1
|
Mutlu IN, Guzelbey T, Erdim C, Dablan A, Kılıckesmez O. A Comparative Analysis of Erector Spinae Plane Block Versus Conscious Sedation in Managing Percutaneous Cholecystostomy Pain. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03722-z. [PMID: 38622304 DOI: 10.1007/s00270-024-03722-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE This study investigates the efficacy of erector spinae plane block (ESPB) for managing perioperative and postoperative pain in patients undergoing percutaneous cholecystostomy (PC) for acute cholecystitis, particularly in high-risk elderly patients with extensive comorbidities and limited functional status. METHODS In a retrospective single-center study, 58 high-risk patients scheduled for PC were assessed. ESPB was administered to 23 patients, while 22 received conscious sedation. Pain intensity was measured using the numeric rating scale before any analgesic or ESPB administration, during the procedure and at 1 and 12 h post-procedure and secondary outcomes included adverse effects and additional analgesic requirements. RESULTS The ESPB group experienced significant pain reduction during and post-procedure compared to the conscious sedation group (p = 0.002). Procedure times were shorter (p = 0.015), and postoperative tramadol was less frequently needed in the ESPB group (p = 0.007). The incidence of nausea was also lower in the ESPB group (p = 0.001). No ESPB-related complications were reported. CONCLUSION ESPB significantly alleviates perioperative and postoperative pain in PC patients, reducing additional analgesic use and side effects. It holds promise as a key component of pain management for high-risk surgical patients. LEVEL OF EVIDENCE Level 3, Non-randomized controlled cohort/follow-up study.
Collapse
Affiliation(s)
- Ilhan Nahit Mutlu
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey
| | - Tevfik Guzelbey
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey.
| | - Cagri Erdim
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey
| | - Ali Dablan
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey
| | - Ozgur Kılıckesmez
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey
| |
Collapse
|
2
|
Terrone A, Di Martino M, Saeidi S, Ranucci C, Di Saverio S, Giuliani A. Percutaneous cholecystostomy in elderly patients with acute cholecystitis: a systematic review and meta-analysis. Updates Surg 2024; 76:363-373. [PMID: 38372956 DOI: 10.1007/s13304-023-01736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/15/2023] [Indexed: 02/20/2024]
Abstract
Percutaneous cholecystostomy (PC) is often preferred over early cholecystectomy (EC) for elderly patients presenting with acute cholecystitis (AC). However, there is a lack of solid data on this issue. Following the PRISMA guidelines, we searched the Medline and Web of Science databases for reports published before December 2022. Studies that assessed elderly patients (aged 65 years and older) with AC treated using PC, in comparison with those treated with EC, were included. Outcomes analyzed were perioperative outcomes and readmissions. The literature search yielded 3279 records, from which 7 papers (1208 patients) met the inclusion criteria. No clinical trials were identified. Patients undergoing PC comprised a higher percentage of cases with ASA III or IV status (OR 3.49, 95%CI 1.59-7.69, p = 0.009) and individuals with moderate to severe AC (OR 1.78, 95%CI 1.00-3.16, p = 0.05). No significant differences were observed in terms of mortality and morbidity. However, patients in the PC groups exhibited a higher rate of readmissions (OR 3.77, 95%CI 2.35-6.05, p < 0.001) and a greater incidence of persistent or recurrent gallstone disease (OR 12.60, 95%CI 3.09-51.38, p < 0.001). Elderly patients selected for PC, displayed greater frailty and more severe AC, but did not exhibit increased post-interventional morbidity and mortality compared to those undergoing EC. Despite their inferior life expectancy, they still presented a greater likelihood of persistent or recurrent disease compared to the control group.
Collapse
Affiliation(s)
- Alfonso Terrone
- Division of Hepatobiliary and Liver Transplantation Surgery, A.O.R.N. Cardarelli, Naples, Italy
| | - Marcello Di Martino
- Division of Hepatobiliary and Liver Transplantation Surgery, A.O.R.N. Cardarelli, Naples, Italy.
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
- Department of Surgery, University Maggiore Hospital Della Carità, Novara, Italy.
