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Early cholecystectomy following percutaneous transhepatic gallbladder drainage is effective for moderate to severe acute cholecystitis in the octogenarians. Arch Gerontol Geriatr 2023; 106:104881. [PMID: 36470181 DOI: 10.1016/j.archger.2022.104881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/11/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute cholecystitis (AC) is a life-threatening infectious/inflammatory disease in older patients. This study aimed to investigate the safety and optimal timing of surgery in patients aged ≥ 80 years with moderate to severe AC who received percutaneous transhepatic gallbladder drainage (PTGBD). METHODS From January 2008 to February 2021, 152 patients were retrospectively enrolled. Clinical outcomes were compared among patients who received laparoscopic cholecystectomy (LC), open cholecystectomy (OC), and conversion surgery, and between those who received early (< 6 weeks after PTGBD) and delayed cholecystectomy (≥ 6 weeks after PTGBD). Logistic regression analysis was used to identify risk factors for recurrent AC, further biliary events, conversion, and perioperative complications. RESULTS Sixty-seven patients underwent LC, 62 underwent OC, and 23 underwent conversion surgery. Operation-related complications and mortality rates did not differ among the types of surgery; however, LC group had shorter operative time than the other groups. Eighty-two patients underwent early cholecystectomy, while 70 underwent delayed cholecystectomy. There were no differences in operative time, operation-related complications, and mortality rates between the groups. However, higher rates of recurrent AC and biliary events were observed in the delayed cholecystectomy group (52.9% vs. 4.9% and 57.1% vs. 8.5%, p < 0.001). On multivariate analysis, delayed cholecystectomy was a significant risk factor for recurrent AC (odds ratio [OR] = 19.42, p < 0.001) and further biliary events (OR = 15.95, p < 0.001). CONCLUSIONS Early cholecystectomy is recommended for patients aged ≥ 80 years with moderate to severe AC following PTGBD.
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Endoscopic Ultrasound-Guided Gallbladder Drainage versus Percutaneous Gallbladder Drainage for Acute Cholecystitis: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:diagnostics13040657. [PMID: 36832143 PMCID: PMC9954901 DOI: 10.3390/diagnostics13040657] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Background: Percutaneous transhepatic gallbladder drainage (PT-GBD) has been the treatment of choice for acute cholecystitis patients who are not suitable for surgery. The effectiveness of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) as an alternative to PT-GBD is not clear. In this meta-analysis, we have compared their efficacy and adverse events. Methods: We adhered to the PRISMA statement to conduct this meta-analysis. Online databases were searched for studies that compared EUS-GBD and PT-GBD for acute cholecystitis. The primary outcomes of interest were technical success, clinical success, and adverse events. The pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated using the random-effects model. Results: A total of 396 articles were screened, and 11 eligible studies were identified. There were 1136 patients, of which 57.5% were male, 477 (mean age 73.33 ± 11.28 years) underwent EUS-GBD, and 698 (mean age 73.77 ± 8.7 years) underwent PT-GBD. EUS-GBD had significantly better technical success (OR 0.40; 95% CI 0.17-0.94; p = 0.04), fewer adverse events (OR 0.35; 95% CI 0.21-0.61; p = 0.00), and lower reintervention rates (OR 0.18; 95% CI 0.05-0.57; p = 0.00) than PT-GBD. No difference in clinical success (OR 1.34; 95% CI 0.65-2.79; p = 0.42), readmission rate (OR 0.34; 95% CI 0.08-1.54; p = 0.16), or mortality rate (OR 0.73; 95% CI 0.30-1.80; p = 0.50) was noted. There was low heterogeneity (I2 = 0) among the studies. Egger's test showed no significant publication bias (p = 0.595). Conclusion: EUS-GBD can be a safe and effective alternative to PT-GBD for treating acute cholecystitis in non-surgical patients and has fewer adverse events and a lower reintervention rate than PT-GBD.
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Malik A, Malik MI, Amjad W, Javaid S. Efficacy of endoscopic trans-papillary gallbladder stenting and drainage in acute calculous cholecystitis in high-risk patients: a systematic review and meta-analysis. Ther Adv Gastrointest Endosc 2023; 16:26317745231192177. [PMID: 37664530 PMCID: PMC10469246 DOI: 10.1177/26317745231192177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/07/2023] [Indexed: 09/05/2023] Open
Abstract
Background and aims Acute calculous cholecystitis (ACC) represents about one-third of all surgical emergencies. The gold standard management of ACC is laparoscopic cholecystectomy. Although cholecystectomy is a safe procedure, it may be dangerous and contraindicated in patients with complex comorbidities. Endoscopic transpapillary gallbladder stenting (ETGBS) and drainage had been widely used to manage patients suffering from ACC with comorbidities. Methods We searched PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant studies assessing the use of ETGBS in patients suffering from ACC with various comorbidities. Risk of bias assessment was performed using the National Institues of Health (NIH) tool. We included the following outcomes: clinical success, technical success, late complications, and pancreatitis. Results We included seven studies that met our inclusion criteria. We found that the pooled proportion of clinical success, technical success, late complications, and pancreatitis was [91.3%, 95% confidence interval (CI) (86.8%, 95.9%)], [92.8%, 95% CI (89%, 96.5%)], [5.4%, 95% CI (2.9%, 7.9%)], and [3.5%, 95% CI (1.2%, 5.8%)], respectively. Conclusion We found that an ETGBS was an effective and well-tolerated method for the treatment of cholecystitis, especially in high-risk individuals.
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Affiliation(s)
- Adnan Malik
- Mountain Vista Medical Center, 1301 S Crismon Rd, Mesa, AZ 85209, USA
| | - Muhammad Imran Malik
- Department of Hematology specialty, Airedale general hospital, West Yorkshire, England
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Slama EM, Hosseini M, Staszak RM, Setya VR. Open Cholecystostomy Under Local Anesthesia for Acute Cholecystitis in the Elderly and High-Risk Surgical Patients. Am Surg 2021; 88:434-438. [PMID: 34734555 DOI: 10.1177/00031348211050593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The morbidity and mortality rates associated with cholecystectomy for acute cholecystitis are higher in the critically ill elderly population. As an alternative to cholecystectomy, we report the results of treatment of acute cholecystitis in the elderly after open cholecystolithotomy with cholecystostomy tube placement under local anesthesia. METHODS A case series was performed on 5 patients from August 2007 to April 2010 who presented with acute cholecystitis and underwent an open cholecystolithotomy and tube placement. Thirty-day mortality, intra- and immediate-postoperative complications, clinical improvement after drainage, additional biliary procedures needed, and outcome after cholecystostomy tube removal were recorded. RESULTS Open cholecystolithotomy and tube placement were performed successfully in all patients and permitted resolution of the acute attack in all after a mean period of 3.75 days. Thirty-day mortality was 0%. Patients did not experience any intraoperative complications. We observed 100% rate of successful short-term outcomes in our patients including resolution pain, and objectively, normalization of leukocytosis, and defervescence. None of the patients required emergency cholecystectomy. All patients had their cholecystostomy tubes removed at a mean postoperative day 27. There were no cases of biliary leakage or tube dislodgement. There were no recurrences of acute cholecystitis within the mean follow-up of 20.75 months. DISCUSSION Emergency open cholecystolithotomy and cholecystostomy tube placement represent an effective, safe, and definitive alternative treatment strategy for acute gallstone cholecystitis in selected elderly patients with a mortality rate of 0% in the authors' experience.
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Affiliation(s)
- Eliza M Slama
- Department of Surgery, 21963Ascension Saint Agnes Hospital, Baltimore, MD, USA
| | - Motahar Hosseini
- Department of Cardiothoracic Surgery, 4352Mayo Clinic, Rochester, MN, USA
| | - Ryan M Staszak
- Department of Trauma, Acute Care, and Critical Care Surgery, 328945Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Viney R Setya
- Department of Surgery, 21963Ascension Saint Agnes Hospital, Baltimore, MD, USA
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Yao P, Chang Z, Liu Z. Factors influencing failure to undergo interval cholecystectomy after percutaneous cholecystostomy among patients with acute cholecystitis: a retrospective study. BMC Gastroenterol 2021; 21:410. [PMID: 34711183 PMCID: PMC8555182 DOI: 10.1186/s12876-021-01989-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/20/2021] [Indexed: 02/07/2023] Open
Abstract
Background Percutaneous cholecystostomy (PC) with interval cholecystectomy is an effective treatment modality in high-risk patients with acute cholecystitis. However, some patients still fail to undergo interval cholecystectomy after PC, with the reasons rarely reported. Hence, this study aimed to explore the factors that prevent a patient from undergoing interval cholecystectomy. Methods Data from patients with acute cholecystitis who had undergone PC from January 1, 2017 to December 31, 2019 in our hospital were retrospectively collected. The follow-up endpoint was the patient undergoing cholecystectomy. Patients who failed to undergo cholecystectomy were followed up every three months until death. Univariate and multivariate analyses were performed to analyze the factors influencing failure to undergo interval cholecystectomy. A nomogram was used to predict the numerical probability of non-interval cholecystectomy. Results Overall, 205 participants were identified, and 67 (32.7%) did not undergo cholecystectomy during the follow-up period. Multivariate analysis revealed that having a Tokyo Guidelines 2018 (TG18) grade III status (odds ratio [OR]: 3.83; 95% confidence interval [CI]: 1.27–11.49; p = 0.017), acalculous cholecystitis (OR: 4.55; 95% CI: 1.59–12.50; p = 0.005), an albumin level < 28 g/L (OR: 4.15; 95% CI: 1.09–15.81; p = 0.037), and a history of malignancy (OR: 4.65; 95% CI: 1.62–13.37; p = 0.004) were independent risk factors for a patient’s failure to undergo interval cholecystectomy. Among them, the presence of a history of malignancy exhibited the highest influence in the nomogram for predicting non-interval cholecystectomy. Conclusions Having a TG18 grade III status, acalculous cholecystitis, severe hypoproteinemia, and a history of malignancy influence the failure to undergo cholecystectomy after PC in patients with acute cholecystitis.
