1
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"Is percutaneous extraction of gallstones safe and effective in high-risk patients? Evidence from a systematic review". Surgeon 2023; 21:99-107. [PMID: 35606261 DOI: 10.1016/j.surge.2022.04.007] [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: 02/05/2022] [Revised: 03/19/2022] [Accepted: 04/14/2022] [Indexed: 12/07/2022]
Abstract
Gallstone disease in high-risk patients presents a management dilemma as cholecystectomy is often not performed due to their co-morbidities. Alternatively, such patients can be managed by percutaneous removal of gallstones. To date, there is paucity of high-quality evidence addressing the safety and efficacy of percutaneous cholecystolithotomy in high-risk patients. We aimed to conduct a systematic review on the feasibility of percutaneous gallstone removal in high-risk patients. METHODS A literature review was conducted using the Cochrane review and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines without setting the time limits to assess the outcomes of percutaneous gallstone removal in high-risk patients. RESULTS Twelve studies were identified. A total of 435 patients underwent percutaneous gallstone removal. Success rate was 91%. Overall complications (including minor and major) were 28%. The mean length of stay was 7 days (range, 1-80). Procedure related mortality was 0.7%. The recurrence rate was 7%. CONCLUSION Percutaneous cholecystolithotomy is a safe and effective technique. Although, it cannot substitute the current standard treatment for gallstones i.e., laparoscopic cholecystectomy. However, it may be considered for the patients who cannot undergo laparoscopic cholecystectomy due to their comorbid conditions.
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2
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MacCormick A, Jenkins P, Zhong J, Makris GC, Gafoor N, Chan D. Nationwide Outcomes following Percutaneous Cholecystostomy for Acute Calculous Cholecystitis and the Impact of Coronavirus Disease 2019: Results of the Multicentre Audit of Cholecystostomy and Further Interventions (MACAFI study). J Vasc Interv Radiol 2023; 34:269-276. [PMID: 36265818 DOI: 10.1016/j.jvir.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 09/09/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To assess the mortality, readmission rates, and practice variation of percutaneous cholecystostomy (PC) in patients with acute calculous cholecystitis in the United Kingdom (UK). MATERIALS AND METHODS A total of 1,186 consecutive patients (636 men [53.6%]; median age, 75 years; range, 24-102 years) who underwent PC for acute calculous cholecystitis between January 1, 2019, and December 31, 2020, were included from 36 UK hospitals. The exclusion criteria were diagnostic aspirations, absence of acute calculous cholecystitis, and age less than 16 years. The coronavirus disease 2019 (COVID-19) lockdown was declared on March 26, 2020, in the UK, which served to distinguish among groups. RESULTS Most patients (66.3%) underwent PC as definitive treatment, whereas 31.3% underwent PC as a bridge to surgery. The overall 30-day readmission rate was 42.2% (500/1,186), and the 30-day mortality was 9.1% (108/1,186). Centers performing fewer than 30 PCs per year had higher 90-day mortality than those performing more than 60 (19.3% vs 11.0%, respectively; P = .006). A greater proportion of patients presented with complicated acute calculous cholecystitis during the COVID-19 pandemic compared to prior (49.9% vs 40.9%, respectively; P = .007), resulting in more PCs (61.3 vs 37.9 per month, respectively; P < .001). More PCs were performed in tertiary hospitals than in district general hospitals (9 vs 3 per 100 beds, respectively; P < .001), with a greater proportion performed as a bridge to surgery (50.5% vs 22.8%, respectively; P < .001). CONCLUSIONS The practice of PC is highly variable throughout the UK. The readmission rates are high, and there is significant correlation between mortality and PC case volume.
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Affiliation(s)
| | - Paul Jenkins
- Peninsula Radiology Academy, Plymouth, United Kingdom; University Hospitals Plymouth NHS Trust, Plymouth, Department of Interventional Radiology, London, United Kingdom; UK National Interventional Radiology Trainee Research (UNITE) Collaborative.
| | - Jim Zhong
- UK National Interventional Radiology Trainee Research (UNITE) Collaborative; St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Harehills, Leeds, and Department of Interventional Radiology
| | - Gregory C Makris
- UK National Interventional Radiology Trainee Research (UNITE) Collaborative; Department of Interventional Radiology, St Thomas' Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom; St Thomas' Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Nelofer Gafoor
- University Hospitals Plymouth NHS Trust, Plymouth, Department of Interventional Radiology, London, United Kingdom
| | - David Chan
- University Hospitals Plymouth NHS Trust, Department of Upper GI Surgery
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- UK National Interventional Radiology Trainee Research (UNITE) Collaborative
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3
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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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Hess GF, Sedlaczek P, Haak F, Staubli SM, Muenst S, Bolli M, Zech CJ, Hoffmann MH, Mechera R, Kollmar O, Soysal SD. Persistent acute cholecystitis after cholecystostomy - increased mortality due to treatment approach? HPB (Oxford) 2022; 24:963-973. [PMID: 34865990 DOI: 10.1016/j.hpb.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Percutaneous cholecystostomy (PC) is a treatment option for acute cholecystitis (AC) in cases where cholecystectomy (CCY) is not feasible due to limited health conditions. The use of PC remains questionable. The aim was to retrospectively analyse the outcome of patients after PC. METHODS All patients who underwent PC for AC at a tertiary referral hospital over 10 years were included. Descriptive statistics, analysed mortality with and without CCY after PC, and a multivariable logistic regression for potential confounder and a landmark sensitivity analysis for immortal time bias were used. RESULTS Of 158 patients, 79 were treated with PC alone and 79 had PC with subsequent CCY. Without CCY, 48% (38 patients) died compared to 9% with CCY. In the multivariable analysis CCY was associated with 85% lower risk of mortality. The landmark analysis was compatible with the main analyses. Direct PC-complications occurred in 17% patients. Histologically, 22/75 (29%) specimens showed chronic cholecystitis, and 76% AC. CONCLUSION Due to the high mortality rate of PC alone, performing up-front CCY is proposed. PC represents no definitive treatment for AC and should remain a short-term solution because of the persistent inflammatory focus. According to these findings, almost all specimens showed persistent inflammation.
