Akute Cholezystitis bei hohem OP-Risiko: sonografische und endoskopische Therapieoptionen

 

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Zusammenfassung

Die Cholezystektomie ist der Goldstandard in der Behandlung der akuten Cholezystitis, hat aber bei multimorbiden Patienten oder bei schwerem Verlauf der akuten Cholezystitis ein deutlich erhöhtes OP-Risiko. In solchen Fällen kann eine Drainage der entzündeten Gallenblase in Kombination mit antibiotischer Therapie der primären Operation überlegen sein. Die Drainage kann entweder als sonografisch geführte perkutan transhepatische Gallenblasendrainage, als EUS-geführte transmurale Stentplatzierung oder endoskopisch-transpapilläre Gallenblasendrainage erfolgen. Diese minimalinvasiven Alternativen zur Cholezystektomie können sowohl als Langzeittherapie bei dauerhaft inoperablen Patienten als auch vorübergehend bei Patienten eingesetzt werden, bei denen die Cholezystektomie nach Verbesserung des Allgemeinzustands angestrebt wird.

In dieser Übersicht werden die verschiedenen Drainagemethoden im Hinblick auf technische Anforderungen sowie klinische Sofort- und Langzeitergebnisse und Komplikationen diskutiert. Mit Fortschritten im Stentdesign entwickelt sich die EUS-geführte transmurale Stentplatzierung von Magen oder Duodenum in die Gallenblase zur bevorzugten Methode der Gallenblasendrainage in Zentren mit entsprechender Expertise.

Abstract

Cholecystectomy is the gold standard in the treatment of acute cholecystitis, but has a significantly increased risk in multimorbid patients or in the severe course of acute cholecystitis. In such cases, drainage of the damaged gallbladder in combination with antibiotic therapy may be superior to primary surgery. The drainage can either be performed as sonographically guided percutaneous transhepatic gallbladder drainage or as EUS-guided transmural stent placement or endoscopic-transpapillary gallbladder drainage. These minimally invasive alternatives to cholecystectomy can be used both as long-term therapy for permanently inoperable patients and temporarily for patients in whom the cholecystectomy is intended after improvement of the general condition. In this overview, the various drainage methods are discussed with regard to technical requirements, immediate and long-term clinical results and complications. With advances in stent design, EUS-guided transmural stent placement from the stomach or duodenum into the gallbladder is becoming the preferred method of gallbladder drainage in centers with the appropriate expertise.

Publication History

Received: 05 April 2021

Accepted: 25 June 2021

Article published online:
10 September 2021

© 2021. Thieme. All rights reserved.