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Affiliation(s)
- Peng Yao
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Zhihui Chang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China.
| | - Zhaoyu Liu
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
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Efficacy and safety of conversion of percutaneous cholecystostomy to endoscopic transpapillary gallbladder stenting in high-risk surgical patients. Hepatobiliary Pancreat Dis Int 2021; 20:478-484. [PMID: 34340921 DOI: 10.1016/j.hbpd.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Endoscopic transpapillary gallbladder stenting (ETGBS) has been used as an alternative to percutaneous cholecystostomy in patients with acute cholecystitis who are considered unfit for surgery. However, there are few data on the efficacy and safety of ETGBS replacement of percutaneous cholecystostomy in high-risk surgical patients. This study aimed to evaluate the feasibility, efficacy, and safety of ETGBS to replace percutaneous cholecystostomy in high-risk surgical patients. METHODS This single center retrospective study reviewed the data of patients who attempted ETGBS to replace percutaneous cholecystostomy between January 2017 and September 2019. The technical success, clinical success, adverse events, and stent patency were evaluated. RESULTS ETGBS was performed in 43 patients (24 male, mean age 80.7 ± 7.4 years) to replace percutaneous cholecystostomy due to high surgical risk. The technical success rate and clinical success rate were 97.7% (42/43) and 90.5% (38/42), respectively. Procedure-related adverse events and stent-related late adverse events occurred in 7.0% (3/43) and 11.6% (5/43), respectively. Of the patients who successfully underwent ETGBS (n = 42), only one had recurrent acute cholecystitis during follow-up. The median stent patency was 415 days (interquartile range 240-528 days). CONCLUSIONS ETGBS, as a secondary intervention for the purpose of internalizing gallbladder drainage in patients following placement of a percutaneous cholecystostomy, is safe, effective, and technically feasible. Thus, conversion of percutaneous cholecystostomy to ETGBS may be considered as a viable option in high-risk surgical patients.
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Requarth J. All the World Is a Nail: Why Are Surgeons Resistant to Learn How to Place Cholecystostomy Drains in Seriously Ill Patients With Acute Acalculous Cholecystitis? Am Surg 2020; 86:1462-1466. [PMID: 33213199 DOI: 10.1177/0003134820965954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgeons routinely provide palliative care, but often the technical procedure needed for the palliative intervention is beyond our training and comfort zone. This case is an example of surgical palliative care that utilizes image-guided techniques to provide optimal care. A frail elderly patient with multiple comorbidities who had been hospitalized for other diseases was diagnosed with acute acalculous cholecystitis. General surgery and gastroenterology were initially consulted, and the patient was referred to interventional radiology for a percutaneous cholecystostomy. The procedure was technically successful, and the patient's clinical status improved. A few days later, a follow-up cholecystogram showed a decompressed gallbladder, patent cystic duct, a common bile duct free of stones, and dilute contrast in the duodenum. After 2 weeks, the fistula tract was interrogated and found to be intact. The cholecystostomy tube was removed without incident. This case is presented as a call to action for surgeons to learn the skills required to place percutaneous cholecystostomies themselves and to add it to their surgical armamentarium.
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Kamarajah SK, Karri S, Bundred JR, Evans RPT, Lin A, Kew T, Ekeozor C, Powell SL, Singh P, Griffiths EA. Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta-analysis. Surg Endosc 2020; 34:4727-4740. [PMID: 32661706 PMCID: PMC7572343 DOI: 10.1007/s00464-020-07805-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is increasingly performed in an ever ageing population; however, the risks are poorly quantified. The study aims to review the current evidence to quantify further the postoperative risk of cholecystectomy in the elderly population compared to younger patients. METHOD A systematic literature search of PubMed, EMBASE and the Cochrane Library databases were conducted including studies reporting laparoscopic cholecystectomy in the elderly population. A meta-analysis was reported in accordance with the recommendations of the Cochrane Library and PRISMA guidelines. Primary outcome was overall complications and secondary outcomes were conversion to open surgery, bile leaks, postoperative mortality and length of stay. RESULTS This review identified 99 studies incorporating 326,517 patients. Increasing age was significantly associated with increased rates of overall complications (OR 2.37, CI95% 2.00-2.78), major complication (OR 1.79, CI95% 1.45-2.20), risk of conversion to open cholecystectomy (OR 2.17, CI95% 1.84-2.55), risk of bile leaks (OR 1.50, CI95% 1.07-2.10), risk of postoperative mortality (OR 7.20, CI95% 4.41-11.73) and was significantly associated with increased length of stay (MD 2.21 days, CI95% 1.24-3.18). CONCLUSION Postoperative outcomes such as overall and major complications appear to be significantly higher in all age cut-offs in this meta-analysis. This study demonstrated there is a sevenfold increase in perioperative mortality which increases by tenfold in patients > 80 years old. This study appears to confirm preconceived suspicions of higher risks in elderly patients undergoing cholecystectomy and may aid treatment planning and informed consent.
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Affiliation(s)
- Sivesh K Kamarajah
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Foundation Trust Hospitals, Newcastle Upon Tyne, UK
- Institute of Cellular Medicine, University of Newcastle, Newcastle Upon Tyne, UK
| | - Santhosh Karri
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - James R Bundred
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Richard P T Evans
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Area 6, 7th Floor, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Aaron Lin
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tania Kew
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Chinenye Ekeozor
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Susan L Powell
- Department of Geriatric Medicine, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Pritam Singh
- Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK
- Regional Oesophago-Gastric Unit, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, GU2 7XX, UK
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Area 6, 7th Floor, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Reppas L, Arkoudis NA, Spiliopoulos S, Theofanis M, Kitrou PM, Katsanos K, Palialexis K, Filippiadis D, Kelekis A, Karnabatidis D, Kelekis N, Brountzos E. Two-Center Prospective Comparison of the Trocar and Seldinger Techniques for Percutaneous Cholecystostomy. AJR Am J Roentgenol 2020; 214:206-212. [PMID: 31573856 DOI: 10.2214/ajr.19.21685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE. The purpose of this study is to compare the safety and efficacy of the bedside ultrasound (US)-guided trocar technique versus the US- and fluoroscopy-guided Seldinger technique for percutaneous cholecystostomy (PC). SUBJECTS AND METHODS. This prospective noninferiority study compared the bedside US-guided trocar technique for PC (the trocar group; 53 patients [28 men and 25 women]; mean [± SD] age, 74.31 ± 16.19 years) with the US- and fluoroscopy-guided Seldinger technique for PC (the Seldinger group; 52 patients [26 men and 26 women], mean age, 79.92 ± 13.38 years) in consecutive patients undergoing PC at two large tertiary university hospitals. The primary endpoints were technical success and procedure-related complication rates. Secondary endpoints included procedural duration, pain assessment, and clinical success after up to 3 months of follow-up. RESULTS. PC was successfully performed for all 105 patients. The clinical success rate was similar between the two study groups (86.8% in the trocar group vs 76.9% in the Seldinger group; p = 0.09). Mean procedural time was significantly lower in the trocar group than in the Seldinger group (1.77 ± 1.62 vs 4.88 ± 2.68 min; p < 0.0001). Significantly more procedure-related complications were noted in the Seldinger group than in the trocar group (11.5% vs 1.9%; p = 0.02). Among patients in the Seldinger group, bile leak occurred in 7.7%, abscess formation in 1.9%, and gallbladder rupture in 1.9%. No procedure-related death was noted. Minor bleeding occurred in one patient (1.9%) in the trocar group, but the bleeding resolved on its own. The mean pain score during the procedure was significantly lower in the Seldinger group than in the trocar group (3.2 ± 1.77 vs 4.76 ± 2.17; p = 0.01). At 12 hours after the procedure, the mean pain score was significantly lower for patients in the trocar group (0.78 ± 1.0 vs 3.12 ± 1.36; p = 0.0001). CONCLUSION. Use of the bedside US-guided trocar technique for PC was equally effective as the Seldinger technique but was associated with fewer procedure-related complications, required less procedural time, and resulted in decreased postprocedural pain, compared with fluoroscopically guided PC using the Seldinger technique.
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Affiliation(s)
- Lazaros Reppas
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Theofanis
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Panagiotis M Kitrou
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Konstantinos Katsanos
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Filippiadis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexis Kelekis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Karnabatidis
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Management of acute cholecystitis after biliary stenting for malignant obstruction: comparison of percutaneous gallbladder drainage and aspiration. Jpn J Radiol 2019; 37:719-726. [PMID: 31486969 DOI: 10.1007/s11604-019-00865-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/18/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate and compare the clinical outcomes between percutaneous gallbladder drainage (PGBD) and percutaneous gallbladder aspiration (PGBA) for acute cholecystitis after biliary stenting for malignant biliary obstruction. MATERIALS AND METHODS Twenty-six and 14 patients underwent PGBD and PGBA, respectively, for acute cholecystitis after biliary stenting for malignant obstruction. The technical success rate, clinical effectiveness, and safety were compared between the 2 groups. RESULTS Technical success was achieved in all patients. Clinical effectiveness rate was significantly higher in the PGBD group than in the PGBA group [100% (26/26) vs. 57% (8/14), p < 0.01]. In the PGBA group, clinical effectiveness rate was significantly lower in patients with tumor involvement of the cystic duct [13% (1/8) with involvement vs. 83% (5/6) without involvement, p = 0.03]. There were no deaths related to the procedure or acute cholecystitis aggravation. Pleural effusion and biliary peritonitis occurred in 1 patient each after PGBD and intra-abdominal bleeding occurred in 1 patient after PGBA as complications requiring treatment. CONCLUSION Although PGBD was a more effective treatment for acute cholecystitis after biliary stenting for malignant obstruction, PGBA may be a less invasive option for high-risk patients without tumor involvement of the cystic duct.
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Wang CH, Wu CY, Lien WC, Liu KL, Wang HP, Wu YM, Chen SC. Early percutaneous cholecystostomy versus antibiotic treatment for mild and moderate acute cholecystitis: A retrospective cohort study. J Formos Med Assoc 2018; 118:914-921. [PMID: 30293928 DOI: 10.1016/j.jfma.2018.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/06/2018] [Accepted: 09/19/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Percutaneous cholecystostomy (PC) is an effective treatment for severe acute cholecystitis (AC). Guidelines recommend PC as rescue therapy for patients with mild or moderate AC who do not receive emergent cholecystectomy. This study aims to investigate whether PC could be a first-line treatment for these patients. METHODS Adult patients admitted through the emergency department between October 2004 and December 2013 were retrospectively reviewed. Patients with mild or moderate AC who did not undergo emergent cholecystectomy were included. Early PC was defined as a PC tube inserted within 24 h of diagnosis. The outcomes were compared between patients who received antibiotics plus early PC (early PC group) and those who received antibiotic treatment alone (antibiotic group). RESULTS A total of 698 patients were included. The mean age was 63.4 years. There were 171 patients in the early PC group and 527 patients in the antibiotic group. Multivariable logistic regression analyses indicated that early PC was significantly associated with a decreased rate of prolonged fever (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.16-0.57; p < 0.001). Early PC also correlated with both increased short-term (OR, 15.95; 95% CI, 5.73-44.38; p < 0.001) and long-term treatment success (OR, 4.27; 95% CI, 2.55-7.15; p < 0.001). CONCLUSION For patients with mild/moderate AC without emergent cholecystectomy, early PC might expedite sepsis resolution and improve the treatment success rate compared with antibiotic treatment alone. This result should be deemed as hypothesis-generating and should be examined in a randomized controlled trial.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC.
