The gold-standard management of acute cholecystitis is cholecystectomy.Surgical intervention may be contraindicated due to permanent causes.To date,the classical approach is percutaneous cholecystostomy in patients un...The gold-standard management of acute cholecystitis is cholecystectomy.Surgical intervention may be contraindicated due to permanent causes.To date,the classical approach is percutaneous cholecystostomy in patients unresponsive to medical therapy.However, with this treatment some patients may experience discomfort,complications and a decrease in their quality of life.In these cases,endoscopic ultrasound (EUS)-guided gallbladder drainage may represent an effective minimally invasive alternative.Our objective is to describe in detail this new and not well-known technique:EUS-guided cholecystenterostomy.We will describe how the patient should be prepared,what accessories are needed and how the technique is performed.We will also discuss the possible indications for this technique and will provide a brief review based on published reports and our own experience.展开更多
Management of acute cholecystitis includes initial sta-bilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the ...Management of acute cholecystitis includes initial sta-bilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the severity of cholecystitis or comorbidities will require a temporary measure as a bridge to surgery or permanent nonoperative management to decrease the mortality and morbidity. Most of these patients who require conservative management were managed with percutaneous transhepatic cholecystostomy or trans-papillary drainage of gallbladder drainage with cystic duct stenting through endoscopic retrograde cholangiopancreaticography （ERCP）. Although, these conservative measures are effective, they can cause signifcant discomfort to the patients especially if used as a long-term measure. In view of this, there is a need for further minimally invasive procedures, which is safe, effective and comfortable to patients. Endoscopic ultrasound （EUS） guided gallbladder drainage is a novel method of gallbladder drainage frst described in 2007[1]. Over the last decade, EUS guided gallbladder drainage has evolved as an effective alternative to percutaneouscholecystostomy and trans-papillary gallbladder drai-nage. Our goal is to review available literature regarding the scope of EUS guided gallbladder drainage as a viable alternative to percutaneous cholecystostomy or cystic duct stenting through ERCP among patients who are not suitable for cholecystectomy.展开更多
BACKGROUND B-mode-ultrasound-guided percutaneous cholecystostomy(PC)may be performed by a transhepatic or transperitoneal approach,called percutaneous transhepatic gallbladder drainage(PHGD)and percutaneous transperit...BACKGROUND B-mode-ultrasound-guided percutaneous cholecystostomy(PC)may be performed by a transhepatic or transperitoneal approach,called percutaneous transhepatic gallbladder drainage(PHGD)and percutaneous transperitoneal gallbladder drainage(PPGD),respectively.We compared the impact of PC related to the route of catheter placement on subsequent laparoscopic cholecystectomy(LC).AIM To compare the impact of PC related to the route of catheter placement on subsequent LC.METHODS We retrospectively studied 103 patients with acute calculous cholecystitis who underwent scheduled LC after PC between January 2010 and January 2019.Group I included 58 patients who underwent scheduled LC after PHGD.Group II included 45 patients who underwent scheduled LC after PPGD.Clinical outcomes were analyzed according to each group.RESULTS Baseline demographic characteristics did not differ significantly between both groups(P>0.05).Both PHGD and PPGD were able to quickly resolve cholecystitis sepsis.Group I showed significantly higher efficacy than group II in terms of lower pain score during puncture(3.1 vs 4.5;P=0.001)and at 12 h follow-up(1.5 vs 2.2;P=0.001),lower rate of fever within 24 h after PC(13.8%vs 42.2%;P=0.001),shorted operation duration(118.3 vs 139.6 min;P=0.001),lower amount of intraoperative bleeding(72.1 vs 109.4 mL;P=0.001)and shorter length of hospital stay(14.3 d vs 18.0 d;P=0.001).However,group II had significantly lower rate of local bleeding at the PC site(2.2%vs 20.7%;P=0.005)and lower rate of severe adhesion(33.5%vs 55.2%;P=0.048).No significant differences were noted between both groups regarding the conversion rate to laparotomy,rate of subtotal cholecystectomy,complications and pathology.CONCLUSION B-mode-ultrasound-guided PHGD is superior to PPGD followed by LC for treatment of acute calculous cholecystitis,with shorter operating time,minimal amount of intraoperative bleeding and short length of hospital stay.展开更多
文摘The gold-standard management of acute cholecystitis is cholecystectomy.Surgical intervention may be contraindicated due to permanent causes.To date,the classical approach is percutaneous cholecystostomy in patients unresponsive to medical therapy.However, with this treatment some patients may experience discomfort,complications and a decrease in their quality of life.In these cases,endoscopic ultrasound (EUS)-guided gallbladder drainage may represent an effective minimally invasive alternative.Our objective is to describe in detail this new and not well-known technique:EUS-guided cholecystenterostomy.We will describe how the patient should be prepared,what accessories are needed and how the technique is performed.We will also discuss the possible indications for this technique and will provide a brief review based on published reports and our own experience.