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• Literatur

• 1 Gutt C, Jenssen C, Barreiros A. et al. Aktualisierte S3-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) zur Prävention, Diagnostik und Behandlung von Gallensteinen. AWMF-Register-Nr. 021/008. Z Gastroenterol 2018; 56: 912-966 DOI: 10.1055/a-0644-2972. (PMID: 30103228)
  Article in Thieme ConnectPubMedGoogle Scholar
• 2 Pisano M, Allievi N, Gurusamy K. et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg 2020; 15: 61 DOI: 10.1186/s13017-020-00336-x. (PMID: 33153472)
  CrossrefPubMedGoogle Scholar
• 3 Fusaroli P, Jenssen C, Hocke M. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part V – EUS-Guided Therapeutic Interventions (short version). Ultraschall Med 2016; 37: 412-420 DOI: 10.1055/s-0035-1553742. (PMID: 27490463)
  Article in Thieme ConnectPubMedGoogle Scholar
• 4 Dietrich CF, Lorentzen T, Appelbaum L. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III – Abdominal Treatment Procedures (Short Version). Ultraschall Med 2016; 37: 27-45 DOI: 10.1055/s-0035-1553965. (PMID: 26871408)
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Dietrich CF, Lorentzen T, Appelbaum L. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III – Abdominal Treatment Procedures (Long Version). Ultraschall Med 2016; 37: E1-E32 DOI: 10.1055/s-0035-1553917. (PMID: 26670019)
  Article in Thieme ConnectPubMedGoogle Scholar
• 6 Fusaroli P, Jenssen C, Hocke M. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part V. Ultraschall Med 2016; 37: 77-99 DOI: 10.1055/s-0035-1553738. (PMID: 26632995)
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 Lorentzen T, Nolsoe CP, Ewertsen C. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part I – General Aspects (long Version). Ultraschall Med 2015; 36: E1-E14 DOI: 10.1055/s-0035-1553593. (PMID: 26468774)
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 Yokoe M, Hata J, Takada T. et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25: 41-54 DOI: 10.1002/jhbp.515. (PMID: 29032636)
  CrossrefPubMedGoogle Scholar
• 9 Tufo A, Pisano M, Ansaloni L. et al. Risk Prediction in Acute Calculous Cholecystitis: A Systematic Review and Meta-Analysis of Prognostic Factors and Predictive Models. J Laparoendosc Adv Surg Tech A 2021; 31: 41-53 DOI: 10.1089/lap.2020.0151. (PMID: 32716737)
  CrossrefPubMedGoogle Scholar
• 10 Endo I, Takada T, Hwang TL. et al. Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-Taiwan multicenter cohort study. J Hepatobiliary Pancreat Sci 2017; 24: 346-361 DOI: 10.1002/jhbp.456. (PMID: 28419741)
  CrossrefPubMedGoogle Scholar
• 11 Teoh AYB, Kitano M, Itoi T. et al. Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1). Gut 2020; 69: 1085-1091 DOI: 10.1136/gutjnl-2019-319996. (PMID: 32165407)
  CrossrefPubMedGoogle Scholar
• 12 Elyaderani M, Gabriele OF. Percutaneous cholecystostomy and cholangiography in patients with obstructive jaundice. Radiology 1979; 130: 601-602 DOI: 10.1148/130.3.601. (PMID: 424523)
  CrossrefPubMedGoogle Scholar
• 13 Zarour S, Imam A, Kouniavsky G, Lin G, Zbar A, Mavor E. Percutaneous cholecystostomy in the management of high-risk patients presenting with acute cholecystitis: Timing and outcome at a single institution. Am J Surg 2017; 214: 456-461 DOI: 10.1016/j.amjsurg.2017.01.030. (PMID: 28237047)
  CrossrefPubMedGoogle Scholar
• 14 Bhatt MN, Ghio M, Sadri L, Sarkar S, Kasotakis G, Narsule C, Sarkar B. Percutaneous Cholecystostomy in Acute Cholecystitis-Predictors of Recurrence and Interval Cholecystectomy. J Surg Res 2018; 232: 539-546 DOI: 10.1016/j.jss.2018.06.051. (PMID: 30463770)
  CrossrefPubMedGoogle Scholar
• 15 Turino SY, Shabanzadeh DM, Eichen NM, Jorgensen SL, Sorensen LT, Jorgensen LN. Percutaneous Cholecystostomy Versus Conservative Treatment for Acute Cholecystitis: a Cohort Study. J Gastrointest Surg 2019; 23: 297-303 DOI: 10.1007/s11605-018-4021-5. (PMID: 30390182)
  CrossrefPubMedGoogle Scholar
• 16 Fleming CA, Ismail M, Kavanagh RG. et al. Clinical and Survival Outcomes Using Percutaneous Cholecystostomy Tube Alone or Subsequent Interval Cholecystectomy to Treat Acute Cholecystitis. J Gastrointest Surg 2020; 24: 627-632 DOI: 10.1007/s11605-019-04194-0. (PMID: 30887298)
  CrossrefPubMedGoogle Scholar
• 17 Mohan BP, Khan SR, Trakroo S. et al. Endoscopic ultrasound-guided gallbladder drainage, transpapillary drainage, or percutaneous drainage in high risk acute cholecystitis patients: a systematic review and comparative meta-analysis. Endoscopy 2020; 52: 96-106 DOI: 10.1055/a-1020-3932. (PMID: 31645067)
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Gurusamy KS, Rossi M, Davidson BR. Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database Syst Rev 2013; CD007088 DOI: 10.1002/14651858.CD007088.pub2. (PMID: 23939652)
  CrossrefPubMedGoogle Scholar