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC
| | - Shyr-Chyr Chen
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC
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Siddiqui A, Kunda R, Tyberg A, Arain MA, Noor A, Mumtaz T, Iqbal U, Loren DE, Kowalski TE, Adler DG, Saumoy M, Gaidhane M, Mallery S, Christiansen EM, Nieto J, Kahaleh M. Three-way comparative study of endoscopic ultrasound-guided transmural gallbladder drainage using lumen-apposing metal stents versus endoscopic transpapillary drainage versus percutaneous cholecystostomy for gallbladder drainage in high-risk surgical patients with acute cholecystitis: clinical outcomes and success in an International, Multicenter Study. Surg Endosc 2018; 33:1260-1270. [DOI: 10.1007/s00464-018-6406-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 08/24/2018] [Indexed: 02/06/2023]
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Percutaneous Cholecystostomy in Acute Cholecystitis-Predictors of Recurrence and Interval Cholecystectomy. J Surg Res 2018; 232:539-546. [PMID: 30463770 DOI: 10.1016/j.jss.2018.06.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Percutaneous cholecystostomy (PC) tube is a preferred option in acute cholecystitis for patients who are high risk for cholecystectomy (CCY). There are no evidence-based guidelines for patient care after PC. We identified the predictors of disease recurrence and successful interval CCY. METHODS A retrospective review of 145 PC patients between 2008 and 2016 at a tertiary hospital was performed. Primary outcomes included mortality, readmissions, hospital and intensive care unit length of stay (LOS), disease recurrence, and interval CCY. RESULTS There were 96 (67%) calculous and 47 (33%) acalculous cholecystitis cases. Seventy-two (49%) had chronic and 73 (51%) had acute prohibitive risks as an indication for PC. There were 54 (37%) periprocedural complications, which most commonly were dislodgements. Twenty-six (18%) patients had a recurrence at a median time of 65 days. Calculous cholecystitis (odds ratio [OR] 3.44, P = 0.038) and purulence in the gallbladder (OR 3.77, P = 0.009) were predictors for recurrence. Forty-one (28%) patients underwent interval CCY. Patients with acute illness were likely to undergo interval CCY (OR 6.67, P = 0.0002). Patients with acalculous cholecystitis had longer hospital LOS (16 versus 8 days) and intensive care unit LOS (2 versus 0 days), and higher readmission rates (OR 2.42, P = 0.02). Thirty-day mortality after PC placement was 9%. Patients receiving interval CCY were noted to have increased survival compared to PC alone. However, this should not be attributed to interval CCY alone in absence of randomization in this study. CONCLUSIONS Calculous cholecystitis and purulence in the gallbladder are independent predictors of acute cholecystitis recurrence. Acute illness is a strong predictor of successful interval CCY. The association of interval CCY and prolonged survival in patients with PC as noted in this study should be further assessed in future prospective randomized trials.
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Lee SO, Yim SK. [Management of Acute Cholecystitis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:264-268. [PMID: 29791985 DOI: 10.4166/kjg.2018.71.5.264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Acute cholecystitis is a common serious complication of gallstones. The reported mortality of acute cholecystitis is approximately 3%, but the rate increases with age or comorbidity of the patient. If appropriate treatment is delayed, complications can develop as a consequence with a grave prognosis. The current standard of care in acute cholecystitis is an early laparoscopic cholecystectomy with the appropriate administration of fluid, electrolyte, and antibiotics. On the other hand, the severity of the disease and patient's operational risk must be considered. In those with high operational risks, gall bladder drainage can be performed as an alternative. Currently percutaneous and endoscopic drainage are available and show clinical success in most cases. After recovering from acute cholecystitis, the patients who have undergone drainage should be considered for cholecystectomy as a definitive treatment. However, in elderly patients or patients with significant comorbidity, operational risks may still be high, making cholecystectomy inappropriate. In these patients, gallstone removal using the percutaneous tract or endoscopy may be considered.
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Affiliation(s)
- Seung Ok Lee
- Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung Kyun Yim
- Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
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Iino C, Shimoyama T, Igarashi T, Aihara T, Ishii K, Sakamoto J, Tono H, Fukuda S. Comparable efficacy of endoscopic transpapillary gallbladder drainage and percutaneous transhepatic gallbladder drainage in acute cholecystitis. Endosc Int Open 2018; 6:E594-E601. [PMID: 29744378 PMCID: PMC5940465 DOI: 10.1055/s-0044-102091] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 01/22/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Although endoscopic transpapillary gallbladder drainage (ETGBD) is reportedly useful in patients who have acute cholecystitis, its efficacy has not been compared to that of percutaneous transhepatic gallbladder drainage (PTGBD). We retrospectively compared the efficacy and safety of ETGBD and PTGBD in patients with acute cholecystitis. PATIENTS AND METHODS We studied 75 patients who required gallbladder drainage for acute cholecystitis between January 2014 and December 2016. Using propensity score matching analysis, we compared the clinical efficacy and length of hospitalization in patients successfully treated with ETGBD and PTGBD. Moreover, we assessed the predictive factors for hospitalization period < 30 days using multivariate analysis. RESULTS ETGBD and PTGBD were successfully performed in 33 patients (77 %) and 42 patients (100 %) ( P < 0.001). Twenty-seven matched pairs were obtained after propensity score matching analysis. No significant differences were observed between patients treated with ETGBD and those treated with PTGBD with respect to improvement in white blood cell count and serum C-reactive protein level. The length of hospitalization in patients treated with ETGBD was significantly shorter than in those treated with PTGBD regardless of the need for surgery. Multivariate logistic regression analysis revealed ETGBD (odds ratio, 7.07; 95 % confidence interval 2.22 - 22.46) and surgery (odds ratio 0.26; 95 % confidence interval 0.09 - 0.79) as independent factors associated with hospitalization period. There were no significant differences in occurrence of complications in ETGBD and PTGBD procedure. CONCLUSIONS ETGBD was shown to be as useful as PTGBD for treatment of acute cholecystitis and was associated with shorter hospitalization period. ETGBD can be an alternative treatment option for acute cholecystitis at times when PTGBD is not possible.
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Affiliation(s)
- Chikara Iino
- Department of Gastroenterology and Hematology, Hirosaki National Hospital, Aomori, Japan,Department of Internal medicine, Hirosaki Municipal Hospital, Aomori, Japan,Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Aomori, Japan,Corresponding author Chikara Iino Department of Gastroenterology and HematologyHirosaki National Hospital1, TominochoOaza, Hirosaki, Aomori 036-8545, Japan+81-172-33-8614
| | - Tadashi Shimoyama
- Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Takasato Igarashi
- Department of Internal medicine, Hirosaki Municipal Hospital, Aomori, Japan,Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Tomoyuki Aihara
- Department of Internal medicine, Hirosaki Municipal Hospital, Aomori, Japan
| | - Kentaro Ishii
- Department of Internal medicine, Hirosaki Municipal Hospital, Aomori, Japan
| | - Juichi Sakamoto
- Department of Internal medicine, Hirosaki Municipal Hospital, Aomori, Japan
| | - Hiroshi Tono
- Department of Internal medicine, Hirosaki Municipal Hospital, Aomori, Japan
| | - Shinsaku Fukuda
- Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Aomori, Japan
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Kim SH, Jung D, Ahn JH, Kim KS. Differentiation between gallbladder cancer with acute cholecystitis: Considerations for surgeons during emergency cholecystectomy, a cohort study. Int J Surg 2017; 45:1-7. [PMID: 28716660 DOI: 10.1016/j.ijsu.2017.07.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Gallbladder cancer (GBCA) is an uncommon malignancy with vague and non-specific symptoms. GBCA is sometimes diagnosed after emergency cholecystectomy for acute cholecystitis. We investigated the differential diagnosis between GBCA with acute cholecystitis. MATERIALS AND METHODS Thirteen patients were diagnosed with GBCA after emergency cholecystectomy carried out for acute cholecystitis. A radiologist who was blinded to the final diagnoses retrospectively reviewed the computed tomography (CT) scans of the patients with GBCA and 25 patients with acute cholecystitis. We retrospectively reviewed the medical records of these patients and compared the clinical characteristics and CT findings between patients with GBCA and those with acute cholecystitis. We also investigated the prognostic factors in patients with GBCA who underwent emergency cholecystectomy. RESULTS Gallbladder (GB) stones were found more often in patients with acute cholecystitis (n = 17, 68%) than in patients with GBCA (n = 7, 53.8%) (p = 0.486). Patients with GBCA showed typical GB masses or focal enhanced wall thickening when compared to diffuse wall thickening in patients with acute cholecystitis. Some GBCA patients showed irregular mural thickening and GB enhancement. Differentiating carcinoma from acute cholecystitis might sometimes not possible, but the latter group of patients had significantly lower C-reactive protein (CRP) levels (p = 0.033) and less regional fat stranding (p = 0.047). Survival was significantly affected by aggressive tumor characteristics (lymphatic invasion [p = 0.025], depth of tumor invasion [p = 0.004]) or R0 resection (p = 0.013) rather than bile spillage (p = 0.112). CONCLUSIONS Surgeons deciding on emergency cholecystectomy for elderly patients with acute cholecystitis must suspect GBCA in patients with a low CRP level, irregular mural thickening or enhancement of GB without regional fat stranding.
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Affiliation(s)
- Sung Hoon Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Dawn Jung
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Jhii-Hyun Ahn
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, South Korea.