| | - Sara Saeidi
- Department of General Surgery, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Chiara Ranucci
- Department of Surgery, Ospedale Santa Maria Della Stella, Orvieto, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Antonio Giuliani
- Department of Surgery, San Giuseppe Moscati Hospital, Aversa, Italy
| |
Collapse
|
3
|
Curry J, Chervu N, Cho NY, Hadaya J, Vadlakonda A, Kim S, Keeley J, Benharash P. Percutaneous cholecystostomy tube placement as a bridge to cholecystectomy for grade III acute cholecystitis: A national analysis. Surg Open Sci 2024; 18:6-10. [PMID: 38312302 PMCID: PMC10831282 DOI: 10.1016/j.sopen.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Percutaneous cholecystostomy (PCT) is an alternative to cholecystectomy (CCY) in high-risk surgical candidates with severe acute cholecystitis. A subset of these patients ultimately undergo delayed CCY. We therefore compared outcomes of delayed CCY in patients with grade III acute cholecystitis who received a PCT on index admission, to those who did not. Methods Non-elective adult hospitalizations for grade III acute cholecystitis that underwent delayed CCY were identified in the 2016-2020 Nationwide Readmission Database. Patients who received a PCT during their index admission comprised the PCT group (others: Non-PCT). Outcomes were assessed for the CCY hospitalization. Entropy balancing was used to generate sample weights to adjust for differences in baseline characteristics. Regression models were created to evaluate the association between PCT and the outcomes of interest. Results Of an estimated 13,782 patients, 13.3 % comprised PCT. Compared to Non-PCT, PCT were older (71.1 ± 13.1 vs 67.4 ± 15.3 years) and more commonly in the highest income quartile (22.5 vs 16.1 %, both p < 0.001). After risk adjustment, PCT was associated with reduced odds of respiratory (AOR 0.67, CI 0.54-0.83) and infectious (AOR 0.77, CI 0.62-0.96) complications after eventual CCY. Finally, PCT had comparable pLOS (β +0.31, CI [-0.14, 0.77]) and operative hospitalization costs (β $800, CI [-2300, +600]). Conclusion In the present study, PCT was associated with decreased odds of perioperative complications and comparable resource utilization upon readmission CCY. Our findings suggest that PCT may be helpful in bridging patients with grade III acute cholecystitis to eventual CCY.
Collapse
Affiliation(s)
- Joanna Curry
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, California, USA
| | - Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, California, USA
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
| | - Shineui Kim
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
| | - Jessica Keeley
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, California, USA
| |
Collapse
|
4
|
Feuerwerker S, Kambli R, Grinberg D, Malhotra A, An G. Management of acute cholecystitis in patients on anti-thrombotic therapy: A single center experience. Surg Open Sci 2023; 16:94-97. [PMID: 37808421 PMCID: PMC10551647 DOI: 10.1016/j.sopen.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023] Open
Abstract
Background Acute cholecystitis in patients on anti-thrombotic therapy (ATT) presents a clinical dilemma at the intersection between conflicting guidelines, specifically between timing of early operative management (OM) versus time-to-reversal of certain ATT agents. With growing recognition that nonoperative management (NOM) is associated with considerable morbidity, and evidence in the literature that early OM in patients on ATT is safe, we reviewed our own practice to examine how we addressed these conflicting guidelines. Materials and methods We performed a retrospective review of patients with acute cholecystitis between December 2017 and March 2022. Patients were classified as ATT or non-ATT; ATT patients were subdivided into anticoagulation (AC) and antiplatelet (AP) groups. Rates of OM were compared. Results 502 patients with acute cholecystitis were identified, 464 non-ATT and 38 ATT. 30 ATT patients were on AC, 7 on AP, and 1 on both. Non-ATT patients were significantly more likely to receive OM at index presentation compared to those on ATT: 89.9 % vs 63.2 % (p < 0.05). Subgroup analysis of the ATT group showed AP patients were significantly less likely to receive OM compared to those on AC, 12.5 % vs 77 % (p < 0.05). Conclusions At our institution, patients on ATT were significantly less likely to undergo OM for acute cholecystitis compared with non-ATT patients. Those on AC received OM significantly more than patients on AP. Further study is needed to better define the management of this growing population so that acute cholecystitis guidelines might address this issue in the future.
Collapse
Affiliation(s)
- Solomon Feuerwerker
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
| | - Ruja Kambli
- Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT 05405, USA
| | - Diana Grinberg
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
| | - Ajai Malhotra
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
| | - Gary An
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
| |
Collapse
|
5
|
Giannopoulos S, Makhecha K, Madduri S, Garcia F, Baumgartner TC, Stefanidis D. What is the ideal timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis? Surg Endosc 2023; 37:8764-8770. [PMID: 37567978 DOI: 10.1007/s00464-023-10332-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Acute cholecystitis (AC) is one of the most prevalent diseases in clinical practice. Poor surgical candidates may benefit from early percutaneous cholecystostomy (PC) drainage followed by interval cholecystectomy (IC), which is the definitive treatment. The optimal timing between the PC drainage and the IC has not been identified. This study aimed to investigate how the duration between PC and IC affects perioperative outcomes and identify the optimal IC timing to minimize complications. METHODS This retrospective cohort study included all adult patients diagnosed with AC who underwent PC followed by IC at a single institution center between 2014 and 2022. Patients with a history of hepatobiliary surgery, stones in the common bile duct, cirrhosis, active malignancy, or prolonged immunosuppression were excluded. The analysis did not include cases with major concurrent procedures during cholecystectomy, previously aborted cholecystectomies, or failure of the PC drain to control the inflammation. Linear and logistic regression models were used to analyze the impact of the interval between PC and IC on intra- and perioperative outcomes. RESULTS One hundred thirty-two patients (62.1% male) with a mean age of 64.4 ± 15 (mean ± SD) years were diagnosed with AC (25% mild, 47.7% moderate, 27.3% severe). All patients underwent PC followed by IC after a median of 64 [48-91] days. Longer ICU stay was associated with longer time intervals between PC and IC (Coef 105.98, p < 0.001). No significant variations were detected in the intraoperative and perioperative outcomes between patients undergoing IC within versus after 8 weeks from PC placement. However, a higher percentage of patients with delayed IC (after 8 weeks) were discharged home (96.4% vs. 83.7%; p = 0.019). CONCLUSIONS Patients may benefit from undergoing IC after the 8-week cutoff after PC. However, very long periods between PC and IC procedures may increase the risk of longer ICU stay.
