A new study reveals that a staged treatment approach for high-risk acute cholecystitis patients is both effective and safe. This strategy involves first performing percutaneous gallbladder drainage (PTGBD) followed by endoscopic treatment.
Korea University Anam Hospital announced on Thursday that a multi-center research team, including gastroenterology professors Lee Ho-seung and Lee Jae-min, has confirmed the efficacy and safety of transitioning from PTGBD to endoscopic ultrasound-guided gallbladder drainage (EUS-GBD).
Acute cholecystitis is primarily caused by gallstones blocking the gallbladder ducts, resulting in inflammation. If left untreated, it can lead to severe complications such as gallbladder tissue necrosis or perforation.
While cholecystectomy is the standard treatment, it may not be feasible for elderly patients or those with serious comorbidities. In these cases, doctors typically perform PTGBD, which involves inserting an external drainage catheter through the skin. However, this approach can cause discomfort and reduce quality of life due to the need for long-term external drainage.
EUS-GBD is an alternative method that uses endoscopic ultrasound to insert a stent between the gallbladder and gastrointestinal tract, allowing for internal bile drainage. However, this procedure may not be suitable for patients with unstable conditions, necessitating initial stabilization through PTGBD before transitioning to EUS-GBD.
The research team analyzed 141 high-risk acute cholecystitis patients who underwent EUS-GBD at three South Korean medical centers. Of these, 117 patients received EUS-GBD initially, while 24 transitioned from PTGBD to EUS-GBD.
The study found comparable success rates between the two groups. Technical success rates were 98.3% for the primary EUS-GBD group and 95.8% for the conversion group. Clinical success rates were similarly high at 95.7% and 91.7%, respectively. No significant differences were observed in adverse reactions, cholecystitis recurrence rates, or stent patency duration.
The researchers employed a technique of injecting saline and contrast agents through existing PTGBD catheters to expand the gallbladder before performing EUS-GBD. This approach allows patients who initially required PTGBD to transition to internal drainage via endoscopy once their condition stabilizes, eliminating the need for external drainage catheters.
Dr. Lee Ho-seung emphasized that while not all high-risk acute cholecystitis patients are candidates for immediate endoscopic treatment, the research confirms that a staged approach – stabilizing patients with percutaneous drainage before transitioning to EUS-GBD – can be an effective and safe treatment strategy.
Dr. Lee Jae-min added that this study provides valuable evidence that expands treatment options in clinical practice. It will aid in developing personalized gallbladder drainage strategies that account for each patient’s overall condition and anatomical characteristics.
The findings of this groundbreaking study have been published in the prestigious international journal Gastrointestinal Endoscopy.