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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Cholecystostomy Treatment in an ICU Population: Complications and Risks. Surg Laparosc Endosc Percutan Tech 2017; 26:410-416. [PMID: 27661202 DOI: 10.1097/sle.0000000000000319] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Percutaneous cholecystostomy tube placement has widely been used as an alternative treatment to cholecystectomy, especially in advanced disease or critically ill patients. Reported postprocedural complication rates have varied significantly over the last decade. The goal of this study is to evaluate the safety of percutaneous cholecystostomy tube treatment in critically ill patients. STUDY DESIGN We performed a retrospective chart analysis of 96 critically ill patients who underwent cholecystostomy tube placement during an intensive care unit (ICU) stay between 2005 and 2010 in a tertiary care center in central Massachusetts. Complications within 72 hours of cholecystostomy tube placement and any morbidity or mortality relating to presence of cholecystostomy tube were considered. RESULTS A total of 65 male and 31 female patients with a mean age of 67.4 years underwent percutaneous cholecystostomy tube placement during an ICU stay. Sixty-six patients experienced a total of 121 complications, resulting in an overall complication rate of 69%. Fifty-four of these complications resulted from the actual procedure or the presence of the cholecystostomy tube; the other 67 complications occurred within 72 hours of the cholecystostomy procedure. Ten patients died. Tube dislodgment was the most common complication with a total of 34 episodes. CONCLUSIONS Cholecystostomy tube placement is associated with frequent complications, the most common of which is tube dislodgment. Severe complications may contribute to serious morbidity and death in an ICU population. Complication rates may be underreported in the medical literature. The potential impact of cholecystostomy tube placement in critically ill patients should not be underestimated.
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Lindberg CG, Jeppsson B, Lundstedt C, Willner J, Stridbeck H. Percutaneous Rotational Lithotripsy of Gallbladder Stones. Acta Radiol 2016. [DOI: 10.1177/028418519303400315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ten patients (aged 39–94 years) with cholecystolithiasis were selected for percutaneous rotational lithotripsy with the Rotolith lithotriptor either because they were considered high-risk patients for cholecystectomy or because they had refused surgery. The procedure was completed in 7 patients. Five of these were stone-free at cholangiography 1 to 2 days after lithotripsy. Conclusive cholangiograms were not obtained in 2 patients due to gallbladder leakage, which in itself did not cause any serious sequelae. At ultrasonography after one month, one of these 2 patients had no visible gallbladder, the other one had small residual gallbladder stones. Rotational lithotripsy is an alternative to cholecystectomy in patients at high surgical risk, especially elderly patients who have undergone cholecystostomy as an emergency treatment for acute cholecystitis.
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Jung WH, Park DE. Timing of Cholecystectomy after Percutaneous Cholecystostomy for Acute Cholecystitis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 66:209-14. [PMID: 26493506 DOI: 10.4166/kjg.2015.66.4.209] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIMS Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis. Percutaneous cholecystostomy is an alternative treatment to resolve acute inflammation in patients with severe comorbidities. The purpose of this study is to determine the optimal timing of laparoscopic cholecystectomy after percutaneous cholecystostomy for the patients with acute cholecystitis. METHODS This retrospective study was conducted in patients who underwent cholecystectomy after percutaneous cholecystostomy from January 2010 through November 2014. Seventy-four patients were included in this study. The patients were divided into two groups by the operation timing. Group I patients underwent cholecystectomy within 10 days after percutaneous cholecystostomy (n=30) and group II patients underwent cholecystectomy at more than 10 days after percutaneous cholecystostomy (n=44). RESULTS There was no significant difference between groups in conversion rate to open surgery, operation time, perioperative complications rate, and days of hospital stay after operation. However, complications related to cholecystostomy such as catheter dislodgement occurred significantly more often in group II than group I (group I:group II=0%:18.2%; p=0.013). CONCLUSIONS Timing of laparoscopic cholecystectomy after percutaneous cholecystostomy did not influence postoperative outcomes. However, late surgery caused more complications related to cholecystostomy than early surgery. Therefore, early laparoscopic cholecystectomy should be considered over late surgery after percutaneous cholecystostomy insertion.
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Affiliation(s)
- Woo Hyun Jung
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Dong Eun Park
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea
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20
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Wang CH, Wu CY, Yang JCT, Lien WC, Wang HP, Liu KL, Wu YM, Chen SC. Long-Term Outcomes of Patients with Acute Cholecystitis after Successful Percutaneous Cholecystostomy Treatment and the Risk Factors for Recurrence: A Decade Experience at a Single Center. PLoS One 2016; 11:e0148017. [PMID: 26821150 PMCID: PMC4731150 DOI: 10.1371/journal.pone.0148017] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/12/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Percutaneous cholecystostomy tube (PCT) has been effectively used for the treatment of acute cholecystitis (AC) for patients unsuitable for early cholecystectomy. This retrospective study investigated the recurrence rate after successful PCT treatment and factors associated with recurrence. METHODS We reviewed patients treated with PCT for AC from October 2004 through December 2013. Patients with successful PCT treatment were those who were free from persistent PCT drainage. We used multivariable logistic regression analysis sequentially to identify factors associated with each outcome. RESULTS The study included 184 patients (mean age: 70.1 years). The average duration for parenteral antibiotics was 14.4 days and 20.0 days for PCT drainage. The one-year recurrence rate was 9.2% (17/184) with most recurrences occurring within two months (6.5%, 12/184) of the procedure. Complicated cholecystitis (odds ratio [OR]: 4.67; 95% confidence interval [CI]: 1.44-15.70; P = 0.01) and PCT drainage duration >32 days (OR: 4.92; 95% CI: 1.03-23.53; P = 0.05) positively correlated with one-year recurrence; parenteral antibiotics duration >10 days (OR: 0.21; 95% CI: 0.05-0.68; P = 0.01) was inversely associated with one-year recurrence. CONCLUSIONS The recurrence rate was low for patients after successful PCT treatment. Predictors for recurrence included the severity of initial AC and subsequently provided treatments.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Justin Cheng-Ta Yang
- Department of Medical Imaging, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- National Taiwan University Hospital, Hsin-Chu Branch and National Taiwan University, Hsinchu City, Taiwan
- * E-mail:
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Shyr-Chyr Chen
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
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Hatanaka T, Itoi T, Ijima M, Matsui A, Kurihara E, Okuno N, Kobatake T, Kakizaki S, Yamada M. Efficacy and Safety of Endoscopic Gallbladder Stenting for Acute Cholecystitis in Patients with Concomitant Unresectable Cancer. Intern Med 2016; 55:1411-7. [PMID: 27250045 DOI: 10.2169/internalmedicine.55.5820] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Objective Endoscopic gallbladder stenting (EGBS) is an alternative treatment option for high-risk surgical patients with acute cholecystitis. However, there are no reports focusing on EGBS in patients with concomitant unresectable cancer. The aim of this study was thus to evaluate EGBS in such patients. Methods Twenty-two consecutive patients with acute cholecystitis and unresectable cancer were enrolled between September 2010 and December 2014. Their median age was 74.5 years (range: 51-95). Thirteen patients were men and nine were women. The primary cancers of the patients were biliary tract cancer (9), pancreas cancer (9), lung cancer (2), gastric cancer (1), and colon cancer (1). The causes of cholecystitis were calculus cholecystitis (7), obstruction by malignant tumor (13), and obstruction by fully covered stent (2). Results EGBS was successfully performed in 17 patients (77.2%). The technical success rates for calculus cholecystitis, obstruction by malignant tumor, and obstruction by fully covered stent were 85.7% (6/7), 69.2% (9/13), and 100% (2/2), respectively. No complications were observed. Percutaneous transhepatic gallbladder drainage was conducted on two patients in whom EGBS had failed and then we performed EGBS by a rendezvous approach. Of the 19 patients in whom we finally deployed EGBS, the median follow-up period was 229 days (range: 14-880 days). A recurrence of acute cholecystitis occurred in three (15.7%) patients 14, 130, and 440 days after EGBS placement. The rates of recurrence of cholecystitis at one and two years were 10.5% and 18.7%, respectively. Conclusion Our study demonstrated that EGBS is a safe and effective method for acute cholecystitis in patients with concomitant unresectable cancer.
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Affiliation(s)
- Takeshi Hatanaka
- Department of Internal Medicine, Isesaki Municipal Hospital, Japan
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Bala M, Mizrahi I, Mazeh H, Yuval J, Eid A, Almogy G. Percutaneous cholecystostomy is safe and effective option for acute calculous cholecystitis in select group of high-risk patients. Eur J Trauma Emerg Surg 2015; 42:761-766. [PMID: 26612179 DOI: 10.1007/s00068-015-0601-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 11/16/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE In high-risk patients with acute calculous cholecystitis (ACC), percutaneous cholecystostomy (PC) can serve as a bridging option to cholecystectomy [laparoscopic cholecystectomy (LC)] or as definitive treatment. The purpose of this study was to identify predictors of the need for permanent PC. METHODS Data from 257 PCs performed for ACC (mean age 67.3 ± 14) was collected for a 10-year period. Demographic and clinical characteristics at initial admission, co-morbidities were analyzed. Patients who underwent interval LC were defined as the surgery group (SG; n = 163, 63.4 %) and the remaining patients as the non-SG (NSG; n = 94, 36.6 %). RESULTS Patients in the SG were significantly younger and had a shorter length of hospital stay (p < 0.01). The rate of coronary artery disease (CAD; 63.2 vs. 20.2 %), chronic renal failure (14.9 vs. 6.1 %), and the mean number of co-morbidities (2.2 vs. 1.4) were significantly higher in the NSG. Sepsis at admission was more common in the NSG (19.1 vs. 4.9 %, p < 0.001). 56 patients (34.4 %) in the SG and 24 patients (25.5 %) in the NSG developed tube-related complications. In hospital mortality was similar between the groups. Multivariate analysis showed that age ≥75, increased alkaline phosphatase (ALK-P), history of CAD, were predictors of PC as a definite treatment in this high-risk group of patients with ACC. CONCLUSIONS High operative risk due to older age and CAD preclude LC in more than one-third of patients following PC especially presenting with sepsis and elevated ALK-P. This study suggests that PC could be a safe treatment option in this select group of high-risk patients.