Collapse
Affiliation(s)
- Spyridon Giannopoulos
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Keith Makhecha
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Sathvik Madduri
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Felix Garcia
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Timothy C Baumgartner
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA.
| |
Collapse
|
6
|
Hanna K, Zangbar B, Kirsch J, Bronstein M, Okumura K, Gogna S, Shnaydman I, Prabhakaran K, Con J. Non-operative management of cirrhotic patients with acute calculous cholecystitis: How effective is it? Am J Surg 2023; 226:668-674. [PMID: 37482476 DOI: 10.1016/j.amjsurg.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Nonoperative management (NOM) of acute calculous cholecystitis (ACC) in patients with cirrhosis was proposed. We examined the outcomes of cirrhotic patients with ACC treated with cholecystectomy compared to NOM. METHODS We analyzed the 2017-Nationwide Readmissions Database including cirrhotic patients with ACC. Patients were stratified: cholecystectomy, percutaneous cholecystostomy (PCT), and antibiotics only. PRIMARY OUTCOMES complications, failure of NOM. SECONDARY OUTCOMES mortality, length of stay (LOS), and charges. RESULTS 3454 patients were identified. 1832 underwent cholecystectomy, 360 PCT, and 1262 were treated with antibiotics. PCT patients had higher mortality 16.9% vs. the antibiotics group 10.9% vs. cholecystectomy group 4.2%. PCT patients had longer LOS, but lower charges compared to the operative group. Failure of NOM was 28.2%. On regression, PCT was associated with mortality. CONCLUSION ACC remains a morbid disease in cirrhosis patients. One in three failed NOM, had longer LOS, and higher mortality. Further studies are warranted to identify predictors of NOM failure. LEVEL OF EVIDENCE Level III, prognostic.
Collapse
Affiliation(s)
- Kamil Hanna
- Department of Surgery, Westchester Medical Center, New York, USA.
| | - Bardiya Zangbar
- Department of Surgery, Westchester Medical Center, New York, USA.
| | - Jordan Kirsch
- Department of Surgery, Westchester Medical Center, New York, USA.
| | | | - Kenji Okumura
- Department of Surgery, Westchester Medical Center, New York, USA.
| | - Shekhar Gogna
- Department of Surgery, Medstar Health, Washington, USA.
| | - Ilya Shnaydman
- Department of Surgery, Westchester Medical Center, New York, USA.
| | | | - Jorge Con
- Department of Surgery, Westchester Medical Center, New York, USA.
| |
Collapse
|
7
|
Karabacak H, Balas Ş. Percutaneous cholecystostomy as a bridge therapy in the geriatric age group with acute cholecystitis. Ir J Med Sci 2023:10.1007/s11845-023-03550-z. [PMID: 37889395 DOI: 10.1007/s11845-023-03550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the efficacy of percutaneous cholecystostomy (PC) in the geriatric patients with acute cholecystitis. MATERIALS AND METHODS The records of geriatric patients with high surgical risk who underwent percutaneous cholecystostomy for acute cholecystitis were reviewed retrospectively. RESULTS The median age of 134 patients who underwent percutaneous cholecystostomy was 77 (65-98) years and 63.4% were women. The mean length of hospital stay was 5 (4-18) days, and the follow-up period until the procedure was 2 (1-6) days. Murphy's sign was positive in 79.1% of patients on physical examination, and the remaining patients (20.9%) had only tenderness on examination. As USG findings, 59.0% of the patients had a gall bladder wall thickness (> 4 mm) with pericholecystic fluid. Additional imaging method, abdominal CT, was performed in 29 patients (21.6%), MRCP was performed in three patients (2.2%), and ERCP was performed in one patient (0.7%). Bacterial growth was detected in 27.6% of the bile cultures performed. During the follow-up period, laparoscopic cholecystectomy was performed in 60.4% of the patients and open cholecystectomy was performed in 5.2% of the patients electively. 34.3% of the patients did not undergo any surgery. Bile leakage was detected in two patients (1.5%) as a procedure-related complication, and no mortality was observed. CONCLUSION Abdominal ultrasonography-guided PC is a safe and effective method in the management of acute cholecystitis in high-risk patients in the geriatric age group.
