Endosonografische Drainage der Gallenblase wegen akuter Cholezystitis bei Patienten mit hohem Operationsrisiko

Zusammenfassung

Hintergrund Die Standardtherapie der akuten Cholezystitis ist die laparoskopische Cholezystektomie. Bei Patienten mit hohem Operationsrisiko kommen alternative Verfahren zur Anwendung. Die perkutane Drainage ist allgemein verfügbar. Die alternative transpapilläre Drainage der Gallenblase über den Ductus cysticus hat nur begrenzte Erfolgsaussichten. Mit der weiten Verbreitung der interventionellen Endosonografie und der Entwicklung neuer Stentsysteme hat sich die endosonografische Gallenblasendrainage als sicheres und zuverlässiges Verfahren erwiesen.

Material und Methode Wir berichten retrospektiv über unsere Erfahrungen mit der endosonografischen Gallenblasendrainage an 11 konsekutiven Patienten bei akuter Cholezystitis zwischen Dezember 2018 und Januar 2021.

Ergebnisse Es wird über 11 Patienten mit akuter Cholezystitis mit einem mittleren Lebensalter von 84,5 Jahren (70–95 Jahre) berichtet. Bei allen Patienten lagen schwere allgemeine Begleitkrankheiten oder fortgeschrittene abdominelle Tumoren beziehungsweise die Kombination beider Konditionen vor. Nach interdisziplinärer Beratung wurde die Indikation zur interventionellen Therapie gestellt. Diese wurde in 9 Fällen mittels alleiniger endosonografischer Drainage und in 2 Fällen mittels perkutaner und zweizeitiger endosonografischer Drainage durchgeführt. Technischer Erfolg wurde bei 10 Fällen (91%), klinischer Erfolg bei 9 Fällen (82%) erzielt. Es gab in 2 Fällen prozedurenbezogene Komplikationen, die zur Operation führten.

Schlussfolgerung Im Falle hoher Operationsrisiken stellt die endosonografische Drainage der Gallenblase eine sichere und definitive Therapie dar. Diese kann allein oder in Kombination mit einer perkutanen Drainage erfolgen. Die endosonografische Drainage ist der alleinigen perkutanen Drainage durch geringere Komplikationsraten und niedrigere Raten notwendiger Folgeeingriffe überlegen. Daher sollte in Fällen eines inadäquat hohen Operationsrisikos die endosonografische Drainage der Gallenblase der perkutanen vorgezogen worden, vor allem, wenn eine definitive Therapie erforderlich ist.

Abstract

Background The standard treatment for acute cholecystitis is laparoscopic cholecystectomy. Alternative procedures are used for patients at high surgical risk. Percutaneous drainage is widely available. The alternative of transpapillary drainage of the gallbladder via the ductus cysticus has only limited prospects of success. With the widespread use of interventional endoscopic ultrasound and the development of new stent systems, endoscopic ultrasound gallbladder drainage has proven to be a safe and reliable procedure.

Material and Method We retrospectively report on our experiences in 11 consecutive patients with endoscopic ultrasound gallbladder drainage in acute cholecystitis between December 2018 and January 2021.

Results 11 patients with acute cholecystitis with a mean age of 84.5 years (70–95 years) are reported. All patients had severe general comorbidities or advanced abdominal tumours or a combination of these conditions. After interdisciplinary debate, the indication for interventional therapy was made. This was carried out in 9 cases by means of endosonographic drainage alone and in 2 cases by means of percutaneous and two-stage endosonographic drainage. Technical success was achieved in 10 cases (91%), clinical success in 9 cases (82%). In 2 cases there were procedural complications that led to the operation.

Conclusion In the case of high surgical risks, endosonographic drainage of the gall bladder is a safe and definitive therapy. This can be performed alone or in combination with percutaneous drainage. Endoscopic ultrasound drainage is superior to percutaneous drainage alone, due to its lower complication rates and lower rates of necessary follow-up interventions. Therefore, in cases of relatively high surgical risk, endoscopic ultrasound drainage of the gall bladder should be preferred to percutaneous drainage, especially when definitive therapy is required.

Schlüsselwörter

akute Cholezystitis - Endosonografie - Operationsrisiko - perkutane Drainage - interventionelle Endoskopie - endosonografische Gallenblasendrainage

Keywords

acute cholecystitis - endoscopic ultrasonography (EUS) - surgical risk - percutaneous drainage - interventional endoscopy - endosonographic gallbladder drainage

Publikationsverlauf

Eingereicht: 22. April 2021

Angenommen nach Revision: 27. September 2021

Artikel online veröffentlicht:
11. November 2021

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