응급 수술이 어려운 급성 담석동반 담낭염 환자에서 내시경적 경유두 담낭 배액술의 유용성

다국어 초록 (Multilingual Abstract)

Background and Objectives: Endoscopic trans-papillary gallbladder drainage (ETGBD) has been proposed as an alternative to surgery or percutaneous cholecystostomy in patients with acute calculus cholecystitis (ACC). We aimed to evaluate the safety and efficacy of ETGBD via endoscopic trans-papillary gallbladder stenting (ETGBS) or endoscopic naso-gallbladder drainage (ENGBD) as either a bridging or a definitive treatment option for patients with ACC when a cholecystectomy is delayed or cannot be performed.
Materials and Methods: From July 2014 to December 2018, 171 patients with ACC in whom ETGBD were attempted were retrospectively reviewed. The technical and clinical success rates and adverse events were evaluated. The predictive factors for technical success and the stent patency in the ETGBS group with high surgical risks were also examined.
Results: The technical and clinical success rates for ETGBD were 90.6% (155/171) and 99.3% (154/155), respectively. Visible cystic duct on cholangiography were significant predictors of technical success (adjusted odds ratio: 7.099, 95% confidence interval: 1.983–25.407, P = 0.003) as per logistic regression analysis. Adverse events occurred in 8.1% of patients (14/171: mild pancreatitis, n = 9; post-endoscopic sphincterotomy bleeding, n = 4; and stent migration, n = 1), but all patients were treated using conservative management. In the ETGBS group, the median stent patency in 70 patients with high surgical risks was 503 days (interquartile range: 404.25–775 days). Among them, one patient (1.4%, 1/70) had ACC recurrence at post procedure day 43 and six patients (8.5%, 6/70) developed acute cholangitis with choledocholithiasis at 150, 221, 299, 346, 381, and 399 days after ETGBS. All patients with recurrent ACC or occurrence of acute cholangitis were successfully retreated endoscopically.
Conclusion: ETGBD, using either ETGBS or ENGBD, may be a suitable bridging option for patients with ACC unfit for urgent cholecystectomy. In patients with high surgical risks, ETGBS may be a promising useful treatment modality with low ACC recurrence.

목차 (Table of Contents)

• Abstract ii
• Abbreviation list iv
• Introduction 1
• Materials and Methods 3
• Results 6
• Discussion 9
• References 14
• Tables 18
• Figures 23
• 국문초록 27