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Affiliation(s)
- Gabriel F Hess
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Philipp Sedlaczek
- University of Basel, Faculty of Medicine, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Fabian Haak
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Sebastian M Staubli
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Simone Muenst
- Institute of Medical Genetics and Pathology, University Hospital Basel, Schönbeinstrasse 40, 4056, Basel, Switzerland
| | - Martin Bolli
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Christoph J Zech
- Institute of Radiology, University Hospital Basel, Petersgraben 4, 4051, Basel, Switzerland
| | - Martin H Hoffmann
- Institute of Radiology, St. Clara Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Robert Mechera
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Otto Kollmar
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Savas D Soysal
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland.
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5
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Wang W, Wang W, Liu B, Li Y. Fluoroscopy-guided percutaneous lithotripsy using FREDDY laser for giant gallstones: Preliminary experience. Lasers Surg Med 2021; 54:392-398. [PMID: 34463963 DOI: 10.1002/lsm.23477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Percutaneous treatment of symptomatic cholelithiasis with large gallstones remains a challenge. We aimed to evaluate the efficacy and safety of a new method for the removal of giant gallstones with percutaneous lithotripsy using a frequency-doubled double-pulse neodymium: YAG (FREDDY) laser. MATERIALS AND METHODS This study included 16 patients (7 males, 9 females; mean age, 63.4 ± 14.9 years) with giant gallstones who experienced the recurrence of cholecystitis and were not eligible for operation. The percutaneous transcystic approach was established using an 8-French sheath. A 6-French steerable sheath were inserted through the sheath. FREDDY laser lithotripsy was performed to break the stones into fragments. The stone fragments were extracted through the 6-French sheath or pushed into the duodenum using a balloon catheter. Cholecystography was performed before removing the catheter. Follow-up ultrasound or computed tomography examination were performed. RESULTS Gallstone clearance was accomplished in 16 (100%) patients at the initial assessment. Eleven patients underwent one session, and five patients underwent two sessions. Residual stones were found in 3 (18.8%) patients during the follow-up period. Peritonitis was found in two (12.5%) patients and hemocholecyst was detected in one (6.3%) patient. No procedure-related deaths occurred. CONCLUSION Percutaneous lithotripsy using a FREDDY laser may be an effective and safe alternative choice for treating giant gallstones, especially for patients who are not eligible for cholecystectomy.
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Affiliation(s)
- Wujie Wang
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Wei Wang
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
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6
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Khayat A, Khayat M, Cline M, Riaz A. Percutaneous Biliary Endoscopy. Semin Intervent Radiol 2021; 38:340-347. [PMID: 34393344 DOI: 10.1055/s-0041-1731372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Biliary endoscopy is underutilized by interventional radiologists and has the potential to become an effective adjunctive tool to help both diagnose and treat a variety of biliary pathology. This is particularly true in cases where endoscopic retrograde cholangiopancreatography fails or is not feasible due to surgically altered anatomy. Both preoperative clinical and technical procedural factors must be taken into consideration prior to intervention. In this article, clinical evaluation, perioperative management, and procedural techniques for percutaneous biliary endoscopy are reviewed.
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Affiliation(s)
- Adam Khayat
- NYU Long Island School of Medicine, Mineola, New York
| | - Mamdouh Khayat
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael Cline
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ahsun Riaz
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
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7
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Hung YL, Sung CM, Fu CY, Liao CH, Wang SY, Hsu JT, Yeh TS, Yeh CN, Jan YY. Management of Patients With Acute Cholecystitis After Percutaneous Cholecystostomy: From the Acute Stage to Definitive Surgical Treatment. Front Surg 2021; 8:616320. [PMID: 33937313 PMCID: PMC8083985 DOI: 10.3389/fsurg.2021.616320] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Percutaneous cholecystostomy (PC) has become an important procedure for the treatment of acute cholecystitis (AC). PC is currently applied for patients who cannot undergo immediate laparoscopic cholecystectomy. However, the management following PC has not been well-reviewed. The efficacy of PC tubes has already been indicated, and compared to complications of other invasive biliary procedures, complications related to PC are rare. Following the resolution of AC, patients who can tolerate anesthesia and the surgical risk should undergo interval cholecystectomy to reduce the recurrence of biliary events. For patients unfit for surgery, whether owing to comorbidities, anesthesia risks, or surgical risks, expectant management may be applied; however, a high incidence of recurrence has been noted. In addition, several interesting issues, such as the indications for cholangiography via the PC tube, removal or maintenance of the PC catheter before definitive treatment, and timing of elective surgery, are all discussed in this review, and a relevant decision-making flowchart is proposed. PC is an effective and safe intervention, whether as expectant treatment or bridge therapy to definitive surgery. High-level evidence of post-PC care is still necessary to modify current practices.