文摘Management of acute cholecystitis includes initial sta-bilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the severity of cholecystitis or comorbidities will require a temporary measure as a bridge to surgery or permanent nonoperative management to decrease the mortality and morbidity. Most of these patients who require conservative management were managed with percutaneous transhepatic cholecystostomy or trans-papillary drainage of gallbladder drainage with cystic duct stenting through endoscopic retrograde cholangiopancreaticography （ERCP）. Although, these conservative measures are effective, they can cause signifcant discomfort to the patients especially if used as a long-term measure. In view of this, there is a need for further minimally invasive procedures, which is safe, effective and comfortable to patients. Endoscopic ultrasound （EUS） guided gallbladder drainage is a novel method of gallbladder drainage frst described in 2007[1]. Over the last decade, EUS guided gallbladder drainage has evolved as an effective alternative to percutaneouscholecystostomy and trans-papillary gallbladder drai-nage. Our goal is to review available literature regarding the scope of EUS guided gallbladder drainage as a viable alternative to percutaneous cholecystostomy or cystic duct stenting through ERCP among patients who are not suitable for cholecystectomy.
文摘BACKGROUND B-mode-ultrasound-guided percutaneous cholecystostomy(PC)may be performed by a transhepatic or transperitoneal approach,called percutaneous transhepatic gallbladder drainage(PHGD)and percutaneous transperitoneal gallbladder drainage(PPGD),respectively.We compared the impact of PC related to the route of catheter placement on subsequent laparoscopic cholecystectomy(LC).AIM To compare the impact of PC related to the route of catheter placement on subsequent LC.METHODS We retrospectively studied 103 patients with acute calculous cholecystitis who underwent scheduled LC after PC between January 2010 and January 2019.Group I included 58 patients who underwent scheduled LC after PHGD.Group II included 45 patients who underwent scheduled LC after PPGD.Clinical outcomes were analyzed according to each group.RESULTS Baseline demographic characteristics did not differ significantly between both groups(P>0.05).Both PHGD and PPGD were able to quickly resolve cholecystitis sepsis.Group I showed significantly higher efficacy than group II in terms of lower pain score during puncture(3.1 vs 4.5;P=0.001)and at 12 h follow-up(1.5 vs 2.2;P=0.001),lower rate of fever within 24 h after PC(13.8%vs 42.2%;P=0.001),shorted operation duration(118.3 vs 139.6 min;P=0.001),lower amount of intraoperative bleeding(72.1 vs 109.4 mL;P=0.001)and shorter length of hospital stay(14.3 d vs 18.0 d;P=0.001).However,group II had significantly lower rate of local bleeding at the PC site(2.2%vs 20.7%;P=0.005)and lower rate of severe adhesion(33.5%vs 55.2%;P=0.048).No significant differences were noted between both groups regarding the conversion rate to laparotomy,rate of subtotal cholecystectomy,complications and pathology.CONCLUSION B-mode-ultrasound-guided PHGD is superior to PPGD followed by LC for treatment of acute calculous cholecystitis,with shorter operating time,minimal amount of intraoperative bleeding and short length of hospital stay.