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Affiliation(s)
- M Bala
- Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel.
| | - I Mizrahi
- Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - H Mazeh
- Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - J Yuval
- Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - A Eid
- Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - G Almogy
- Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
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Na BG, Yoo YS, Mun SP, Kim SH, Lee HY, Choi NK. The safety and efficacy of percutaneous transhepatic gallbladder drainage in elderly patients with acute cholecystitis before laparoscopic cholecystectomy. Ann Surg Treat Res 2015; 89:68-73. [PMID: 26236695 PMCID: PMC4518032 DOI: 10.4174/astr.2015.89.2.68] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 02/07/2015] [Accepted: 03/10/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Laparoscopic cholecystectomy (LC) is the standard management for acute cholecystitis. Percutaneous transhepatic gallbladder drainage (PTGBD) may be an alternative interim strategy before surgery in elderly patients with comorbidities. This study was designed to evaluate the safety and efficacy of PTGBD for elderly patients (>60 years) with acute cholecystitis. METHODS We reviewed consecutive patients diagnosed with acute cholecystitis between January 2009 and December 2013. Group I included patients who underwent PTGBD, and patients of group II did not undergo PTGBD before LC. RESULTS All 116 patients (72.7 ± 7.1 years) were analyzed. The preoperative details of group I (n = 39) and group II (n = 77) were not significantly different. There was no significant difference in operative time (P = 0.057) and intraoperative estimated blood loss (P = 0.291). The rate of conversion to open operation of group I was significantly lower than that of group II (12.8% vs. 32.5%, P < 0.050). No significant difference of postoperative morbidity was found between the two groups (25.6% vs. 26.0%, P = 0.969). In addition, perioperative mortality was not significantly different. Preoperative hospital stay of group I was significantly longer than that of group II (10.3 ± 5.7 days vs. 4.4 ± 2.8 days, P < 0.050). However, two groups were not significantly different in total hospital stay (16.3 ± 9.0 days vs. 13.4 ± 6.5 days, P = 0.074). CONCLUSION PTGBD is a proper preoperative management before LC for elderly patients with acute cholecystitis.
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Affiliation(s)
- Byung-Gon Na
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Young-Sun Yoo
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Seong-Pyo Mun
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Seong-Hwan Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Hyun-Young Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
| | - Nam-Kyu Choi
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
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Successful laparoscopic cholecystectomy after percutaneous cholecystostomy tube placement. J Trauma Acute Care Surg 2015; 78:100-4. [PMID: 25539209 DOI: 10.1097/ta.0000000000000498] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Interval cholecystectomy (IC) after percutaneous cholecystostomy tube (PCT) placement is the definitive treatment for cholecystitis in patients who are operative candidates after optimization of medical comorbidities. It is not clear, however, which patients will be able to have a laparoscopic IC after PCT placement. We aimed to identify factors associated with successful laparoscopic IC in these patients. METHODS This is a retrospective review of patients who had a PCT from 2009 to 2011. Patient's baseline demographics, clinical data, and outcomes were analyzed. Univariable and multivariable comparisons were performed between patients who did and did not undergo IC. A subgroup analysis of patients who had laparoscopic IC and open IC was performed. Data are presented as percentages, medians with interquartile ranges (IQRs), or odds ratios with 95% confidence interval as appropriate. RESULTS A total of 245 patients had PCT placement, with a median age of 71 years (IQR, 59-80 years); 63% were male, of whom 72 (29%) underwent IC. The median time from PCT placement to IC was 55 days (IQR, 42-75 days). IC patients had a lower Charlson Comorbidity Index (5 [4-6] vs. 6 [4-8], p = 0.005) at the time of PCT placement. When controlling for other factors, lower Charlson Comorbidity Index and fewer previous abdominal operations were associated with performance of IC. Laparoscopic surgery was planned for 89% of the patients and completed successfully in 78%. The only factor associated with successful laparoscopic IC was fewer previous abdominal operations. CONCLUSION Patients who have been medically optimized following PCT can undergo laparoscopic IC with a high rate of success. The degree of illness at the time of PCT placement did not seem to influence the rate of success of laparoscopic IC. LEVEL OF EVIDENCE Therapeutic/care management study, level III.
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Itoi T, Kawakami H, Katanuma A, Irisawa A, Sofuni A, Itokawa F, Tsuchiya T, Tanaka R, Umeda J, Ryozawa S, Doi S, Sakamoto N, Yasuda I. Endoscopic nasogallbladder tube or stent placement in acute cholecystitis: a preliminary prospective randomized trial in Japan (with videos). Gastrointest Endosc 2015; 81:111-8. [PMID: 25527052 DOI: 10.1016/j.gie.2014.09.046] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/02/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are currently no prospective, controlled trials of endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis. OBJECTIVE We evaluated the technical success rate and efficacy of endoscopic transpapillary gallbladder drainage by using either endoscopic nasogallbladder drainage (ENGBD) or endoscopic gallbladder stenting (EGBS) for patients with acute cholecystitis. DESIGN Randomized, controlled study. SETTING Tertiary-care referral centers. PATIENTS Seventy-three consecutive patients with acute cholecystitis were randomized. INTERVENTIONS ENGBD by using a 5F or 7F tube (n = 37) or EGBS (n = 36) by using a 7F stent. MAIN OUTCOME AND MEASUREMENTS Technical success, clinical success, adverse events, and procedure-related pain score. RESULTS The overall technical success rates in the ENGBD and EGBS groups were 91.9% and 86.1%, respectively (P > .05). The mean procedure times of ENGBD and EGBS were 20.3 ± 12.1 and 22.2 ± 14.5 minutes, respectively (P > .05). The overall clinical success rates by per protocol analysis were 94.1% and 90.3% in the ENGBD and EGBS groups, respectively, whereas the rates by intention-to-treat analysis were 86.5% and 77.8%, respectively (P > .05). Moderate adverse events were observed in the ENGBD (n = 2) and EGBS (n = 1) groups. The mean visual analog score of postprocedure pain in the ENGBD group was significantly higher than that in the EGBS group (1.3 ± 1.1 vs 0.4 ± 0.8, respectively; P < .001). LIMITATIONS Small sample size and the participation of multiple endoscopists who may have different levels of experience in endoscopic transpapillary gallbladder drainage. CONCLUSIONS Both ENGBD and EGBS appear to be suitable for the treatment of acute cholecystitis in patients who are poor candidates for emergency cholecystectomy. ( CLINICAL TRIAL REGISTRATION NUMBER UMIN000012316.).
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Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hiroshi Kawakami
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Prefectural Medical College, Fukushima, Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Fumihide Itokawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Reina Tanaka
- Department of Gastroenterology, Toda Chuo General Hospital, Saitama, Japan
| | - Junko Umeda
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shinpei Doi
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
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Can percutaneous cholecystostomy be a definitive management for acute cholecystitis in high-risk patients? Surg Laparosc Endosc Percutan Tech 2014; 24:187-91. [PMID: 24686358 DOI: 10.1097/sle.0b013e31828fa45e] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the efficacy, long-term outcome, and safety of percutaneous cholecystostomy (PC) in high-risk surgical patients. METHODS This was a retrospective descriptive review of the medical records of 36 patients who underwent PC for acute cholecystitis (AC) at a single institution between 2000 and 2011. Primary outcomes were overall morbidity, mortality, and need for interval cholecystectomy. RESULTS PC was initially successful, and symptoms disappeared within 3 days in all patients. Seven patients (2 during hospitalization and 5 during follow-up) died, 6 for a reason unrelated to AC, and 1 succumbed to a sepsis-related condition caused by uncontrolled cholecystitis progression. Elective cholecystectomy was performed in 6 patients. PC was a definitive treatment in 63.9% of patients. CONCLUSIONS PC is a safe and efficient treatment option for patients with AC who are less eligible for surgery. After patients recover from PC, further treatment such as cholecystectomy may not be needed.
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Charlier C, Fevre C, Travier L, Cazenave B, Bracq-Dieye H, Podevin J, Assomany D, Guilbert L, Bossard C, Carpentier F, Cales V, Leclercq A, Lecuit M. Listeria monocytogenes-associated biliary tract infections: a study of 12 consecutive cases and review. Medicine (Baltimore) 2014; 93:e105. [PMID: 25319439 PMCID: PMC4616294 DOI: 10.1097/md.0000000000000105] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
At present, little is known regarding Listeria monocytogenes-associated biliary tract infection, a rare form of listeriosis.In this article, we will study 12 culture-proven cases reported to the French National Reference Center for Listeria from 1996 to 2013 and review the 8 previously published cases.Twenty cases were studied: 17 cholecystitis, 2 cholangitis, and 1 biliary cyst infection. Half were men with a median age of 69 years (32-85). Comorbidities were present in 80%, including cirrhosis, rheumatoid arthritis, and diabetes. Five patients received immunosuppressive therapy, including corticosteroids and anti-tumor necrosis factor biotherapies. Half were afebrile. Blood cultures were positive in 60% (3/5). Gallbladder histological lesions were analyzed in 3 patients and evidenced acute, chronic, or necrotic exacerbation of chronic infection. Genoserogroup of the 12 available strains were IVb (n=6), IIb (n=5), and IIa (n=1). Their survival in the bile was not enhanced when compared with isolates from other listeriosis cases. Adverse outcome was reported in 33% (5/15): 3 deaths, 1 recurrence; 75% of the patients with adverse outcome received inadequate antimicrobial therapy (P=0.033).Biliary tract listeriosis is a severe infection associated with high mortality in patients not treated with appropriate therapy. This study provides medical relevance to in vitro and animal studies that had shown Listeria monocytogenes ability to survive in bile and induce overt biliary infections.
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Affiliation(s)
- Caroline Charlier
- Institut Pasteur, Biology of Infection Unit (CC, CF, LT, ML); Institut Pasteur French National Reference Center and WHO Collaborating Center for Listeria (CC, BC, HBD, AL, ML); Inserm U1117 (CC, CF, LT, ML); Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker-Enfants Malades, Institut Imagine (CC, ML); Service de Chirurgie viscérale, Centre Hospitalier Universitaire de Nantes (JP); Service de Chirurgie viscérale et digestive, Centre Hospitalier de Roubaix (DA, LG); Service d'Anatomopathologie et Cytologie, Centre Hospitalier Universitaire de Nantes (CB); Service d'Anatomopathologie et Cytologie, Centre Hospitalier de Roubaix (FC); and Service d'Anatomopathologie et Cytologie, Centre Hospitalier de Pau (VC)
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Cha BH, Song HH, Kim YN, Jeon WJ, Lee SJ, Kim JD, Lee HH, Lee BS, Lee SH. Percutaneous cholecystostomy is appropriate as definitive treatment for acute cholecystitis in critically ill patients: a single center, cross-sectional study. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 63:32-8. [PMID: 24463286 DOI: 10.4166/kjg.2014.63.1.32] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND/AIMS Percutaneous cholecystostomy (PC) is an effective treatment for cholecystitis in high-risk surgical patients. However, there is no definitive agreement on the need for additional cholecystectomy in these patients. METHODS All patients who were admitted to Cheju Halla General Hospital (Jeju, Korea) for acute cholecystitis and who underwent ultrasonography-guided PC between 2007 and 2012 were consecutively enrolled in this study. Among 82 total patients enrolled, 35 underwent laparoscopic cholecystectomy after recovery and 47 received the best supportive care (BSC) without additional surgery. RESULTS The technical and clinical success rates for PC were 100% and 97.5%, respectively. The overall mean survival was 12.8 months. In the BSC group, mean survival was 5.4 months, and in the cholecystectomy group, mean survival was 22.4 months (p<0.01). However, there was no significant difference between these groups in multivariate analysis (relative risk [RR]=1.92; 95% CI, 0.77-4.77; p=0.16). However, advanced age (RR=1.05; 95% CI, 1.02-1.08; p=0.001) and higher class in the American Society of Anesthesiologists' physical status (RR=3.06; 95% CI, 1.37-6.83, p=0.006) were significantly associated with survival in the multivariate analysis. Among the 47 patients in the BSC group, the cholecystostomy tube was removed in 31 patients per protocol. Recurrent cholecystitis was not observed in either group of patients during the follow-up period. CONCLUSIONS In high-risk surgical patients, PC without additional cholecystectomy might be the best definitive management. Furthermore, the cholecystostomy drainage catheter can be safely removed in certain patients.