Collapse
Affiliation(s)
- Harun Karabacak
- General Surgery Clinic, Ankara Etlik City Hospital, Ankara, 06500, Turkey.
| | - Şener Balas
- Department of General Surgery and Transplantation, Başkent University, Ankara, Turkey
| |
Collapse
|
8
|
Arkoudis NA, Moschovaki-Zeiger O, Reppas L, Grigoriadis S, Alexopoulou E, Brountzos E, Kelekis N, Spiliopoulos S. Percutaneous cholecystostomy: techniques and applications. Abdom Radiol (NY) 2023; 48:3229-3242. [PMID: 37338588 DOI: 10.1007/s00261-023-03982-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
Acute cholecystitis (AC) is a critical condition requiring immediate medical attention and treatment and is one of the most frequently encountered acute abdomen emergencies in surgical practice, requiring hospitalization. Laparoscopic cholecystectomy is considered the favored treatment for patients with AC who are fit for surgery. However, in high-risk patients considered poor surgical candidates, percutaneous cholecystostomy (PC) has been suggested and employed as a safe and reliable alternative option. PC is a minimally invasive, nonsurgical, image-guided intervention that drains and decompresses the gallbladder, thereby preventing its perforation and sepsis. It can act as a bridge to surgery, but it may also serve as a definitive treatment for some patients. The goal of this review is to familiarize physicians with PC and, more importantly, its applications and techniques, pre- and post-procedural considerations, and adverse events.
Collapse
Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece.
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
| | - Stavros Grigoriadis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| |
Collapse
|
9
|
Yamahata H, Yabuta M, Rahman M. Retrospective comparison of clinical outcomes of ultrasound-guided percutaneous cholecystostomy in patients with and without coagulopathy: a single center's experience. Jpn J Radiol 2023; 41:1015-1021. [PMID: 37029879 DOI: 10.1007/s11604-023-01422-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE To compare the complication rate and clinical outcomes for percutaneous cholecystostomy (PC) in patients with or without coagulopathy. MATERIALS AND METHODS We retrospectively reviewed electronic medical chart of patients who underwent ultrasound-guided PC with a 8.5-F drainage tube for acute cholecystitis between November 2003 and March 2017. We divided the patients into two groups: patients with coagulopathy (international normalized ratio > 1.5 or platelet count < 50 × 109/L or with a history of anticoagulant medication in preceding 5 days) and patients without coagulopathy. Duration of drainage, duration of hospital stay, 30-day mortality and complication rates were compared between these two groups. Student's t test, Chi-square test or Fisher's exact test was used for bivariate analyses. Age, age-adjusted Charlson Comorbidity Index (ACCI) and sepsis-adjusted complication rates were also compared. RESULTS In total, 141 patients had PC (mean age was 73.3 years [SD 13.3]; range 33-96 years; 94 men and 47 women). Fifty-two patients (36.9%) had coagulopathy and 89 patients (63.1%) were without any history of coagulopathy. Hemorrhagic complication rate was 3.5% (5 out of 141 patients, including 4 with coagulopathy and 1 without). One patient with coagulopathy died due to the hemorrhage. Duration of drainage was longer in patients with coagulopathy than patients without coagulopathy (20.0 days vs. 14.8 days; P = 0.033). No significant difference was observed with regard to duration of hospital stay (32.3 days vs. 25.6 days; P = 0.103) and 30-day mortality (7.7% vs. 1.1%; P = 0.062). The overall complication rate did not significantly differ (9.6% and 11.2%; P = 0.763), nor did age, ACCI or sepsis-adjusted complications. CONCLUSION Clinical outcomes and complications rates after PC did not statistically differ between patients with and without coagulopathy, but there was a tendency of higher risk of hemorrhage in coagulopathy patients. Therefore, the indication of this procedure should be carefully determined.
Collapse
Affiliation(s)
- Hayato Yamahata
- Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan.