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Affiliation(s)
- Yu-Liang Hung
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Mu Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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8
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Safety and Efficacy of Early Tube Removal Following Percutaneous Transhepatic Gallbladder Drainage: an Observational Study. Surg Laparosc Endosc Percutan Tech 2021; 30:164-168. [PMID: 31972834 PMCID: PMC7147403 DOI: 10.1097/sle.0000000000000761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Background: There are currently no guidelines concerning the advisability and timing of tube removal following percutaneous transhepatic gallbladder drainage (PTGBD). The present study aimed to assess the feasibility and risks of early removal of the PTGBD tube under the scenario of subsiding inflammation, patent cystic and common bile ducts, and absence of intraperitoneal leakage. Methods: Patient background and outcomes were assessed retrospectively in 701 cases of acute cholecystitis treated with PTGBD. The median times until tube removal and tube dislodgement and the cumulative rates of tube dislodgement were calculated. Results: Tube removal was performed in 275 patients after a median time of 16 days (range: 6 to 213 d); biliary peritonitis was observed in 2 patients following tube removal. Tubes were removed in 8 and 35 patients within 7 and 10 days, respectively. Tube dislodgement was observed in 82 patients after a median time of 12 days (range: 1 to 125 d). Conclusion: The present study suggests that drainage tube removal is safe and effective when performed after a short drainage period of 7 to 10 days if the criteria for the removal of the drainage tube were met.
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9
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Kim SK, Mani NB, Darcy MD, Picus DD. Percutaneous Cholecystolithotomy Using Cholecystoscopy. Tech Vasc Interv Radiol 2019; 22:139-148. [PMID: 31623754 DOI: 10.1053/j.tvir.2019.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The morbidity and mortality of cholecystectomy can increase to 10% in high surgical risk patients. The technique for percutaneous cholecystolithotomy consists of 3 steps: (1) percutaneous cholecystostomy, (2) tract dilation and cholecystolithotomy, and (3) tract evaluation and catheter removal. Cholecystoscopy is critical in guiding the lithotripsy probe for fragmentation of large stones and is useful for locating small stone fragments not seen in cholangiography. Cholecystoscopy is also useful for assessing ambiguous lesions and in distinguishing between stone vs debris or mass. Technical success rate of percutaneous cholecystolithotomy using cholecystoscopy ranges from 93% to 100%. Procedure related complication rate has been reported as 4%-15%. The most common complication is bile leak during the procedure or after catheter removal. Although recurrence rate of gallstones has been reported up to 40%, the symptom recurrence rate is much lower. Therefore, percutaneous cholecystolithotomy using cholecystoscopy can be an alternative to cholecystectomy in high surgical risk patients with symptomatic gallstones.
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Affiliation(s)
- Seung K Kim
- Department of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St Louis, MO.
| | - Naganathan B Mani
- Department of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St Louis, MO
| | - Michael D Darcy
- Department of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St Louis, MO
| | - Daniel D Picus
- Department of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St Louis, MO
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10
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Raymond CJ, Khayat M, Chick JFB, Srinivasa RN. Endoscopy as an Adjunct to Image-Guided Interventions: A New Frontier in Interventional Radiology. Tech Vasc Interv Radiol 2019; 22:119-124. [PMID: 31623750 DOI: 10.1053/j.tvir.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Endoscopy is an underutilized technique in the practice of interventional radiology. The objectives of this article are to discuss potential uses of interventional radiology-operated endoscopy and to outline basic endoscopy setup and equipment uses. Endoscopy represents a new frontier to the fluoroscopically-guided procedures in biliary, gastrointestinal, and genitourinary disease that interventional radiologists commonly perform. It shows promise to improve interventional radiology procedure success rates and reduce procedure-associated risk for patients. Endoscopy has been traditionally performed by gastroenterologists and urologists and is relatively new in the practice of interventional radiology. The hand-eye coordination and manual dexterity required to perform standard image-guided procedures places interventional radiologists in a unique position to introduce endoscopy into standard practice. A focused and collaborative effort is needed by interventional radiologists to learn the techniques required to successfully integrate endoscopy into practice.
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Affiliation(s)
- Clifford J Raymond
- Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mamdouh Khayat
- Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195
| | - Ravi N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, UCLA Medical Center, Los Angeles, CA
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11
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Park JK, Yang JI, Wi JW, Park JK, Lee KH, Lee KT, Lee JK. Long-term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis. J Gastroenterol Hepatol 2019; 34:784-790. [PMID: 30674071 DOI: 10.1111/jgh.14611] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 01/03/2019] [Accepted: 01/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Percutaneous cholecystostomy (PC) has been frequently used as an alternative treatment for acute cholecystitis in seriously ill patients unfit for surgery. The aim of this study was to investigate the recurrence rate and risk factors of recurrence. METHODS Medical records of 102 patients who were followed up for more than 1 year after PC tube removal among 716 patients who underwent PC for acute cholecystitis treatment were retrospectively analyzed. RESULTS The recurrence rate of acute cholecystitis after PC tube removal was 20.6% (21/102), and the mean time to recur was 660 days. Underlying cancer (odds ratio [OR]: 3.369; 95% confidence interval [CI]: 1.006-11.282; P = 0.0489), PC duration shorter than 44 days (OR: 5.596; 95% CI: 1.35-23.201; P = 0.0176), and the presence of common bile duct stone in initial imaging studies (OR: 24.393; 95% CI: 2.696-220.746; P = 0.0045) were positively correlated with recurrence. Tubogram before PC tube removal did not significantly lower the recurrence. However, PC tube clamping for several days significantly lowered the recurrence (OR: 0.108; 95% CI: 0.015-0.794; P = 0.0288). Fifty-nine (57.8%) had acalculous cholecystitis. Calculous cholecystitis was negatively correlated with recurrence (OR: 0.267; 95% CI: 0.074-0.967; P = 0.0444). Receiver operating characteristic curve of the prediction model for recurrence verified its accuracy (area under the curve: 0.8475). CONCLUSION We should try to keep PC more than 6 weeks and clamp for 1-2 weeks before removal. For those with the presence of common bile duct stones, calculous cholecystitis, and underlying malignancy, we should keep PC for longer duration and carefully observe symptoms and signs of recurrence.