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Affiliation(s)
- Byung Hyo Cha
- Digestive Disease Center, Department of Internal Medicine, Cheju Halla General Hospital, Doreongno 65, Jeju 690-766, Korea
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Cull JD, Velasco JM, Czubak A, Rice D, Brown EC. Management of acute cholecystitis: prevalence of percutaneous cholecystostomy and delayed cholecystectomy in the elderly. J Gastrointest Surg 2014; 18:328-33. [PMID: 24197550 DOI: 10.1007/s11605-013-2341-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 08/26/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Published guidelines recommend early cholecystectomy for acute cholecystitis in the elderly. Alternatively, percutaneous cholecystostomy can be used in compromised patients. METHODS We reviewed 806 elderly patients diagnosed with biliary disease retrospectively identified through billing and diagnosis codes. Two hundred sixty-five patients with histologically documented acute cholecystitis were selected. RESULTS Initially, 75 patients had percutaneous cholecystostomy (Group 1), 64 (24 % underwent interval cholecystectomy, 74 (28 %) early (Group 2), and 127 (48 %) delayed cholecystectomy (Group 3). Group 1 was more likely to have American Society of Anesthesiologists (ASA) scores of 4 when compared to those in Groups 2 and 3 (p = 0.04). No difference existed among the groups when patients with an ASA of 4 were excluded: conversion rates (11 %), biliary leak, bowel injury, need for reoperation, or 30 days mortality. Patients in Group 1 and in Group 3 were five times (p = 0.04) and four times (p = 0.06) more likely, respectively, than those in Group 2 to have recurrent episodes of pancreatitis, cholecystitis, and cholangitis. CONCLUSION Patients were more likely to have delayed cholecystectomy after initial antibiotic therapy or cholecystostomy without the benefit of a lower conversion rate when compared to the early group, but they had higher recurrent episodes of cholecystitis/pancreatitis or cholangitis.
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Affiliation(s)
- John D Cull
- Department of General Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
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Shibasaki S, Takahashi N, Toi H, Tsuda I, Nakamura T, Hase T, Minagawa N, Homma S, Kawamura H, Taketomi A. Percutaneous transhepatic gallbladder drainage followed by elective laparoscopic cholecystectomy in patients with moderate acute cholecystitis under antithrombotic therapy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:335-42. [PMID: 24027011 DOI: 10.1002/jhbp.28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Standard treatment for acute cholecystitis (AC) in patients receiving antithrombotic drugs has not been established. We evaluated the safety of percutaneous transhepatic gallbladder drainage (PTGBD) followed by elective laparoscopic cholecystectomy (LC) in patients with moderate AC who were receiving antithrombotics. METHODS Seventy-five patients received PTGBD from January 2006 to March 2013 followed by elective LC for moderate AC. Patients were divided into Group A, which consisted of patients receiving antithrombotic therapy (n = 23), and Group B, which included the remaining patients (n = 52). We analyzed clinical outcomes and perioperative complications between groups. RESULTS No hemorrhagic events occurred during PTGBD insertion regardless of antithrombotic treatment. The open conversion rate was not significantly different between the two groups. Postoperative complications were found in 10 patients (13.3%). The rate of postoperative complications in Group A was slightly higher than that in Group B, but the difference was not significant (21.7% vs. 9.6%; P = 0.15). Complications associated with PTGBD occurred in six patients (8%). There were no significant differences in the incidence of these complications, operation time, intraoperative blood loss, or length of postoperative hospital stay. CONCLUSIONS Percutaneous transhepatic gallbladder drainage followed by elective LC may be an effective therapeutic strategy for moderate AC in patients receiving antithrombotic therapy.
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Affiliation(s)
- Susumu Shibasaki
- Department of Surgery, Hokushinkai Megumino Hospital, Eniwa, Hokkaido, Japan; Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N15 W7 Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
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Nikfarjam M, Yeo D, Perini M, Fink MA, Muralidharan V, Starkey G, Jones RM, Christophi C. Outcomes of cholecystectomy for treatment of acute cholecystitis in octogenarians. ANZ J Surg 2013; 84:943-8. [DOI: 10.1111/ans.12313] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Mehrdad Nikfarjam
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | - David Yeo
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | - Marcos Perini
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | - Michael A. Fink
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | | | - Graham Starkey
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | - Robert M. Jones
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
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Changing trends and outcomes in the use of percutaneous cholecystostomy tubes for acute cholecystitis. Ann Surg 2013; 257:1112-5. [PMID: 23263191 DOI: 10.1097/sla.0b013e318274779c] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Percutaneous cholecystostomy tube (PCT) placement serves as a treatment option for acute cholecystitis in elderly and critically ill patients. The objective of this study was to compare PCT and cholecystectomy outcomes over time. METHODS PCTs placed from April 1, 1998, to December 31, 2009 (time period 2) were retrospectively reviewed. Patients who underwent cholecystectomies served as matched controls. Institutional data from March 1, 1989, to March 31, 1998 (time period 1) were reviewed to compare trends. RESULTS A total of 143 patients successfully underwent PCT placement in time period 2. When compared with patients undergoing cholecystectomy, PCT patients had a higher rate of cardiovascular disease (66% vs 26%, P = 0.001), diabetes (27% vs 13%, P = 0.001), and a higher mean Charlson comorbidity index (3.27 vs 1.07, P = 0.001). Compared with the first time period, patients undergoing PCT in the second time period had lower American Society of Anesthesiologist's classifications (American Society of Anesthesiologist's class I, II: 0% vs 18%, P = 0.001). Thirty-day mortality decreased from 36% to 12% in patients undergoing PCT (P = 0.001). CONCLUSIONS Among patients with acute cholecystitis, percutaneous cholecystostomy tubes were placed in older patients with increased comorbidities compared to cholecystectomy. Mortality rates after PCT decreased over time.
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Sanjay P, Mittapalli D, Marioud A, White RD, Ram R, Alijani A. Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB (Oxford) 2013; 15:511-6. [PMID: 23750493 PMCID: PMC3692020 DOI: 10.1111/j.1477-2574.2012.00610.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/27/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to review a series of consecutive percutaneous cholecystostomies (PC) to analyse the clinical outcomes. METHODS All patients who underwent a PC between 2000 and 2010 were reviewed retrospectively for indications, complications, and short- and long-term outcomes. RESULTS Fifty-three patients underwent a PC with a median age was 74 years (range 14-93). 92.4% (n = 49) of patients were American Society of Anesthesiologists (ASA) III and IV. 82% (43/53) had ultrasound-guided drainage whereas 18% (10/53) had computed tomography (CT)-guided drainage. 71.6% (n = 38) of PC's employed a transhepatic route and 28.4% (n = 15) transabdominal route. 13% (7/53) of patients developed complications including bile leaks (n = 5), haemorrhage (n = 1) and a duodenal fistula (n = 1). All bile leaks were noted with transabdominal access (5 versus 0, P = 0.001). 18/53 of patients underwent a cholecystectomy of 4/18 was done on the index admission. 6/18 cholecystectomies (33%) underwent a laparoscopic cholecystectomy and the remaining required conversion to an open cholecystectomy (67%). 13/53 (22%) patients were readmitted with recurrent cholecystitis during follow-up of which 7 (54%) had a repeated PC. 12/53 patients died on the index admission. The overall 1-year mortality was 37.7% (20/53). CONCLUSIONS Only a small fraction of patients undergoing a PC proceed to a cholecystectomy with a high risk of conversion to an open procedure. A quarter of patients presented with recurrent cholecystitis during follow-up. The mortality rate is high during the index admission from sepsis and within the 1 year of follow-up from other causes.
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Affiliation(s)
| | | | - Aseel Marioud
- HPB Unit, Auckland City HospitalAuckland, New Zealand
| | - Richard D White
- Department of Radiology, Ninewells Hospital and Medical SchoolDundee, UK
| | - Rishi Ram
- HPB Unit, Auckland City HospitalAuckland, New Zealand
| | - Afshin Alijani
- Upper GI & HPB Unit, Ninewells Hospital and Medical SchoolDundee, UK
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Maekawa S, Nomura R, Murase T, Ann Y, Oeholm M, Harada M. Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older. BMC Gastroenterol 2013; 13:65. [PMID: 23586815 PMCID: PMC3675408 DOI: 10.1186/1471-230x-13-65] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/10/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Endoscopic transpapillary pernasal gallbladder drainage and endoscopic gallbladder stenting (EGS) have recently been reported to be useful in patients with acute cholecystitis for whom a percutaneous approach is contraindicated. The aim of this study was to evaluate the efficacy of permanent EGS for management of acute cholecystitis in elderly patients who were poor surgical candidates. METHODS We retrospectively studied 46 elderly patients aged 65 years or older with acute cholecystitis who were treated at Japan Labour Health and Welfare Organization Niigata Rosai Hospital. In 40 patients, acute cholecystitis was diagnosed by transabdominal ultrasonography and computed tomography, while 6 patients were transferred from other hospitals after primary management of acute cholecystitis. All patients underwent EGS, with a 7Fr double pig-tail stent being inserted into the gallbladder. If EGS failed, percutaneous transhepatic gallbladder drainage or percutaneous transhepatic gallbladder aspiration was subsequently performed. The main outcome measure of this study was the efficacy of EGS. RESULTS Permanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis. The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13). In 30 of these 31 patients (96.7%), there was no recurrence of cholecystitis and 29 patients (93.5%) remained asymptomatic until death or the end of the study period (after 1 month to 5 years). CONCLUSIONS EGS can be effective for elderly patients with acute cholecystitis who are poor surgical candidates and can provide a solution for several years.