| | - Minoru Yabuta
- Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Mahbubur Rahman
- Division of Epidemiology, Graduate School of Public Health, St. Luke's International University, 3-6-2 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| |
Collapse
|
10
|
Tuncer K, Kilinc Tuncer G, Çalık B. Factors affecting the recurrence of acute cholecystitis after treatment with percutaneous cholecystostomy. BMC Surg 2023; 23:143. [PMID: 37231394 DOI: 10.1186/s12893-023-02042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The aim of this study was to determine the recurrence rate of patients who did not have interval cholecystectomy after treatment with percutaneous cholecystostomy and to investigate the factors that may affect the recurrence. METHODS Patients who did not undergo interval cholecystectomy after percutaneous cholecystostomy treatment between 2015 and 2021 were retrospectively screened for recurrence. RESULTS 36.3% of the patients had recurrence. Recurrence was found more frequently in patients with fever symptoms at the time of admission to the emergency department (p = 0.003). Recurrence was found to be more frequent in those who had a previous cholecystitis attack (p = 0.016). It was determined that patients with high lipase and procalcitonin levels had statistically more frequent attacks (p = 0.043, p = 0.003). It was observed that the duration of catheter insertion was longer in patients who had relapses (p = 0.019). The cut-off value for lipase was calculated as 15.5, and the cut-off value for procalcitonin as 0.955, in order to identify patients at high risk for recurrence. In the multivariate analysis for the development of recurrence, presence of fever, a history of previous cholecystitis attack, lipase value higher than 15.5 and procalcitonin value higher than 0.955 were found to be risk factors. CONCLUSIONS Percutaneous cholecystostomy is an effective treatment method in acute cholecystitis. Insertion of the catheter within the first 24 h may reduce the recurrence rate. Recurrence is more common in the first 3 months following removal of the cholecystostomy catheter. Having a previous history of cholecystitis attack, fever symptom at the time of admission, elevated lipase and procalcitonin are risk factors for recurrence.
Collapse
Affiliation(s)
- Korhan Tuncer
- Department of General Surgery, University of Bakırçay, Çiğli Training and Research Hospital, Izmir, Turkey.
| | - Gizem Kilinc Tuncer
- Department of General Surgery, University of Health Sciences Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Bülent Çalık
- Department of General Surgery, University of Health Sciences Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
| |
Collapse
|
11
|
Kesim Ç, Özen Ö. Ultrasound-guided percutaneous cholecystostomy as bridging or definitive treatment in patients with acute cholecystitis grade II or III. Heliyon 2023; 9:e15601. [PMID: 37153409 PMCID: PMC10160755 DOI: 10.1016/j.heliyon.2023.e15601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
Background We aimed to investigate the extent to which ultrasound (US)-guided percutaneous cholecystostomy (PC) is used as a bridging or definitive therapy for grade II and III acute cholecystitis and whether this treatment causes significant changes in C-reactive protein (CRP) and direct bilirubin (DB) levels in the first 72 h and the first three weeks. Methods We included 145 consecutive patients who underwent PC over 17 years. No patient had cirrhosis. PC was performed in the interventional radiology department under US guidance. Results US-guided PC was the definitive treatment for more than half of the patients (51.7%) and decreased DB levels significantly more than CRP levels. Conclusion No statistically significant correlation between those whose CRP and DB levels normalized within three weeks and those who did not and required a second invasive procedure. Nevertheless, the bridging treatment group was significantly older than the definitive treatment group.
Collapse
Affiliation(s)
- Çağrı Kesim
- Başkent University, Konya Hospital, Department of Radiology, Interventional Radiology Section, Turkey
- Corresponding author.
| | - Özgür Özen
- Başkent University, Ankara Hospital, Department of Radiology, Interventional Radiology Section, Turkey
| |
Collapse
|
12
|
González-Castillo AM, Sancho-Insenser J, Miguel-Palacio MD, Morera-Casaponsa JR, Membrilla-Fernández E, Pons-Fragero MJ, Grande-Posa L, Pera-Román M. Risk factors for complications in acute calculous cholecystitis. Deconstruction of the Tokyo Guidelines. Cir Esp 2023; 101:170-179. [PMID: 36108956 DOI: 10.1016/j.cireng.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/12/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To challenge the risk factors described in Tokyo Guidelines in Acute Calculous Cholecystitis. METHODS Retrospective single center cohort study with 963 patients with Acute Cholecystitis during a period of 5 years. Some 725 patients with a "pure" Acute Calculous Cholecystitis were selected. The analysis included 166 variables encompassing all risk factors described in Tokyo Guidelines. The Propensity Score Matching method selected two subgroups of patients with equal comorbidities, to compare the severe complications rate according to the initial treatment (Surgical vs Non-Surgical). We analyzed the Failure-to-rescue as a quality indicator in the treatment of Acute Calculous Cholecystitis. RESULTS the median age was 69 years (IQR 53-80). 85.1% of the patients were ASA II or III. The grade of the Acute Calculous Cholecystitis was mild in a 21%, moderate in 39% and severe in 40% of the patients. Cholecystectomy was performed in 95% of the patients. The overall complications rate was 43% and the mortality was 3.6%. The Logistic Regression model isolated 3 risk factor for severe complication: ASA > II, cancer without metastases and moderate to severe renal disease. The Failure-to-Rescue (8%) was higher in patients with non-surgical treatment (32% vs. 7%; P = 0.002). After Propensity Score Matching, the number of severe complications was similar between Surgical and Non-Surgical treatment groups (48.5% vs 62.5%; P = 0.21). CONCLUSIONS the recommended treatment for Acute Calculous Cholecystitis is the Laparoscopic Cholecystectomy. Only three risk factors from the Tokyo Guidelines list appeared as independent predictors of severe complications. The failure-to-rescue is higher in non-surgically treated patients.
