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Chung HY, Hsu CC, Hung YL, Chen HW, Wong MS, Fu CY, Tsai CY, Chen MY, Wang SY, Hsu JT, Yeh TS, Yeh CN, Jan YY. Alternative application of percutaneous cholecystostomy in patients with biliary obstruction. Abdom Radiol (NY) 2021; 46:2891-2899. [PMID: 33388808 DOI: 10.1007/s00261-020-02898-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Percutaneous cholecystostomy (PC) is an important modality for acute cholecystitis and has been applied for other clinical scenarios as well. In the present study, we aimed to investigate an alternative use of PC for obstructive jaundice. METHODS From January 2012 to December 2018, eligible subjects were selected from patients undergoing PC in our institute. The characteristics, spectrum of underlying disease, indication for PC performance, details of the procedure, and treatment effect were all investigated. RESULTS During the study period, 1364 patients underwent PC. Seventy patients fulfilled the defined inclusion criteria. While 47 patients were diagnosed with malignant biliary obstruction with or without cholangitis, 23 patients were diagnosed with nonmalignant biliary obstruction and acute cholangitis. There were 63 patients (90%) diagnosed with acute cholangitis. Pancreatic cancer (n = 24, 51%) and advanced malignancy (n = 28, 59%) were noted mostly in the group with malignant biliary obstruction. Treatment effects were proven by laboratory data, including the white blood cell count, C-reactive protein level, and hepatic function. CONCLUSION PC can temporize definitive therapies and serve as an alternative treatment for patients with nonmalignant conditions. For patients with advanced malignancy, PC can serve as a palliative procedure that has a high success rate and low complication rate and effectively relieves biliary obstruction.
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Affiliation(s)
- Hung-Yu Chung
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chih-Chieh Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Yu-Liang Hung
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Huan-Wu Chen
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Man Si Wong
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chun-Yi Tsai
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Ming-Yang Chen
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan.
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Taiwan.
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Taiwan.
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
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Park JM, Kang CD, Lee M, Park SC, Lee SJ, Jeon YH, Cho SW. Percutaneous cholecystostomy for biliary decompression in patients with cholangitis and pancreatitis. J Int Med Res 2018; 46:4120-4128. [PMID: 30027779 PMCID: PMC6166347 DOI: 10.1177/0300060518786632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective This study was performed to assess the effectiveness and safety of
percutaneous cholecystostomy (PC) for biliary decompression. Methods We retrospectively analyzed our institution’s PC database from March 2015 to
August 2017 and selected patients with biliary obstruction. The primary
outcomes were the technical and clinical success rates. As secondary
outcomes, adverse events and pain after PC were compared with those of
patients who underwent PC for acute cholecystitis during the same
period. Results Twenty patients underwent PC for biliary obstruction (cholangitis, 19;
pancreatitis, 1). The technical and clinical success rates were 100%. The
median serum total bilirubin level decreased considerably from 4.5 to 1.4
mg/dL after PC. An adverse event (catheter migration) occurred in 1 patient,
and 17 patients developed pain after PC. During the same period, 104
patients underwent PC for cholecystitis. Adverse events occurred in 7
patients, and 62 developed pain. There was no significant difference in the
adverse event rate between the cholangitis/pancreatitis and cholecystitis
groups (5.0% vs. 6.7%, respectively), but pain occurred considerably more
frequently in the cholangitis/pancreatitis group (94.4% vs. 63.9%,
respectively). Conclusions PC is an effective and safe method for biliary decompression in selected
patients. However, attention should be paid to postoperative pain.
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Affiliation(s)
- Jin Myung Park
- Department of Internal Medicine, Kangwon National University
Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
| | - Chang Don Kang
- Department of Internal Medicine, Kangwon National University
Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
- Chang Don Kang, Department of Internal
Medicine, Kangwon National University Hospital, Kangwon National University
School of Medicine, 156 Baekryung-ro, Chuncheon, Kangwon-do 24289, Korea.