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Affiliation(s)
- Jae Keun Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju-Il Yang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Good Gang-an Hospital, Busan, Korea
| | - Jin Woo Wi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Kyung Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Hyuck Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Taek Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Kyun Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Roberts DG, Plotnik AN, Chick JF, Srinivasa RN. Interventional radiology-operated percutaneous cholecystoscopy with ultrasonic lithotripsy and stone basket retrieval: A treatment for symptomatic cholelithiasis in non-operative candidates. J Med Imaging Radiat Oncol 2019; 63:340-345. [PMID: 30925003 DOI: 10.1111/1754-9485.12879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/02/2019] [Indexed: 01/14/2023]
Abstract
Interventional radiology-operated percutaneous endoscopy has seen a recent resurgence with potential to return to the scope of Interventional Radiology practice. Endoscopy adds a new dimension to the Interventional Radiology armamentarium by offering a unique opportunity to diagnose and treat conditions under direct visualization with improved maneuverability. Cholecystoscopy (gallbladder endoscopy), as a method for percutaneous removal of gallstones, is an effective treatment option in patients with symptomatic cholelithiasis who are poor candidates for surgical cholecystectomy. This article presents a case of Interventional Radiology-operated cholecystoscopy using ultrasonic lithotripsy and stone basket retrieval with an emphasis on the equipment, technique, and peri-procedural management essential to the procedure, as well as a review of the literature.
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Affiliation(s)
- Dustin G Roberts
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Adam N Plotnik
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Division of Interventional Radiology, Department of Radiology, UCLA, Los Angeles, California, USA
| | - Jeffrey Fb Chick
- Cardiovascular and Interventional Radiology, INOVA Alexandria Hospital, Alexandria, Virginia, USA
| | - Ravi N Srinivasa
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Division of Interventional Radiology, Department of Radiology, UCLA, Los Angeles, California, USA
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13
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Srinivasa RN, Pampati R, Patel N, Srinivasa RN, Hage AN, Chick JFB. Interventional Radiology-Operated Endoscopy: Indications, Implementation, and Innovation. Semin Intervent Radiol 2019; 35:477-485. [PMID: 30728664 DOI: 10.1055/s-0038-1676327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ravi N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan.,Division of Vascular and Interventional Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Rudra Pampati
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Nishant Patel
- Radiology Imaging Associates Endovascular, Englewood, Colorado
| | - Rajiv N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Anthony N Hage
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
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Srinivasa RN, Chick JFB, Cooper K, Srinivasa RN. Interventional Radiology-Operated Endoscopy as an Adjunct to Image-Guided Interventions. Curr Probl Diagn Radiol 2018; 48:184-188. [PMID: 29674012 DOI: 10.1067/j.cpradiol.2018.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/16/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Interventional radiology-operated endoscopy is an underused technique, which may have a significant impact on the ability to treat patients with a variety of conditions. The purpose of this article is to discuss the setup, equipment, and potential clinical uses of interventional radiology-operated endoscopy. METHODS A number of new and innovative interventions may be performed in the biliary, genitourinary, and gastrointestinal systems through percutaneous access that interventional radiologists already create. When used in combination, endoscopy adds an entirely new dimension to the fluoroscopic-guided procedures of which interventional radiologists are accustomed. RESULTS Interventional radiologists are in a unique position to implement endoscopy into routine practice given the manual dexterity and hand-eye coordination already required to perform other image-guided interventions. CONCLUSION Although other specialists traditionally have performed endoscopic interventions and local politics often dictate referral patterns, a collaborative relationship among these specialists and interventional radiology will allow for improved patient care. A concerted effort is needed by interventional radiologists to learn the techniques and equipment required to successfully incorporate endoscopy into practice.
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Affiliation(s)
- Rajiv N Srinivasa
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, MI.
| | | | - Kyle Cooper
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Ravi N Srinivasa
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, MI
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15
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Chan JHY, Teoh AYB. The development of peroral cholecystoscopy and advanced gallbladder interventions. Endosc Ultrasound 2018; 7:85-88. [PMID: 29667622 PMCID: PMC5914192 DOI: 10.4103/eus.eus_7_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Joey Ho Yi Chan
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Anthony Yuen Bun Teoh
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Kim YH, Kim YJ, Shin TB. Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath in high-risk surgical patients with acute cholecystitis. Korean J Radiol 2011; 12:210-5. [PMID: 21430938 PMCID: PMC3052612 DOI: 10.3348/kjr.2011.12.2.210] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 12/20/2010] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Materials and Methods Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Results Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Conclusion Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis.
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Affiliation(s)
- Young Hwan Kim
- Department of Radiology, Keimyung University, College of Medicine, Daegu 700-712, Korea.
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Andonian S, Rastinehad A, Smith AD, Siegel DN. Percutaneous cholecystolithotomy: a case for fulguration of the gallbladder wall. J Laparoendosc Adv Surg Tech A 2009; 19:393-5. [PMID: 19245311 DOI: 10.1089/lap.2008.0089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Percutaneous cholecystolithotomy (PC) has been described previously as an alternative to laparoscopic cholecystectomy in high-risk patients and in those with adherent gallbladders that are not amenable for laparoscopic cholecystectomy. However, it is associated with a high (41%) recurrence of cholelithiasis due to intact gallbladder mucosa. In this paper, we describe a case of PC with fulguration of the gallbladder mucosa to scar and defunctionalize the mucosa and thus prevent recurrence of stones. After 12 months of follow-up, the patient remains asymptomatic.