Collapse
Affiliation(s)
- Ana María González-Castillo
- Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM).
| | - Juan Sancho-Insenser
- Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)
| | - Maite De Miguel-Palacio
- Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)
| | | | - Estela Membrilla-Fernández
- Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)
| | - María-José Pons-Fragero
- Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)
| | - Luis Grande-Posa
- Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)
| | - Miguel Pera-Román
- Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de Urgencias, Sección de Cirugía General, Servicio de Cirugía General y Digestiva, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)
| |
Collapse
|
13
|
Yao P, Chang Z, Li B, Wang C, Liu Z. Clinical characteristics and prognosis of patients with healthcare-associated cholecystitis receiving percutaneous cholecystostomy. Langenbecks Arch Surg 2023; 408:20. [PMID: 36633712 DOI: 10.1007/s00423-023-02757-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/19/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Acute cholecystitis occurring outside the hospital setting is categorized as community-acquired cholecystitis (CAC). In contrast, it would be classified as a healthcare-associated cholecystitis (HAC) when it is associated with healthcare risk factors. This study aimed to compare the clinical characteristics of HAC to those of CAC and analyze their difference in prognosis after percutaneous cholecystostomy (PC). METHODS A retrospective study was conducted for patients with acute cholecystitis who underwent PC between January 1, 2017, and June 30, 2020, in our hospital. Patients with HAC and CAC were compared in terms of demographics, laboratory tests, isolated pathogens, treatment response after PC, mortality, complications, and subsequent management. RESULTS A total of 247 patients with a mean age of 68 years were enrolled, among whom 131 patients (53.0%) were male. Twenty patients (8.1%) had HAC, and 227 patients (91.9%) had CAC. Patients with HAC were more likely to present with the following: fever (65.0% vs 35.7%; p = 0.010), acalculous cholecystitis (50.0% vs 20.3%; p = 0.002), and a history of malignancy (50.0% vs 15.4%; p < 0.001), poorer clinical responses to PC treatment (75.0% vs 93.0%; p = 0.006), longer length of stay (14.15 days vs 7.62 days; p < 0.001), and higher all-cause mortality (30.0% vs 9.7%; p = 0.006). In addition, a relatively small number of patients with HAC underwent cholecystectomy in subsequent management (35.0% vs 69.2%; p = 0.002). CONCLUSIONS In conclusion, compared to patients with CAC, those with HAC had more atypical symptoms, poorer clinical response to PC, longer hospital stay, and higher all-cause mortality, which makes the acceptability of PC treatment questionable.
Collapse
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
| | - Beibei Li
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Chuanzhuo Wang
- 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
| |
Collapse
|
14
|
Beji H, Atri S, Maghrebi H, Haddad A, Makni A, Kacem M. Acute cholangitis due to haemobilia complicating percutaneous cholecystostomy: First literature case report. Int J Surg Case Rep 2022; 96:107273. [PMID: 35714394 PMCID: PMC9207561 DOI: 10.1016/j.ijscr.2022.107273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/22/2022] [Accepted: 06/02/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis. Cholecystostomy is a good option in patients with significant comorbidities. We report a case of a patient having had a percutaneous cholecystostomy for acute cholecystitis complicated with haemobilia and acute cholangitis. PRESENTATION OF A CASE A woman aged 64 years old, with a history of diabetes, arterial hypertension, and chronic obstructive pulmonary disease was admitted to our institution with acute cholecystitis. We opted for transhepatic percutaneous cholecystostomy (PC) and antibiotics. On the fourth day, the patient had acute cholangitis due to haemobilia. We injected physiologic saline serum through the drain of cholecystostomy to dissolve the blood clot. There was a clinical improvement. We performed laparoscopic cholecystectomy two months later. The patient had an uneventful recovery with a follow-up of five months. DISCUSSION We report the first literature report of acute cholangitis due to haemobilia complicating percutaneous cholecystostomy in a patient admitted for cholecystitis. We highlight the importance of the injection of saline physiologic serum from the catheter. Medical treatment with antibiotics may be enough knowing that blood clots can disappear spontaneously. In case of failure, ERCP with sphincterotomy should be performed. CONCLUSION Haemobilia causing acute cholangitis is a rare complication of percutaneous cholecystostomy. Conservative treatment with antibiotics and injection of saline physiologic serum from the catheter is a good treatment option. In case of failure, ERCP should not be delayed.