| | - Minjong Lee
- Department of Internal Medicine, Kangwon National University
Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
| | - Sung Chul Park
- Department of Internal Medicine, Kangwon National University
Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
| | - Sung Joon Lee
- Department of Internal Medicine, Kangwon National University
Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
| | - Yong Hwan Jeon
- Department of Radiology, Kangwon National University Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
| | - Seong Whi Cho
- Department of Radiology, Kangwon National University Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
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Li YL, Wong KH, Chiu KWH, Cheng AKC, Cheung RKO, Yam MKH, Chan ALC, Chan VSH, Law MWM, Lee PSF. Percutaneous cholecystostomy for high-risk patients with acute cholangitis. Medicine (Baltimore) 2018; 97:e0735. [PMID: 29742738 PMCID: PMC5959387 DOI: 10.1097/md.0000000000010735] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/22/2018] [Indexed: 01/05/2023] Open
Abstract
Percutaneous cholecystostomy (PC) is a well-established treatment for acute cholecystitis. We investigate the performance and role of PC in managing acute cholangitis.Retrospective review on all patients who underwent PC for acute cholangitis between January 2012 and June 2017 at a major regional hospital in Hong Kong.Thirty-two patients were included. The median age was 84 years and median American Society of Anaesthesiologists (ASA) physical status was Class III (severe systemic disease). All fulfilled Tokyo Guidelines 2013 (TG13) diagnostic criteria for moderate or severe cholangitis. Eighty-four percent of the patients were shown to have lower common bile duct stones on imaging. The majority had previously failed intervention by endoscopic retrograde cholangiopancreatography (38%), percutaneous transhepatic biliary drainage (38%), or both (13%)The technical success rate for PC was 100% with no procedure-related mortality. The overall 30-day mortality was 9%. Rest of the patients (91%) had significant improvement in clinical symptoms and could be discharged with median length of stay of 14 days. Significant postprocedural biochemical improvement was observed in terms of white cell count (P < .001), serum bilirubin (P < .001), alkaline phosphatase (P = .001), and alanine transaminase levels (P < .001). Time from admission to PC was associated with excess mortality (P = .002).PC is an effective treatment for acute cholangitis in high-risk elderly patients. Early intervention is associated with lower mortality. PC is particularly valuable as a temporising measure before definitive treatment in critical patients or as salvage therapy where other methods endoscopic retrograde cholangiopancreatography/percutaneous transhepatic biliary drainage (ERCP/PTBD) have failed.
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Affiliation(s)
- Yan-Lin Li
- Department of Radiology, Queen Mary Hospital, Pok Fu Lam
- Department of Radiology, North District Hospital, Sheung Shui
| | - Kin-Hoi Wong
- Department of Radiology, Queen Mary Hospital, Pok Fu Lam
- Department of Radiology, North District Hospital, Sheung Shui
| | - Keith Wan-Hang Chiu
- Department of Radiology, Queen Mary Hospital, Pok Fu Lam
- Department of Diagnostic Radiology, University of Hong Kong, Pokfulam, Hong Kong
| | - Andrew Kai-Chun Cheng
- Department of Radiology, Queen Mary Hospital, Pok Fu Lam
- Department of Radiology, North District Hospital, Sheung Shui
| | | | - Max Kai-Ho Yam
- Department of Radiology, Queen Mary Hospital, Pok Fu Lam
- Department of Radiology, North District Hospital, Sheung Shui
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Kapan M, Onder A, Tekbas G, Gul M, Aliosmanoglu I, Arikanoglu Z, Aldemir M. Percutaneous cholecystostomy in high-risk elderly patients with acute cholecystitis: a lifesaving option. Am J Hosp Palliat Care 2012; 30:167-71. [PMID: 22556287 DOI: 10.1177/1049909112445372] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To analyze the results of percutaneous cholecystostomy in in high-risk elderly patients with acute cholecystitis. MATERIALS AND METHODS Between June 2010 and May 2011, 11 patients aged over 60 who had at least 1 systemic disease and underwent percutaneous cholecystostomy were reviewed retrospectively. RESULTS The procedure was technically successful in 10 (90.9%) patients. Clinical improvement was achieved in 81.8% of patients within 72 hours. Two patients received emergency surgery while elective cholecystostomy was performed in 5 patients. Percutaneous cholecystostomy was performed singly in 4 (36.4%) patients. Early complication rate was 18.2%. Two (18.2%) patients died. CONCLUSION Percutaneous cholecystostomy can be performed with low mortality and morbidity. Cholecystectomy should be performed in all patients with suitable general conditions due to the high recurrence rates of percutaneous cholecystostomy.
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Affiliation(s)
- Murat Kapan
- Department of General Surgery, Dicle University Medical Faculty, Diyarbakir, Turkey.
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