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Affiliation(s)
- Sero Andonian
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA
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18
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Wise JN, Gervais DA, Akman A, Harisinghani M, Hahn PF, Mueller PR. Percutaneous Cholecystostomy Catheter Removal and Incidence of Clinically Significant Bile Leaks: A Clinical Approach to Catheter Management. AJR Am J Roentgenol 2005; 184:1647-51. [PMID: 15855132 DOI: 10.2214/ajr.184.5.01841647] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to determine the incidence of bile leaks upon removal of small-bore percutaneous cholecystostomy catheters and to evaluate clinical and imaging guidelines to ensure safe catheter removal. MATERIALS AND METHODS A retrospective evaluation of all gallbladder drainages performed over a 5-year period revealed 163 patients (range, 7-98 years) who underwent percutaneous cholecystostomy catheter placement. Medical records and imaging studies were reviewed to assess the events at catheter removal (e.g., inadvertent removal, controlled removal with cholangiography without tract imaging, or controlled removal with cholangiography with tract imaging) and the incidence of major and minor bile leaks. RESULTS The events at catheter removal were assessed in 66 patients. Group 1 was 45 patients whose catheters were removed after a minimum of approximately 3 weeks with a cholangiogram that established cystic and common duct patency and no imaging of the tract. Catheters were not removed until the patient recovered from acute illnesses that contributed to acalculous cholecystitis. Group 2 was 11 patients managed similarly to group 1 except that tract imaging was performed at catheter removal. Group 3 was 10 patients whose tubes came out inadvertently without cholangiogram or tract imaging. Two major (group 2 and group 3) and two minor (group 2) bile leaks occurred. No bile leaks occurred in group 1 (p = 0.006). CONCLUSION Major bile leaks occurred in 3% of patients, and minor leaks occurred with equal frequency. Tract imaging may not be necessary in patients with small-bore gallbladder catheters who have recovered from critical illness, show patent cystic and common ducts, and have had catheters for 3-6 weeks.
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Affiliation(s)
- James N Wise
- Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St., White 270, Boston, MA 02114, USA
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20
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Byrne MF, Suhocki P, Mitchell RM, Pappas TN, Stiffler HL, Jowell PS, Branch MS, Baillie J. Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center. J Am Coll Surg 2003; 197:206-11. [PMID: 12892798 DOI: 10.1016/s1072-7515(03)00143-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Standard treatment for acute cholecystitis is cholecystectomy, but some patients are at high risk for immediate surgery. Percutaneous cholecystostomy might be the procedure of choice in this group. We reviewed the experience of percutaneous cholecystostomy in a large tertiary center population. STUDY DESIGN We performed a retrospective analysis of patients who underwent percutaneous cholecystostomy, and recorded indications for cholecystostomy, duration of tube placement, clinical outcome, death within 30 days of procedure, complications, bacteriology of aspirated bile, gallbladder contents, and performance of interval cholecystectomy. RESULTS Forty-five patients (mean age 63 years) had cholecystostomy tubes placed from July 1999 to March 2002. All had confirmed or presumed acute cholecystitis. Mean duration of tube insertion was 54.3 days. Thirty-six patients improved clinically within 5 days. Nine patients died within 30 days; only one death was directly related to gallbladder sepsis. Nine patients subsequently had laparoscopic cholecystectomy, eight had open cholecystectomy, and two had cholecystoenterostomy. Cholecystectomy was planned in another five patients. Cholecystostomy tubes leaked in two patients, blocked in four, and dislodged in one. One patient developed a hemoperitoneum. Bile aspirated at cholecystostomy was culture positive in 12 patients, negative in 16, and not sent or recorded in 17. Twenty-two patients had gallstones, 10 had sludge, 9 had both, and 4 had neither. CONCLUSIONS In experienced hands, percutaneous cholecystostomy is easy to perform, with low complication and high success rates. It is the procedure of choice in patients with acute cholecystitis unfit for emergency surgery. Patients often improve clinically, so that cholecystectomy can be done electively.
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Affiliation(s)
- Michael F Byrne
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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21
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Federmann G, Walenzyk J. Application of trocar technique in ultrasound-guided drainage of the gallbladder. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 1999; 9:207-12. [PMID: 10657595 DOI: 10.1016/s0929-8266(99)00029-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE The ultrasound-guided drainage of the gallbladder (USDGB) is mainly performed by Seldinger technique. We aim to evaluate the use of the easier performable trocar technique in draining critically ill patients with acute calculous or acalculous cholecystitis. PATIENTS AND METHODS Critically ill patients with acute acalculous (AAC; n=29) or calculous cholecystitis (ACC; n=7) underwent trocar technique application of USD. Technical problems, complications and patients' further courses were recorded. RESULTS In group 1 (AAC) 29/29 patients could be drained without problems or complications. Three dislocations of the USDGB were seen. In group 2 (CAC) only four out of seven could be drained by this technique, in these four patients (a) major bleeding and (b) pericholecystic fluid collections were observed. In both groups no further complications during USDGB or its removal were seen. CONCLUSIONS In acute acalculous cholecystitis the use of trocar technique in applying the USDGB is easy and bedside performable, in acute calculous cholecystitis the USD should be done by Seldinger technique.
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Affiliation(s)
- G Federmann
- Chirurgische Klinik, SHG-Kliniken Völklingen, Richardstr. 5-9, D-66333, Völklingen, Germany.