Collapse
Affiliation(s)
- Hazem Beji
- Corresponding author at: 52, Street of roses, 8050 Hammamet, Tunisia.
| | | | | | | | | | | |
Collapse
|
15
|
Bejarano González N, Romaguera Monzonís A, Rebasa Cladera P, García Monforte N, Labró Ciurans M, Badia Closa J, Criado Paredes E, García Borobia FJ. Is percutaneous cholecystostomy safe and effective in acute cholecystitis? Analysis of adverse effects associated with the technique. Cir Esp 2022; 100:281-287. [PMID: 35487433 DOI: 10.1016/j.cireng.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/08/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The main objective of our study is to assess the safety and efficacy of percutaneous cholecystostomy for the treatment of acute cholecystitis, determining the incidence of adverse effects in patients undergoing this procedure. MATERIAL AND METHOD Observational study with consecutive inclusion of all patients diagnosed with acute cholecystitis for 10 years. The main variable studied was morbidity (adverse effects) collected prospectively. Minimum one-year follow-up of patients undergoing percutaneous cholecystostomy. RESULTS Of 1223 patients admitted for acute cholecystitis, 66 patients required percutaneous cholecystostomy. 21% of these have presented some adverse effect, with a total of 22 adverse effects. Only 5 of these effects, presented by 5 patients (7.6%), could have been attributed to the gallbladder drainage itself. The mortality associated with the technique is 1.5%. After cholecystostomy, one third of the patients (22 patients) have undergone cholecystectomy. Urgent surgery was performed due to failure of percutaneous treatment in 2 patients, and delayed in another 2 patients due to recurrence of the inflammatory process. The rest of the cholecystectomized patients underwent scheduled surgery, and the procedure could be performed laparoscopically in 16 patients (72.7%). CONCLUSION We consider percutaneous cholecystostomy as a safe and effective technique because it is associated with a low incidence of morbidity and mortality, and it should be considered as a bridge or definitive alternative in those patients who do not receive urgent cholecystectomy after failure of conservative antibiotic treatment.
Collapse
Affiliation(s)
- Natalia Bejarano González
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain.
| | - Andreu Romaguera Monzonís
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Pere Rebasa Cladera
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Neus García Monforte
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Meritxell Labró Ciurans
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain; Servicio de Cirugía General y del Aparato Digestivo, Althaia Xarxa Assistencial Universitària, Manresa, Barcelona, Spain
| | - Jesús Badia Closa
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Eva Criado Paredes
- Unidad de Radiología Vascular Intervencionista, Servicio de Radiología, UDIAT Centro Diagnóstico, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Francisco Javier García Borobia
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| |
Collapse
|
16
|
Ben Yehuda A, Markov E, Jeroukhimov I, Lavy R, Hershkovitz Y. Should cholangiography be part of the management of every patient with percutaneous cholecystostomy? Am J Surg 2022; 224:987-989. [PMID: 35501188 DOI: 10.1016/j.amjsurg.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/19/2022]
Affiliation(s)
- A Ben Yehuda
- Division of Surgery Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel
| | - E Markov
- Division of Surgery Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel
| | - I Jeroukhimov
- Trauma Unit Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel
| | - R Lavy
- Division of Surgery Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel
| | - Y Hershkovitz
- Trauma Unit Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel.
| |
Collapse
|
17
|
Chen BQ, Xie F, Chen GD, Li X, Mao X, Jia B. Value of nonenhanced CT combined with laboratory examinations in the diagnosis of acute suppurative cholecystitis treated with percutaneous cholecystostomy: a retrospective study. BMC Gastroenterol 2022; 22:155. [PMID: 35350979 PMCID: PMC8966294 DOI: 10.1186/s12876-022-02224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/17/2022] [Indexed: 12/07/2022] Open
Abstract
PURPOSES In this study, we aimed to identify the distribution of presenting laboratory and nonenhanced computed tomography (CT) imaging features within 48 h before percutaneous cholecystostomy (PC) and create a model to appropriately guide the diagnosis of acute suppurative cholecystitis (ASC). METHODS The study population included 204 acute cholecystitis patients who underwent PC. Based on the timing of the last laboratory and CT examinations before PC, the patients were divided into two groups: within 48 h before PC (Group 1, n = 138) and over 48 h before PC (Group 2, n = 63). The clinical features of the ASC patients in the two groups were compared. A multivariable model for the diagnosis of ASC in the patients in Group 1 was developed. RESULTS Thirty-nine patients in Group 1 had ASC (28.3%). Gallbladder stones, common bile duct stones, gallbladder wall thickness > 2.85 mm, and neutrophil granulocytes > 82.55% were confirmed to be independent risk factors for ASC. The receiver operating characteristic curve of the recurrence prediction model verified its accuracy (area under the curve: 0.803). Compared with the ASC patients in Group 2, the ASC patients in Group 1 had a higher proportion of pericholecystic exudation or fluid (P = 0.013) and thicker gallbladder walls (P = 0.033). CONCLUSIONS Using nonenhanced CT imaging features and cutoffs for neutrophil granulocytes, we were able to identify a simple algorithm to discriminate ASC. The degree of local inflammation of the gallbladder in ASC patients progressively increases over time, and these changes can be observed on nonenhanced CT images. However, the symptoms of abdominal pain are of little help in estimating the disease duration in elderly patients.
