内镜胆囊引流与经皮引流的比较研究

Prashant Kedia, MD, Reem Z. Sharaiha, MD, MSc, Nikhil A. Kumta, MD, Jessica Widmer, DO, Armeen Jamal-Kabani, FNP-BC, Kristen Weaver, RN, Andrea Benvenuto, NP, Jennifer Millman, RN, Rahul Barve, MD, Monica Gaidhane, MD, MPH, Michel Kahaleh, MD

Background: High-risk patients with cholecystitis have conventionally been offered percutaneous gallbladder drainage (PGBD) for treatment. A growing experience of endoscopic gallbladder drainage (EGBD) has been reported to be effective and safe.

Objective: To compare the short- and long-term outcomes of EGBD and PGBD.

Design: A retrospective review.

Setting: Single academic tertiary care center.

Patients: Inpatients diagnosed with cholecystitis.

Interventions: Any patient deemed a nonsurgical candidate and who has undergone either PGBD or EGBD was included in the analysis.

Main Outcome Measurements: Patient demographics along with procedural and clinical outcomes were recorded for each group.

Results: Forty-three patients underwent PGBD and 30 underwent EGBD (24 transpapillary, 6 transmural). Technical (97.6% vs 100%) and clinical (97.6% vs 86.7%) success rates of PGBD and EGBD were similar. However, postprocedure hospital length of stay (16.3 vs 7.6 days), time to clinical resolution (4.6 vs 3.0 days), adverse event rate (39.5% vs 13.3%), number of sessions (2.0 vs 1.0), number of repeat interventions (53.4% vs 13.3%), and postprocedure pain scores (3.8 vs 2.1) were significantly higher for PGBD than EGBD.

Limitations: Retrospective analysis.

Conclusion: Although EGBD has similar technical and clinical success compared with PGBD, it uses fewer hospital resources and results in fewer adverse events, improved pain scores, and decreased need for repeat gallbladder drainage. EGBD may provide a less-invasive, safer, cost-effective option for gallbladder drainage than PGBD with improved clinical outcomes. (Gastrointest Endosc 2015;82:1031-6.)


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