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Affiliation(s)
- Satoshi Maekawa
- Department of Gastroenterological Medicine, Japan Labour Health and Welfare
Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata,
942-8502, Japan
| | - Ryosuke Nomura
- Department of Gastroenterological Medicine, Japan Labour Health and Welfare
Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata,
942-8502, Japan
| | - Takayuki Murase
- Department of Gastroenterological Medicine, Japan Labour Health and Welfare
Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata,
942-8502, Japan
| | - Yasuyoshi Ann
- Department of Gastroenterological Medicine, Japan Labour Health and Welfare
Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata,
942-8502, Japan
| | - Masayuki Oeholm
- Department of Gastroenterological Medicine, Japan Labour Health and Welfare
Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata,
942-8502, Japan
| | - Masaru Harada
- Third Department of Internal Medicine, University of Occupational and
Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka,
807-8555, Japan
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Little MW, Briggs JH, Tapping CR, Bratby MJ, Anthony S, Phillips-Hughes J, Uberoi R. Percutaneous cholecystostomy: the radiologist's role in treating acute cholecystitis. Clin Radiol 2013; 68:654-60. [PMID: 23522484 DOI: 10.1016/j.crad.2013.01.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/13/2013] [Accepted: 01/20/2013] [Indexed: 12/22/2022]
Abstract
Acute cholecystitis is a common condition, with laparoscopic cholecystectomy considered the gold-standard for surgical management. However, surgical options are often unfavourable in patients who are very unwell, or have numerous medical co-morbidities, in which the mortality rates are significant. Percutaneous cholecystostomy (PC) is an image-guided intervention, used to decompress the gallbladder, reducing patient's symptoms and the systemic inflammatory response. PC has been shown to be beneficial in high-risk patient groups, predominantly as a bridging therapy; allowing safer elective cholecystectomy once the patient has recovered from the acute illness; or, in the minority, as a definitive treatment in patients deemed unfit for surgery. This review aims to develop a broader understanding of PC, discussing its specific indications, patient management, technical factors, imaging guidance, and outcomes following the procedure.
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Affiliation(s)
- M W Little
- Department of Radiology, Oxford University Hospitals, John Radcliffe Hospital, Headington, Oxford, UK
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Clinical usefulness of percutaneous transhepatic gallbladder aspiration in patients with acute calculous cholecystitis. J Clin Gastroenterol 2013; 47:288-90. [PMID: 23328303 DOI: 10.1097/mcg.0b013e318272f430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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McKay A, Katz A, Lipschitz J. A population-based analysis of the morbidity and mortality of gallbladder surgery in the elderly. Surg Endosc 2013; 27:2398-406. [PMID: 23443477 DOI: 10.1007/s00464-012-2746-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 12/04/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Historically, emergency gallbladder surgery in elderly patients has been associated with high rates of morbidity and mortality. Recent studies have described much lower complication rates that may still overestimate morbidity. The purpose of this study was to determine the true population morbidity and mortality rates after gallbladder surgery in the elderly. METHODS All elderly patients (defined as age 65 years or older) admitted to the hospital with a principle diagnosis related to benign gallbladder disease in the Province of Manitoba from January 1, 1995 to December 31, 2008 were identified by using administrative claims data. Outcomes after emergency gallbladder surgery, including complication rates and their predictors, were compared with outcomes after elective surgery and after nonoperative treatment for gallbladder-related hospital admissions. RESULTS A total of 9,936 patients were included: 2,355 had emergency or urgent surgery and 4,901 had elective procedures, whereas 2,680 patients were treated without surgery. Emergency gallbladder surgery was associated with a mortality rate of 0.7 %, compared with 1.6 % for elective cases and 5.6 % for patients treated nonoperatively. Complication rates were 16.2, 17.7, and 25 % respectively. Independent predictors of 30-day mortality were age, male gender, increasing comorbidity, surgeon experience, and surgical treatment. CONCLUSIONS Emergency gallbladder surgery in the elderly was not associated with higher mortality or complication rate compared with the elective setting. Elderly patients with gallbladder-related emergencies should be offered urgent surgery when feasible.
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Affiliation(s)
- Andrew McKay
- Department of Surgery, Health Sciences Centre, University of Manitoba, GF-431, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada.
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Lorenz JM. Evaluating the controversial role of cholecystostomy in current clinical practice. Semin Intervent Radiol 2012. [PMID: 23204643 DOI: 10.1055/s-0031-1296087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hsieh YC, Chen CK, Su CW, Chan CC, Huo TI, Liu CJ, Fang WL, Lee KC, Lin HC. Outcome after percutaneous cholecystostomy for acute cholecystitis: a single-center experience. J Gastrointest Surg 2012; 16:1860-8. [PMID: 22829241 DOI: 10.1007/s11605-012-1965-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 07/06/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Percutaneous cholecystostomy is an alternative treatment for acute cholecystitis patients with high surgical risk. METHODS One hundred and sixty-six patients consecutively treated by percutaneous cholecystostomy for acute cholecystitis in a single medical center were retrospectively reviewed. RESULTS The cohort included 121 males and 45 females with mean age of 75.9 years. The overall inhospital mortality rate was 15.1 % (n = 25). Elevated serum creatinine level at diagnosis [odds ratio (OR) 1.497; p = 0.020], septic shock (OR 11.755; p = 0.001), and development of cholecystitis during admission (OR 7.256; p = 0.007) were predictive of inhospital mortality. Of 126 patients who recovered from calculous cholecystitis, 11 experienced recurrent cholecystitis within 2 months. Serum C-reactive protein (CRP) level >15 mg dl(-1) at diagnosis [hazard ratio (HR) 10.141; p = 0.027] and drainage duration of cholecystostomy longer than 2 weeks (HR 3.638; p = 0.039) were independent risk factors of early recurrence. The 53 patients who underwent cholecystectomy had an 18.9 % perioperative complication rate and no operation-related mortality. CONCLUSIONS In-patients or those with septic shock or renal insufficiency have worse outcome. Prolonged drainage duration and high CRP level predict early recurrence. Removal of the drainage tube is recommended after resolution of the acute illness.
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Affiliation(s)
- Yun-Cheng Hsieh
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
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Al-Jundi W, Cannon T, Antakia R, Anoop U, Balamurugan R, Everitt N, Ravi K. Percutaneous cholecystostomy as an alternative to cholecystectomy in high risk patients with biliary sepsis: a district general hospital experience. Ann R Coll Surg Engl 2012; 94:99-101. [PMID: 22391374 DOI: 10.1308/003588412x13171221501302] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Cholecystectomy is the standard treatment for patients with acute cholecystitis. However, percutaneous cholecystostomy (PC) is an alternative for patients at high risk for surgery. We present our five-year clinical experience with the aim of evaluating the efficacy of PC in high risk patients. METHODS A retrospective review was performed on 30 consecutive patients who underwent PC at our institution. The indications for cholecystostomy, route of insertion, technical success, clinical improvement, length of hospitalisation, in-hospital or 30-day mortality, complications, subsequent admissions and performance of interval cholecystectomy were recorded. The median follow-up period was 25 months (range: 1-52 months). RESULTS Thirty-two PCs were performed in thirty patients (mean age: 76.1 years; range: 52-90 years). The indications for PC were acute calculous cholecystitis (29/32), acalculous cholecystitis (1/32) and emphysematous cholecystitis (2/32). The route of insertion was transperitoneal for 22/32 PCs (68.8%) and transhepatic for 10/32 (31.2%). The procedure was technically successful in all patients although 2/22 transperitoneal drains (9.1%) were dislodged subsequently. Twenty-seven PCs (84.4%) resulted in clinical improvement within five days. The in-hospital or 30-day mortality rate was 16.7% (5/30). Eleven patients (36.7%) had a subsequent cholecystectomy: 6 were laparoscopic and 5 converted to open procedures at a median interval of 58 days (range: 1-124 days). CONCLUSIONS PCs are straightforward with few complications. Most patients improve clinically and the procedure can therefore be used as a definitive treatment in unfit patients or as a bridge to surgery in those who might subsequently prove fit for a definitive operation.
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Affiliation(s)
- W Al-Jundi
- Chesterfield Royal Hospital NHS Foundation Trust, UK.
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Carrafiello G, D'Ambrosio A, Mangini M, Petullà M, Dionigi GL, Ierardi AM, Piacentino F, Fontana F, Fugazzola C. Percutaneous cholecystostomy as the sole treatment in critically ill and elderly patients. Radiol Med 2012; 117:772-9. [PMID: 22327921 DOI: 10.1007/s11547-012-0794-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 10/27/2010] [Indexed: 10/14/2022]
Abstract
PURPOSE This study was done to investigate the effectiveness and clinical outcome of percutaneous cholecystostomy (PC) of treating acute cholecystitis in critical ill and elderly patients. MATERIALS AND METHODS In the last 3 years, PC was performed on 30 elderly and critically ill patients (17 men, 13 women; mean age 78.6, range 57-97 years) with acute cholecystitis and comorbid diseases. RESULTS Technical success was 30/30 (100%). Clinical effectiveness was 30/30 (100%), with statistically significant reductions in while blood cell (WBC) count, C-reactive protein (CRP) and fever. Mean WBC upon admission (19.87×10(3)±1.61×10(3) /μl), axillary temperature (38.2±0.11 °C), and CRP (248.7±4.76 mg/l) values were significantly decreased in the 72 h following PC [12.9×10(3) ± 1.05×10(3)/μl (p≤0.0001), 37 ± 0.04 °C (p≤0.0001), 113.5 ± 3 mg/l (p≤0.0001), respectively]. Clinical and ultrasonographic (US) signs of acute cholecystitis decreased in all patients. There were no major complications or procedure-related deaths, and the morbidity rate was low (3/30; 10%). CONCLUSIONS PC appears to be a fast, easy and effective treatment for the acute phase of cholecystitis in elderly and critically ill patients. Procedure-related morbidity and mortality rates are very low compared with surgery. Conservative treatment for patients who are not eligible for surgery is acceptable.