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22
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Shrestha R, Trouillot TE, Everson GT. Endoscopic stenting of the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease awaiting orthotopic liver transplantation. LIVER TRANSPLANTATION AND SURGERY : OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES AND THE INTERNATIONAL LIVER TRANSPLANTATION SOCIETY 1999; 5:275-81. [PMID: 10388500 DOI: 10.1002/lt.500050402] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Cholecystectomy in patients with advanced cirrhosis is associated with excessive morbidity and mortality. Because open cholecystectomy in patients with Child's class C cirrhosis has a reported mortality rate as high as 83%, symptomatic gallbladder disease in patients awaiting orthotopic liver transplantation (OLT) poses a unique clinical problem. The goal of this study is to determine whether the treatment of symptomatic gallbladder disease with endoscopic stenting of the gallbladder effectively reduces biliary symptoms and complications or the need for cholecystectomy. Thirteen patients with symptomatic gallbladder disease with and without cholelithiasis and advanced cirrhosis who were candidates for OLT underwent placement of a biliary stent from the gallbladder to the duodenum at endoscopic retrograde cholangiography. In each patient, biliary symptoms and complications ceased after stent placement. Seven patients underwent successful OLT 1 to 24 months after the procedure. One patient subsequently became a noncandidate for OLT and died of diabetes complications 3 years after the procedure. Five others are awaiting OLT (6 to 28 months postprocedure). One patient had recurrent pericholecystic fluid collection requiring percutaneous drainage and antibiotic therapy 8 months after the procedure. No patient has had recurrent symptoms, and currently all patients are free of complications. None required surgical intervention of the gallbladder or biliary tree. We conclude that endoscopic stenting of the gallbladder is the preferred treatment for symptomatic gallbladder disease in patients with end-stage liver disease awaiting OLT. This approach is noninvasive, safe, and effective in preventing potential morbidity and mortality.
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Affiliation(s)
- R Shrestha
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Denver, CO, USA
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23
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Goodacre BW, Esch OE, Vansonnenberg E, Pencil S, D'agostino HB, Sanchez RS. Large bore transhepatic tract dilatation in pigs: Results and implications for human procedures. MINIM INVASIV THER 1999. [DOI: 10.3109/13645709909153125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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24
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Abstract
Although much is still to be learned about the pathogenesis of cholelithiasis, recent investigations have greatly advanced our knowledge regarding the mechanisms of cholesterol supersaturation and nucleation. Laparoscopic cholecystectomy has lessened the usual peri-operative morbidity of cholecystectomy, but is associated with a higher bile duct injury rate. Acute cholecystitis, the commonest complication of cholelithiasis, is a chemical inflammation usually requiring cystic duct obstruction and supersaturated bile. The treatment of this condition in the laparoscopic era is controversial. Early operation may lessen hospital stay but an increased risk of biliary injury has been reported.
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Affiliation(s)
- S M Strasberg
- Department of Surgery, Washington University, St Louis, Missouri, USA
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25
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Affiliation(s)
- S M Wu
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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26
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Abstract
BACKGROUND Chemical ablation of the gallbladder might avoid the need for surgery in elderly, unfit patients. This study examined the efficacy of various chemicals in destroying gallbladder mucosa. METHODS Ninety-five per cent ethanol, 3 per cent sodium tetradecyl sulphate (STD), trifluoroacetic acid (TFA) 2 mol/l, tetracycline 50 mg/ml, 30 and 50 per cent phenol, and a mucosal exfoliant solution (compound ethylene diamine tetra-acetic acid) were tested for gallbladder ablation in rabbits. Histology was obtained 8 weeks after exposure to these chemicals. RESULTS Thirty per cent phenol, tetracycline, TFA and ethanol when used as single agents were moderately effective in causing complete gallbladder mucosal obliteration, 50 per cent phenol caused a macroscopic burn of the entire gallbladder. The mucosal exfoliant solution and STD on their own did not cause mucosal destruction but had significantly enhanced efficacy when combined with 95 per cent ethanol, allowing reliable mucosal destruction with a 5-min contact duration. CONCLUSION Ninety-five per cent ethanol and STD after pretreatment with a mucosal exfoliant solution may be the combination of choice for in situ gallbladder mucosal ablation.
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Affiliation(s)
- A W Majeed
- Department of Surgical and Anaesthetic Sciences, University of Sheffield, UK
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27
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Hamy A, Visset J, Likholatnikov D, Lerat F, Gibaud H, Savigny B, Paineau J. Percutaneous cholecystostomy for acute cholecystitis in critically ill patients. Surgery 1997; 121:398-401. [PMID: 9122869 DOI: 10.1016/s0039-6060(97)90309-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cholecystectomy remains the best treatment for acute cholecystitis but may cause high morbidity or mortality in critically ill or elderly patients. METHODS We report a retrospective study of ultrasonography-guided percutaneous cholecystostomy (USGPC) performed between 1988 and 1994 in 41 patients (mean age, 77.8 years; range, 42-95 years) as an alternative to surgery. RESULTS Five patients (12.2%) died in the hospital, four (9.8%) subsequently underwent operation without complications, six (15%) had a recurrence of cholecystitis between 3 and 24 months after withdrawal of drainage, and 26 patients are cured without recurrence after a mean follow-up of 33 months (range, 3-67 months). CONCLUSIONS USGPC appears to be the treatment of choice for high-risk patients, especially those with postoperative cholecystitis, severe acute calculous pancreatitis, or total parenteral nutrition.
