Feasibility, Efficacy, and Predictive Factors for the Technical Success of Endoscopic Nasogallbladder Drainage: A Prospective Study
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Background/Aims: Several studies have shown the usefulness of endoscopic nasogallbladder drainage (ENGBD) in patients with acute cholecystitis. However, the procedure is difficult, and factors that affect technical success have not yet been clarified. We conducted a prospective study to evaluate the technical feasibility, efficacy, and predictive factors for the technical success of ENGBD in patients with acute cholecystitis. Methods: All patients with moderate or severe acute cholecystitis who were enrolled underwent ENGBD between April 2009 and April 2011. Patients with surgically altered anatomy or pancreatobiliary malignancies were excluded. The primary outcomes included technical success, clinical success, and complications. Factors that could affect the technical success were also examined. Results: Of the 27 patients who underwent ENGBD during the study period, technical success was achieved in 21 (78%) and clinical improvement was achieved in 20 (95%). Early complications were encountered in four patients (15%). Gallbladder wall thickness (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.08 to 2.47) and age (OR, 1.16; 95% CI, 1.00 to 1.35) were effective predictors of technical failure. Conclusions: ENGBD was effective in resolving acute cholecystitis; however, this modality was technically challenging and had a limited success rate. Because of technical difficulties, ENGBD should be reserved for limited indications.
Abstract
Background/Aims: Several studies have shown the usefulness of endoscopic nasogallbladder drainage (ENGBD) in patients with acute cholecystitis. However, the procedure is difficult, and factors that affect technical success have not yet been clarified. We conducted a prospective study to evaluate the technical feasibility, efficacy, and predictive factors for the technical success of ENGBD in patients with acute cholecystitis. Methods: All patients with moderate or severe acute cholecystitis who were enrolled underwent ENGBD between April 2009 and April 2011. Patients with surgically altered anatomy or pancreatobiliary malignancies were excluded. The primary outcomes included technical success, clinical success, and complications. Factors that could affect the technical success were also examined. Results: Of the 27 patients who underwent ENGBD during the study period, technical success was achieved in 21 (78%) and clinical improvement was achieved in 20 (95%). Early complications were encountered in four patients (15%). Gallbladder wall thickness (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.08 to 2.47) and age (OR, 1.16; 95% CI, 1.00 to 1.35) were effective predictors of technical failure. Conclusions: ENGBD was effective in resolving acute cholecystitis; however, this modality was technically challenging and had a limited success rate. Because of technical difficulties, ENGBD should be reserved for limited indications.
참고문헌 (25)
- Lau H, "Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis", Surg Endosc, 20, pp.82~87 (2006)
- Yamashita Y, "TG13 surgical management of acute cholecystitis", J Hepatobiliary Pancreat Sci, 20, pp.89~96 (2013)
- Bloch RS, "Cholecystectomy in patients with cirrhosis: a surgical challenge", Arch Surg, 120, pp.669~672 (1985)
- Frazee RC, "Acute acalculous cholecystitis", Mayo Clin Proc, 64, pp.163~167 (1989)
- Miura F, "TG13 flowchart for the management of acute cholangitis and cholecystitis", J Hepatobiliary Pancreat Sci, 20, pp.47~54 (2013)
- Patterson EJ, "An alternative approach to acute cholecystitis. Percutaneous cholecystostomy and interval laparoscopic cholecystectomy", Surg Endosc, 10, pp.1185~1188 (1996)
- Tsuyuguchi T, "TG13 indications and techniques for gallbladder drainage in acute cholecystitis", J Hepatobiliary Pancreat Sci, 20, pp.81~88 (2013)
- Okamoto K, "TG13 management bundles for acute cholangitis and cholecystitis", J Hepatobiliary Pancreat Sci, 20, pp.55~59 (2013)
- vanSonnenberg E, "Percutaneous gallbladder puncture and cholecystostomy: results, complications, and caveats for safety", Radiology, 183, pp.167~170 (1992)
- Feretis C, "Endoscopic drainage of acute obstructive cholecystitis in patients with increased operative risk", Endoscopy, 25, pp.392~395 (1993)
- Johlin FC Jr, "Drainage of the gallbladder in patients with acute acalculous cholecystitis by transpapillary endoscopic cholecystotomy", Gastrointest Endosc, 39, pp.645~651 (1993)
- Nakatsu T, "Endoscopic transpapillary gallbladder drainage (ETGBD) for the treatment of acute cholecystitis", J Hepatobiliary Pancreat Surg, 4, pp.31~35 (1997)
- Toyota N, "Endoscopic naso-gallbladder drainage in the treatment of acute cholecystitis: alleviates inflammation and fixes operator’s aim during early laparoscopic cholecystectomy", J Hepatobiliary Pancreat Surg, 13, pp.80~85 (2006)
- Kjaer DW, "Endoscopic gallbladder drainage of patients with acute cholecystitis", Endoscopy, 39, pp.304~308 (2007)
- Itoi T, "Endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis in whom percutaneous transhepatic approach is contraindicated or anatomically impossible", Gastrointest Endosc, 68, pp.2008~2068 (2008)
- Ogawa O, "Predicting the success of endoscopic transpapillary gallbladder drainage for patients with acute cholecystitis during pretreatment evaluation", Can J Gastroenterol, 22, pp.681~685 (2008)
- Mutignani M, "Endoscopic gallbladder drainage for acute cholecystitis: technical and clinical results", Endoscopy, 41, pp.539~546 (2009)
- Itoi T, "Endoscopic gallbladder drainage for management of acute cholecystitis", Gastrointest Endosc, 71, pp.1038~1045 (2010)
- Yokoe M, "TG13 diagnostic criteria and severity grading of acute cholecystitis", J Hepatobiliary Pancreat Sci, 20, pp.35~46 (2013)
- Cotton PB, "A lexicon for endoscopic adverse events: report of an ASGE workshop", Gastrointest Endosc, 71, pp.446~454 (2010)
- Kanda Y, "Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics", Bone Marrow Transplant, 48, pp.452~458 (2013)
- Kiviniemi H, "Percutaneous cholecystostomy in acute cholecystitis in high-risk patients: an analysis of 69 patients", Int Surg, 83, pp.299~302 (1998)
- Chopra S, "Treatment of acute cholecystitis in non-critically ill patients at high surgical risk: comparison of clinical outcomes after gallbladder aspiration and after percutaneous cholecystostomy", AJR Am J Roentgenol, 176, pp.1025~1031 (2001)
- Spira RM, "Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis", Am J Surg, 183, pp.62~66 (2002)
- Ito K, "Percutaneous cholecystostomy versus gallbladder aspiration for acute cholecystitis: a prospective randomized controlled trial", AJR Am J Roentgenol, 183, pp.193~196 (2004)