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Affiliation(s)
- G Carrafiello
- Department of Radiology, Università dell'Insubria, Viale Borri 57, 21100, Varese, Italy.
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McKay A, Abulfaraj M, Lipschitz J. Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Surg Endosc 2011; 26:1343-51. [PMID: 22089258 DOI: 10.1007/s00464-011-2035-0] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 09/10/2011] [Indexed: 01/05/2023]
Abstract
BACKGROUND Percutaneous cholecystostomy is a less invasive method to treat acute cholecystitis in patients who are critically ill or have serious medical comorbidities precluding the use of general anesthesia. It remains controversial whether interval cholecystectomy is warranted. The objectives of the study were to determine the success rate and complications of percutaneous cholecystostomy and the proportion of patients without recurrent attacks in whom interval cholecystectomy was not needed. METHODS This was a retrospective review to determine the outcomes after percutaneous cholecystostomy for acute calculous cholecystitis between 1995 and 2007. Administrative data were used to better capture recurrent symptoms requiring treatment. RESULTS Sixty-eight patients with a mean age of 74 years were identified. Sixty-seven (98.5%) underwent successful insertion of the cholecystostomy tubes. Eleven patients suffered tube-related complications, including tube dislodgment (9), tube blockage (1), and bleeding that was controlled with conservative management (1). The initial episode of cholecystitis was treated successfully in 58 patients (85%). The overall in-hospital and 30-day mortality were both 15% (10 patients). A total of 7 patients (10%) underwent cholecystectomy while still in hospital. There were 39 patients at risk for recurrent disease who survived the initial episode and did not receive an interval cholecystectomy. Of these 39 patients, 16 (41%) suffered recurrent gallbladder-related disease. CONCLUSIONS Percutaneous cholecystostomy is an alternative to cholecystectomy in patients with acute calculous cholecystitis who are at high risk for surgical mortality and morbidity. It appears to have a low complication rate and good clinical success. Because a significant number of patients suffer recurrent attacks, elective cholecystectomy should be considered routinely. Unfortunately, firm criteria for selecting percutaneous cholecystostomy over cholecystectomy are lacking, and the surgeon's clinical judgment is critically important.
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Affiliation(s)
- Andrew McKay
- Department of Surgery, Health Sciences Centre, University of Manitoba, GF-431, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
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Itoi T, Itokawa F, Kurihara T. Endoscopic ultrasonography-guided gallbladder drainage: actual technical presentations and review of the literature (with videos). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:282-6. [PMID: 20652716 DOI: 10.1007/s00534-010-0310-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE Endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) has been developed as an alternative drainage method in patients with acute cholangitis. Here, we describe two successful EUS-GBD cases and review the literature on this topic. METHODS EUS-GBD was conducted using a curved linear array echoendoscope and a 19-gauge needle. RESULTS A 7-Fr double pigtail stent was successfully placed transgastrically in one patient and transduodenally in the other patient, without any serious early adverse events in either patient. No late complications or relapse of acute cholecystitis have been seen during the 3- to 6-month follow-up period. CONCLUSIONS EUS-GBD holds high potential as an alternative gallbladder decompression procedure. However, because current experience is limited, multicenter trials for the accurate evaluation of this procedure appear to be necessary in the near future.
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Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, Japan.
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Gumus B. Percutaneous Cholecystostomy as a First-Line Therapy in Chronic Hemodialysis Patients with Acute Cholecystitis with Midterm Follow-up. Cardiovasc Intervent Radiol 2010; 34:362-8. [DOI: 10.1007/s00270-010-0025-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 10/15/2010] [Indexed: 10/18/2022]
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Riall TS, Zhang D, Townsend CM, Kuo YF, Goodwin JS. Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. J Am Coll Surg 2010; 210:668-77, 677-9. [PMID: 20421027 PMCID: PMC2866125 DOI: 10.1016/j.jamcollsurg.2009.12.031] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 12/29/2009] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cholecystectomy during initial hospitalization is the current recommended therapy for acute cholecystitis. The rate of cholecystectomy and subsequent health care trajectory in elderly patients with acute cholecystitis has not been evaluated. STUDY DESIGN We used 5% national Medicare sample claims data from 1996 to 2005 to identify a cohort of patients aged 66 years and older, requiring urgent or emergent admission for acute cholecystitis. We evaluated cholecystectomy rates on initial hospitalization, factors independently predicting receipt of cholecystectomy, factors predicting further gallstone-related complications, and 2-year survival in the cholecystectomy and no cholecystectomy groups in univariate and multivariate models. RESULTS There were 29,818 Medicare beneficiaries who were urgently or emergently admitted for acute cholecystitis from 1996 to 2005. Mean age was 77.7 +/- 7.3 years, 89% of patients were white, and 58% were female. Twenty-five percent of patients did not undergo cholecystectomy during the index admission. Lack of definitive therapy was associated with a 27% subsequent cholecystectomy rate and a 38% gallstone-related readmission rate in the 2 years after discharge; the readmission rate was only 4% in patients undergoing cholecystectomy (p < 0.0001). No cholecystectomy on initial hospitalization was associated with worse 2-year survival (hazard ratio 1.56, 95% CI 1.47 to 1.65) even after controlling for patient demographics and comorbidities. Readmissions led to an additional $7,000 in Medicare payments per readmission. CONCLUSIONS Our study demonstrated that 25% of cholecystectomies on Medicare beneficiaries were not performed on initial hospitalization, leading to readmissions in 38% of surviving patients. For patients requiring readmission, the percentage of open procedures was increased, and the additional Medicare payment was $7,000 per re-admission. Cholecystectomy for acute cholecystitis in elderly patients should be performed during initial hospitalization to prevent recurrent episodes of cholecystitis, multiple readmissions, higher readmission rates, and increased costs.
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Affiliation(s)
- Taylor S Riall
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
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Abstract
Biliary tract interventions remain a tremendous technical challenge to the interventionalist and require appropriate clinical postprocedural management. The increased use of endoscopy for biliary tract evaluation and intervention has served to largely replace percutaneous techniques, resulting in a decreased number of patients requiring primary percutaneous transhepatic biliary interventions. However, those patients who do present for percutaneous biliary procedures often represent a more technically difficult subset. Thorough familiarity with normal and variant biliary tract anatomy, and experience with a variety of techniques, will allow for successful biliary tract interventions in complex situations. This article reviews the current role of percutaneous transhepatic interventions in the emergency evaluation and management of biliary tract disease.
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Lee JH, Won JH, Bae JI, Kim JH, Lee HS, Jung SM. Chemical Ablation of the Gallbladder with Acetic Acid. J Vasc Interv Radiol 2009; 20:1471-6. [DOI: 10.1016/j.jvir.2009.07.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Revised: 06/19/2009] [Accepted: 07/13/2009] [Indexed: 10/20/2022] Open
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Abstract
Laparoscopic cholecystectomy (LC) is the method of choice of surgical treatment of gallbladder diseases. Operations in elderly people over 65 years because of chronic diseases, are often associated with high operative and postoperative morbidity and mortality. The aim of this study was to analyze the outcome of LC in the treatment of cholelithiasis in patients older than 65 years. For evaluation of LC effectiveness and security in old patients, we did this prospective analysis of 81 patients surgically treated because of symptomatic cholelithiasis. We had analyzed associated diseases, operative and postoperative complications, the reasons of conversion to open cholecystectomy. The research points to the small percentage of operative and postoperative complications, short hospital stay, less postoperative pain, quick recovery and savings in treatment. The age can not be contraindication for LC in older patients. In uncomplicated symptomatic cholelithiasis in elderly people, LC is a successful and safe procedure. Complicated symptomatic cholelithiasis, because of longer duration of operations is looking for a good assessment of general condition and associated diseases for LC.
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Winbladh A, Gullstrand P, Svanvik J, Sandström P. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford) 2009; 11:183-93. [PMID: 19590646 PMCID: PMC2697889 DOI: 10.1111/j.1477-2574.2009.00052.x] [Citation(s) in RCA: 229] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Percutaneous cholecystostomy (PC) is an established low-mortality treatment option for elderly and critically ill patients with acute cholecystitis. The primary aim of this review is to find out if there is any evidence in the literature to recommend PC rather than cholecystectomy for acute cholecystitis in the elderly population. METHODS In April 2007, a systematic electronic database search was performed on the subject of PC and cholecystectomy in the elderly population. After exclusions, 53 studies remained, comprising 1918 patients. Three papers described randomized controlled trials (RCTs), but none compared the outcomes of PC and cholecystectomy. A total of 19 papers on mortality after cholecystectomy in patients aged >65 years were identified. RESULTS Successful intervention was seen in 85.6% of patients with acute cholecystitis. A total of 40% of patients treated with PC were later cholecystectomized, with a mortality rate of 1.96%. Procedure mortality was 0.36%, but 30-day mortality rates were 15.4 % in patients treated with PC and 4.5% in those treated with acute cholecystectomy (P < 0.001). CONCLUSIONS There are no controlled studies evaluating the outcome of PC vs. cholecystectomy and the papers reviewed are of evidence grade C. It is not possible to make definitive recommendations regarding treatment by PC or cholecystectomy in elderly or critically ill patients with acute cholecystitis. Low mortality rates after cholecystectomy in elderly patients with acute cholecystitis have been reported in recent years and therefore we believe it is time to launch an RCT to address this issue.
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Affiliation(s)
- Anders Winbladh
- Department of Surgery, Faculty of Clinical and Experimental Medicine, Linköping University Hospital, Linköping, Sweden.
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Howard JM, Hanly AM, Keogan M, Ryan M, Reynolds JV. Percutaneous cholecystostomy--a safe option in the management of acute biliary sepsis in the elderly. Int J Surg 2009; 7:94-9. [PMID: 19223255 DOI: 10.1016/j.ijsu.2009.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 11/25/2008] [Accepted: 01/11/2009] [Indexed: 02/07/2023]
Abstract
Percutaneous cholecystostomy (PC) has been used in the management of acute cholecystitis and biliary sepsis in patients with severe comorbidities where emergency cholecystectomy or open cholecystostomy are considered to carry prohibitive risks of mortality. We reviewed three consecutive cases of elderly patients with biliary sepsis presenting acutely to our unit who were managed successfully with this approach, and present herein these cases and a review of the literature.
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Affiliation(s)
- J M Howard
- Department of Upper Gastrointestinal Surgery, St. James's Hospital and Trinity College, Dublin, Ireland.
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