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Affiliation(s)
- A Hamy
- Department of Surgery, University Hospital, Nantes, France
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28
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Courtois CS, Picus DD, Hicks ME, Darcy MD, Aliperti G, Edmundowicz S, Hovsepian DM. Percutaneous gallstone removal: long-term follow-up. J Vasc Interv Radiol 1996; 7:229-34. [PMID: 9007802 DOI: 10.1016/s1051-0443(96)70766-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To evaluate gallstone and symptom recurrence rates, long-term complications, and life expectancy after percutaneous gallstone removal. PATIENTS AND METHODS Medical records of 87 patients (mean age, 69 years +/- 14 [standard deviation]) undergoing percutaneous gallstone removal between 1987 and 1992 were reviewed. Physicians and patients (or their families) were contacted for clinical follow-up. Thirty-one patients returned for follow-up ultrasound (US). RESULTS The final study group consisted of 65 patients. Mean survival from the time of initial gallbladder drainage was 33 months +/- 19. Over a mean clinical follow-up period of 33 months, eight of 65 patients (12%) developed recurrent symptoms; six of these eight had recurrent gallstones shown at US. Of 30 patients with technically adequate US images (mean follow-up, 14 months +/- 12), 12 (40%) had recurrent gallstones. Six of these 12 patients had recurrent symptoms. No long-term complications were identified. CONCLUSION The risk of gallstone recurrence after percutaneous removal is notable, but the symptom recurrence rate is much lower. Percutaneous gallstone removal is beneficial for patients at prohibitive surgical or general anesthetic risk.
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Affiliation(s)
- C S Courtois
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
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29
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van Overhagen H, Meyers H, Tilanus HW, Jeekel J, Laméris JS. Percutaneous cholecystectomy for patients with acute cholecystitis and an increased surgical risk. Cardiovasc Intervent Radiol 1996; 19:72-6. [PMID: 8662161 DOI: 10.1007/bf02563896] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk. METHODS Thirty-three patients with acute cholecystitis (calculous, n = 22; acalculous, n = 11) underwent percutaneous cholecystostomy by means of a transhepatic (n = 21) or transperitoneal (n = 12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy. RESULTS All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decrease in body temperature (n = 13), normalization of the white blood cell count (n = 3), or both (n = 6). There were 6 (18%) minor-moderate complications (transhepatic access, n = 3; transperitoneal access, n = 3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n = 9) and percutaneous and endoscopic stone removal (n = 3). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n = 2) and gallbladder ablation (n = 2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related. CONCLUSIONS Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary.
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Affiliation(s)
- H van Overhagen
- Department of Radiology, University Hospital Dijkzigt, Rotterdam, The Netherlands
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Abstract
The development of small-diameter flexible endoscopes has expanded the role of biliary endoscopy to include percutaneous interventions. Percutaneous biliary endoscopy is a technique that is easily learned. The equipment for percutaneous biliary endoscopy is readily available since most hospitals have an appropriate-sized choledochoscope and light source for intraoperative use. Therefore, the initial capital costs associated with flexible biliary endoscopy are minimal. Percutaneous biliary endoscopy in the interventional radiology suite is an ideal arrangement to facilitate a wide variety of biliary diagnostic and interventional procedures.
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Affiliation(s)
- D Picus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110 USA
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31
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Pereira SP, Ellul JP, Keightley A, Kennedy C, Dick J, Dowling RH. Percutaneous cholecystolithotomy: risks, benefits, and long-term outcome. Scand J Gastroenterol 1995; 30:484-8. [PMID: 7638577 DOI: 10.3109/00365529509093312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND For symptomatic patients with gallbladder stones and a patent cystic duct who wish to retain their 'functioning' gallbladders, percutaneous cholecystolithotomy (PCCL) offers an alternative to open or laparoscopic cholecystectomy. However, there are few data on the risks and benefits of this approach or on the long-term outcome. METHODS AND RESULTS In 21 patients with symptomatic calcified gallstones, PCCL was successful (gallstone clearance) in 17 (81%). Four to 62 (median, 35) months after clearance 9 of the 17 remained symptom-free and stone-free, whereas 4 developed biliary sludge at 7, 30, 32, and 35 months, 2 of whom subsequently developed gallstones. In four other patients gallstones recurred without evidence of preceding biliary sludge at 9, 16, 19, and 27 months, corresponding to an actuarial gallstone recurrence rate at 36 months of 53.4 +/- SEM 15.1%, and a combined stone/sludge recurrence rate of 63.4 +/- 13.5%. CONCLUSIONS PCCL is moderately effective but, because of the frequency of complications and sludge/stone recurrence, is likely to have only a limited residual role in the era of laparoscopic cholecystectomy.
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Affiliation(s)
- S P Pereira
- Gastroenterology Unit, Guy's Hospital Campus, UMDS, London, England
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Kalloo AN, Thuluvath PJ, Pasricha PJ. Treatment of high-risk patients with symptomatic cholelithiasis by endoscopic gallbladder stenting. Gastrointest Endosc 1994; 40:608-10. [PMID: 7988828 DOI: 10.1016/s0016-5107(94)70263-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- A N Kalloo
- Section of Therapeutic Endoscopy, Johns Hopkins Hospital, Baltimore, MD 21287-4461
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McDermott VG, Arger P, Cope C. Gallstone recurrence and gallbladder function following percutaneous cholecystolithotomy. J Vasc Interv Radiol 1994; 5:473-8. [PMID: 8054750 DOI: 10.1016/s1051-0443(94)71533-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To determine the frequency of recurrent symptoms and gallstones following successful percutaneous cholecystolithotomy (PCCL) and to evaluate the effect of the procedure on gallbladder function. PATIENTS AND METHODS Between 1988 and 1991, 32 patients underwent successful PCCL for the treatment of symptomatic gallstones. Outcome was assessed clinically (mean follow-up, 24 months) in 31 patients and by means of serial ultrasound examination (mean follow-up, 26 months) in 23 patients. RESULTS Symptomatic relief following the procedure was good, with only five of 31 patients (16%) experiencing recurrent symptoms during the follow-up period. Eight patients died of unrelated causes with no recurrence of symptoms. Nine (39%) of the remaining 23 patients have either retained gallstone fragments (four patients [16%]) or recurrent gallstones (five patients [22%]). Gallbladder motility was studied after PCCL in 10 patients, including four with retained or recurrent stones, and nine gallbladders were shown to be functioning well. CONCLUSION PCCL is a useful treatment for symptomatic gallstones in patients at high risk for surgery. It preserves gallbladder function, but recurrent gallstones are a significant problem.