• 19 Ambe PC, Kaptanis S, Papadakis M, Weber SA, Jansen S, Zirngibl H. The Treatment of Critically Ill Patients With Acute Cholecystitis. Dtsch Arztebl Int 2016; 113: 545-551 DOI: 10.3238/arztebl.2016.0545. (PMID: 27598871)
  CrossrefPubMedGoogle Scholar
• 20 Heinzmann A, Muller T, Leitlein J, Braun B, Kubicka S, Blank W. Endocavitary contrast enhanced ultrasound (CEUS)--work in progress. Ultraschall Med 2012; 33: 76-84 DOI: 10.1055/s-0031-1299056. (PMID: 22183864)
  Article in Thieme ConnectPubMedGoogle Scholar
• 21 Rassameehiran S, Tantrachoti P, Nugent K. Percutaneous gallbladder aspiration for acute cholecystitis. Proc (Bayl Univ Med Cent) 2016; 29: 381-384 DOI: 10.1080/08998280.2016.11929476. (PMID: 27695167)
  CrossrefPubMedGoogle Scholar
• 22 Kozarek RA. Selective cannulation of the cystic duct at time of ERCP. J Clin Gastroenterol 1984; 6: 37-40 (PMID: 6699392)
  PubMedGoogle Scholar
• 23 Feretis CB, Manouras AJ, Apostolidis NS, Golematis BC. Endoscopic transpapillary drainage of gallbladder empyema. Gastrointest Endosc 1990; 36: 523-525 DOI: 10.1016/s0016-5107(90)71134-0. (PMID: 2227333)
  CrossrefPubMedGoogle Scholar
• 24 Kim TH, Park DE, Chon HK. Endoscopic transpapillary gallbladder drainage for the management of acute calculus cholecystitis patients unfit for urgent cholecystectomy. PLoS One 2020; 15: e0240219 DOI: 10.1371/journal.pone.0240219. (PMID: 33035230)
  CrossrefPubMedGoogle Scholar
• 25 Sagami R, Hayasaka K, Ujihara T. et al. A New Technique of Endoscopic Transpapillary Gallbladder Drainage Combined with Intraductal Ultrasonography for the Treatment of Acute Cholecystitis. Clin Endosc 2020; 53: 221-229 DOI: 10.5946/ce.2019.099. (PMID: 31684701)
  CrossrefPubMedGoogle Scholar
• 26 Hayasaka K, Harada H, Shimizu T, Suehiro S, Katsuyama Y. The effectiveness of intraductal ultrasonography for cystic duct cannulation. Gastrointest Endosc 2017; 85: 1307-1308 DOI: 10.1016/j.gie.2017.04.025. (PMID: 28522019)
  CrossrefPubMedGoogle Scholar
• 27 Mori Y, Itoi T, Baron TH. et al. Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25: 87-95 DOI: 10.1002/jhbp.504. (PMID: 28888080)
  CrossrefPubMedGoogle Scholar
• 28 Nakahara K, Michikawa Y, Morita R. et al. Endoscopic transpapillary gallbladder stenting using a newly designed plastic stent for acute cholecystitis. Endosc Int Open 2019; 7: E1105-E1114 DOI: 10.1055/a-0747-5668. (PMID: 31475227)
  Article in Thieme ConnectPubMedGoogle Scholar
• 29 Itoi T, Coelho-Prabhu N, Baron TH. Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc 2010; 71: 1038-1045 DOI: 10.1016/j.gie.2010.01.026. (PMID: 20438890)
  CrossrefPubMedGoogle Scholar
• 30 Podboy A, Yuan J, Stave CD, Chan SM, Hwang JH, Teoh AYB. Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis: a systematic review with network meta-analysis. Gastrointest Endosc 2020; DOI: 10.1016/j.gie.2020.09.040. (PMID: 32987004)
  CrossrefPubMedGoogle Scholar
• 31 Corral JE, Das A, Krner PT, Gomez V, Wallace MB. Cost effectiveness of endoscopic gallbladder drainage to treat acute cholecystitis in poor surgical candidates. Surg Endosc 2019; 33: 3567-3577 DOI: 10.1007/s00464-019-07026-z. (PMID: 31350611)
  CrossrefPubMedGoogle Scholar
• 32 Kwan V, Eisendrath P, Antaki F, Le Moine O, Deviere J. EUS-guided cholecystenterostomy: a new technique (with videos). Gastrointest Endosc 2007; 66: 582-586 DOI: 10.1016/j.gie.2007.02.065. (PMID: 17725950)
  CrossrefPubMedGoogle Scholar
• 33 Walter D, Teoh AY, Itoi T. et al. EUS-guided gall bladder drainage with a lumen-apposing metal stent: a prospective long-term evaluation. Gut 2016; 65: 6-8 DOI: 10.1136/gutjnl-2015-309925. (PMID: 26041748)
  CrossrefPubMedGoogle Scholar
• 34 Dollhopf M, Larghi A, Will U. et al. EUS-guided gallbladder drainage in patients with acute cholecystitis and high surgical risk using an electrocautery-enhanced lumen-apposing metal stent device. Gastrointest Endosc 2017; 86: 636-643 DOI: 10.1016/j.gie.2017.02.027. (PMID: 28259594)
  CrossrefPubMedGoogle Scholar
• 35 Ge N, Sun S, Sun S, Wang S, Liu X, Wang G. Endoscopic ultrasound-assisted transmural cholecystoduodenostomy or cholecystogastrostomy as a bridge for per-oral cholecystoscopy therapy using double-flanged fully covered metal stent. BMC Gastroenterol 2016; 16: 9 DOI: 10.1186/s12876-019-0947-7. (PMID: 30764766)
  CrossrefPubMedGoogle Scholar
• 36 Anderloni A, Buda A, Vieceli F, Khashab MA, Hassan C, Repici A. Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis. Surg Endosc 2016; 30: 5200-5208 DOI: 10.1007/s00464-016-4894-x. (PMID: 27059975)
  CrossrefPubMedGoogle Scholar
• 37 Stanek A, Dohan A, Barkun J. et al. Percutaneous cholecystostomy: A simple bridge to surgery or an alternative option for the management of acute cholecystitis?. Am J Surg 2018; 216: 595-603 DOI: 10.1016/j.amjsurg.2018.01.027. (PMID: 29429546)
  CrossrefPubMedGoogle Scholar