacks of external percutaneous gallbladder drainage (PGBD). The availability of dedicated lumen-apposing metal stents (LAMS) for EUS-guided transluminal interventions contributed to the expansion of endoscopic therapies for acute cholecystitis, making endoscopic gallbladder drainage easier, faster, and hence more widely available. Moreover, EUS-GBD with LAMS opened the possibility of several cholecystoscopy-guided interventions, such as gallstone lithotripsy and clearance. Finally, EUS-GBD has also been proposed as a rescue drainage modality in malignant biliary obstruction after failure of standard techniques, with encouraging results. In this review, we will describe the TBGD and EUS-GBD techniques, and we will discuss the available data on clinical efficacy in different settings in comparison with PGBD. Finally, we will comment on the future perspectives of EUS-GBD, discussing the areas of uncertainty in which new data are more strongly awaited.
摘要：
近年来,治疗性内窥镜检查已成为胆囊疾病的基本工具，鉴于其最小的侵入性，临床疗效高,和良好的安全性。内镜经乳头胆囊引流（TGBD）和内镜超声（EUS）引导胆囊引流（EUS-GBD）为不适合胆囊切除术的急性胆囊炎患者提供有效的内引流。避免了经皮胆囊外引流术(PGBD)的弊端。用于EUS引导的腔内干预的专用腔内金属支架（LAMS）的可用性有助于扩大急性胆囊炎的内窥镜治疗。使内镜下胆囊引流更容易，更快,因此更广泛地可用。此外，使用LAMS的EUS-GBD打开了几种胆囊镜检查指导干预措施的可能性，如胆结石碎石和清除。最后,EUS-GBD也被提议作为标准技术失败后恶性胆道梗阻的抢救引流方式。结果令人鼓舞。在这次审查中,我们将描述TBGD和EUS-GBD技术，我们将讨论与PGBD相比，不同环境下临床疗效的可用数据。最后,我们将评论EUS-GBD的未来前景，讨论更强烈期待新数据的不确定性领域。