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Affiliation(s)
- V G McDermott
- Department of Diagnostic Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104
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Aagaard BD, Wetter LA, Montgomery CK, Gordon RL. Heat ablation of the normal gallbladder in pigs. J Vasc Interv Radiol 1994; 5:331-9. [PMID: 8186604 DOI: 10.1016/s1051-0443(94)71497-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The safety and efficacy of ablating gallbladder mucosa was investigated with a percutaneously placed heater catheter in an animal study. MATERIALS AND METHODS The study was performed in three stages with 39 pigs. In stage 1 (15 heat-treated animals, one control), the configuration of the heater catheter was progressively improved and the temperature settings for stage 2 were defined. In stage 2 (11 heat-treated animals, four controls), the predetermined settings were used with mechanical mixing and cystic duct ligation to test for safety and efficacy. In stage 3 (eight animals), prior heat ablation of the cystic duct was added to reduce epithelial regeneration. RESULTS Gallbladder ablation was achieved at temperatures below 60 degrees C. Mechanical mixing of the intraluminal contents was essential for even heat distribution for ablation and to reduce the incidence of adjacent organ damage. Thermal injury to adjacent organs occurred when gallbladder ablation temperature exceeded 54 degrees C and serosal temperatures of adjacent organs exceeded 43 degrees C. Thermal ablation at 54 degrees C for 35 minutes was completely successful in 25%, partially successful in 50%, and failed in 25% of animals. Cystic duct ablation improved overall results and appears vital in removing duct epithelium as a source for regeneration of the mucosal lining. CONCLUSION Defunctionalization of the retained gallbladder is potentially achievable with use of thermal techniques, but the thermal range between complete gallbladder ablation and adjacent organ injury is narrow.
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Affiliation(s)
- B D Aagaard
- Department of Radiology, University of California, San Francisco 94143-0628
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35
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Abstract
Laparoscopic cholecystectomy may be performed safely in most patients with symptomatic cholelithiasis. There are few absolute contraindications to laparoscopic cholecystectomy. Many relative contraindications exist, which relate to the surgeon's experience and the ability of the operating team to manage potential complications. Preoperative evaluation should assess the potential nonbiliary problems that affect the performance of laparoscopic cholecystectomy, including severe cardiopulmonary disease, coagulopathy, cirrhosis, and pregnancy. Since most therapeutic laparoscopic procedures are currently performed with a carbon dioxide (CO2) pneumoperitoneum, the physiologic effects of the elevated abdominal pressure and absorbed CO2 must be understood by the surgeon. Specific nonbiliary problems addressed in this review are cardiopulmonary disease, hypercortisolism, cirrhosis and portal hypertension, morbid obesity, previous abdominal surgery, and pregnancy.
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Affiliation(s)
- N J Soper
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110
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Abstract
The management of gallstone diseases has been revolutionized in less than 2 years by the advent of laparoscopic cholecystectomy (LC). However, the rapid adoption of LC has occurred without comparative randomized trials with other available therapies. Thus, the evaluation of LC versus other therapies can only be based on case series. The criteria used for this evaluation are clinical effectiveness, cost-effectiveness, and the patient's level of acceptance and satisfaction with the procedure. The techniques of both LC and open cholecystectomy (OC) have the advantage over other approaches, such as extracorporeal shock-wave lithotripsy or bile acid therapy, of eliminating not only the gallstones but also the gallbladder, thereby preventing recurrence of the disease. Additionally, medical therapies are effective in only a subgroup of patients. Since the complications of surgery are more frequent and more severe in older patients and, due to life expectancy, the risk of recurrence is lower in this population, cost-effectiveness analyses have shown that medical therapies may be preferable in older patients in the subgroup eligible for the respective medical therapies. Compared with OC, LC results in a reduction in hospital stay and time to return to work, in lower cost, and in higher patient satisfaction with the procedure. However, a major concern with the laparoscopic approach has been an increase in the incidence of bile duct injury, particularly during the learning phase of the procedure. Clearly, this problem must be solved. The development of training courses in laparoscopy and the adoption of rigorous criteria for ductal identification are critical in preventing such injuries. Bile duct injury can probably be reduced at least to the level of OC (about 1 in 1,000). Acute cholecystitis may also be treated by LC, but the safety and timing of surgery should be conclusively evaluated. Patients with gallbladder stones and choledocholithiasis are usually treated by endoscopic sphincterotomy either before or soon after laparoscopic surgery. Laparoscopic techniques of common bile duct exploration that will obviate the need for endoscopic sphincterotomy are in the developmental stages. When such a technique is available, comparative trials with endoscopic sphincterotomy will be necessary to assess the best approach.
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Affiliation(s)
- S M Strasberg
- Hepatobiliary-Pancreatic Group, Washington University School of Medicine, St. Louis, Missouri
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Picus D, Burns MA, Hicks ME, Darcy MD, Vesely TM. Percutaneous management of persistently immature cholecystostomy tracts. J Vasc Interv Radiol 1993; 4:97-101; discussion 101-2. [PMID: 8425098 DOI: 10.1016/s1051-0443(93)71827-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- D Picus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
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