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        A New Technique of Endoscopic Transpapillary Gallbladder Drainage Combined with Intraductal Ultrasonography for the Treatment of Acute Cholecystitis

        Ryota Sagami,Kenji Hayasaka,Tetsuro Ujihara,Ryotaro Nakahara,Daisuke Murakami,Tomoyuki Iwaki,Satoshi Suehiro,Yasushi Katsuyama,Hideaki Harada,Yuji Amano 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.2

        Background/Aims: Endoscopic transpapillary gallbladder drainage (ETGBD) is useful for the treatment of acute cholecystitis; however,the technique is diffcult to perform. When intraductal ultrasonography (IDUS) is combined with ETGBD, the orifice of the cystic ductin the common bile duct may be more easily detected in the cannulation procedure. The aim of this study was to evaluate the effcacy ofETGBD with IDUS compared with that of ETGBD alone. Methods: A total of 100 consecutive patients with acute cholecystitis requiring ETGBD were retrospectively recruited. The first 50consecutive patients were treated using ETGBD without IDUS, and the next 50 patients were treated using ETGBD with IDUS. Through propensity score matching analysis, we compared the clinical outcomes between the groups. The primary outcome was thetechnical success rate. Results: The technical success rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (92.0% vs. 76.0%, p=0.044). There was no significant difference in procedure length between the two groups (74.0 min vs. 66.7 min, p=0.310). Thecomplication rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (6.0% vs. 0%, p<0.001); however,only one case showed an IDUS technique-related complication (pancreatitis). Conclusions: The assistance of IDUS may be useful in ETGBD.

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        Current Status in the Treatment of Acute Cholecystitis Patients Receiving Antithrombotic Therapy: Is Endoscopic Drainage Feasible?- A Systematic Review

        Ryota Sagami,Kenji Hayasaka,Hidefumi Nishikiori,Hideaki Harada,Yuji Amano 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.2

        The bleeding complication risk of surgery or percutaneous transhepatic gallbladder drainage (PTGBD) may increase in patients withacute cholecystitis receiving antithrombotic therapy (ATT). Endoscopic gallbladder drainage (EGBD) may be recommended forsuch patients. English articles published between 1991 and 2018 in peer-reviewed journals that discuss cholecystectomy, PTGBD, andEGBD in patients with ATT or coagulopathy were reviewed to assess the safety of the procedures, especially in terms of the bleedingcomplication. There were 8 studies on cholecystectomy, 3 on PTGBD, and 1 on endoscopic transpapillary gallbladder drainage (ETGBD)in patients receiving ATT. With respect to EGBD, 28 studies on ETGBD (including 1 study already mentioned above) and 26 studies onendoscopic ultrasound-guided gallbladder drainage (EUS-GBD) were also analyzed. The overall bleeding complication rate in patientswith ATT who underwent cholecystectomy was significantly higher than that in patients without ATT (6.5% [23/354] vs. 1.2% [26/2,224],p<0.001). However, the bleeding risk of cholecystectomy and PTGBD in patients receiving ATT was controversial. The overall technicalsuccess, clinical success, and bleeding complication rates of ETGBD vs. EUS-GBD were 84% vs. 96% (p<0.001), 92% vs. 97% (p<0.001),and 0.65% vs. 2.1% (p=0.005), respectively. One patient treated with ETGBD experienced bleeding complication among 191 patientswith bleeding tendency. ETGBD may be an ideal drainage procedure for patients receiving ATT from the viewpoint of bleeding,although EUS-GBD is also effcacious.

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