PDF(Pubmed)
Abstract：
This study retrospectively evaluated the outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using novel electrocautery-enhanced lumen-apposing metal stents (LAMS) in high-risk patients with acute cholecystitis (AC). Between January 1, 2021, and November 30, 2022, 58 high-risk surgical patients with AC underwent EUS-GBD with the novel electrocautery-enhanced LAMS. The technical success rate was 94.8% (55/58), with one case of duodenal perforation requiring surgery with complete stent migration and two of partial stent migration into the gallbladder. However, the clinical success rate was 100% (55/55). Recurrent AC occurred in 3.6% of the cases (2/55), managed with double pigtail plastic stents through the LAMS. Early AEs observed in 1.8% (1/55) due to stent obstruction. Late AEs occurred in 5.4% (3/55), including two cases of cholangitis and one of stent obstruction. For 33 patients followed over 6 months, LAMS maintenance was sustained in 30 cases. Two patients underwent double-pigtail plastic stent replacement after LAMS removal, and one underwent LAMS removal during surgery following tumor stage regression after chemotherapy for cholangiocarcinoma. The novel electrocautery-enhanced LAMS demonstrated high technical and clinical success rates in high-risk surgical patients with AC, maintaining effective gallbladder drainage with minimal AEs during long-term follow-up, thus highlighting its efficacy and safety in challenging patients.
摘要：
这项研究回顾性评估了在急性胆囊炎（AC）高危患者中，使用新型电灼增强的腔内贴壁金属支架（LAMS）进行内镜超声引导下胆囊引流（EUS-GBD）的结果。在2021年1月1日至2022年11月30日之间，58例AC高危手术患者接受了新型电灼增强LAMS的EUS-GBD。技术成功率为94.8%(55/58),1例十二指肠穿孔需要手术，支架完全移位，2例支架部分移位进入胆囊。然而,临床成功率为100%(55/55)。复发AC发生在3.6%的病例中(2/55)，通过LAMS用双尾纤塑料支架管理。观察到由于支架阻塞导致的早期AE为1.8%(1/55)。晚期不良事件发生率为5.4%(3/55)，包括2例胆管炎和1例支架阻塞。对于33名患者，随访超过6个月，30例维持LAMS。两名患者在LAMS移除后接受了双尾纤塑料支架置换术，其中一人在胆管癌化疗后肿瘤分期消退后在手术期间接受了LAMS切除。新型电灼增强的LAMS在高风险的AC手术患者中显示出很高的技术和临床成功率，在长期随访期间保持有效的胆囊引流，并将不良事件降至最低，从而突出了其在挑战性患者中的疗效和安全性。