Collapse
Affiliation(s)
- Bai-Qing Chen
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China.,Dalian Medical University, 9 Western Sections, Lvshun South Street, Lvshunkou District, Dalian, 116044, China
| | - Feng Xie
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China.
| | - Guo-Dong Chen
- Department of Radiology, Panjin Liaohe Oilfield Gem Flower Hospital, 26 Yingbin Road, Xinglongtai District, Panjin, 124010, China
| | - Xue Li
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Xue Mao
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Bao Jia
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| |
Collapse
|
18
|
Polito C, Zhang X, Yang J, Spaniolas K, Pryor A, Sbayi S. Timing of cholecystectomy following cholecystostomy tube placement for acute cholecystitis: a retrospective study aiming to identify the optimal timing between a percutaneous cholecystostomy and cholecystectomy to reduce the number of poor surgical outcomes. Surg Endosc 2022. [PMID: 35312851 DOI: 10.1007/s00464-022-09193-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/07/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE Our study aims to identify the optimal timing between a percutaneous cholecystostomy (PC) and cholecystectomy to reduce the number of poor surgical outcomes. BACKGROUND Biliary disease is a common surgical disease and laparoscopic cholecystectomy is the preferred strategy for the management of acute cholecystitis. However, in high-risk surgical patients, a PC tube may be placed instead. In the 2018 Tokyo Guidelines, the optimal timing of cholecystectomy following a PC has been identified as an important future research question. METHODS This is a retrospective study that focuses on identifying the ideal timing of cholecystectomy after PC tube placement to minimize complications. Poor surgical outcomes were measured as 90-day reoperations, 30-day readmissions, 30-day emergency department (ED) visits, length of stay (LOS), and discharge destination. Patients were selected from the New York SPARCS database from 2005 to September 30, 2015. RESULTS 1213 records that consisted of both PC and cholecystectomy were collected. No significant differences in 30-day readmissions, 90-day reoperations, and 30-day ED visits in relation to timing between PC and cholecystectomy were found. Additionally, the decision to replace or not replace dislodged PC tubes was not associated with 90-day reoperation, 30-day readmission, 30-day ED visit, LOS, or discharge destination. However, discharge destination and LOS were significantly different between early intervention of 3 days or less between PC and cholecystectomy and late intervention of more than 14 days with late intervention being associated with shorter LOS and more home discharges. CONCLUSION Performing a cholecystectomy more than 14 days after a PC is associated with better surgical outcomes.
Collapse
|
19
|
Ostapenko A, Liechty S, Manuia E, Stroever S, Casasanta M, Kleiner D. The Rise and Fall of Percutaneous Cholecystostomy in a Community Hospital: Is It Possible to Turn the Tide of History? J Gastrointest Surg 2022; 26:602-607. [PMID: 34545546 DOI: 10.1007/s11605-021-04996-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/23/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the gold standard for treatment of acute cholecystitis. Percutaneous cholecystostomy (PC) drains are alternatives to cholecystectomy in critically ill patients in whom surgery carries an unacceptably high risk. Recently, several studies demonstrated a significant increase in complications in patients undergoing PC in comparison to laparoscopic cholecystectomy. METHODS We conducted a retrospective analysis of patients who underwent PC drainage or cholecystectomy from 2014 through 2019 at our institution. We determined the rate of PC use and performed a linear regression analysis to evaluate PC utilization over time. After creating institutional guidelines and reeducating physicians on appropriate use of PC drainage in 2019, we compared PC utilization to prior years. RESULTS A total of 146 PCs and 3163 cholecystectomies were performed over the study period. Of the cholecystectomies, 754 (23.8%) were performed in hospitalized patients under urgent or emergent conditions. Of the patients with acute cholecystitis, 16.2% were treated with PC. Linear regression analysis demonstrated a significant association between year and rate of PC procedures (p<0.001). The rate of PC rose from 13.8 to 22.5% between 2014 and 2018 and dropped to 10.9% (p=0.006) in 2019 after the reeducation program. CONCLUSIONS With a rising rate of PC utilization and in light of recent studies suggesting increased complications and healthcare costs for patients undergoing this procedure, care needs to be taken to ensure that only appropriate patients are referred for PC. Publication of institutional guidelines, resident and attending surgeon reeducation, and case review can reduce placement of unnecessary PCs.
Collapse
Affiliation(s)
- Alexander Ostapenko
- Department of General Surgery, Danbury Hospital, Nuvance Health, 24 Hospital Ave, Danbury, CT, 06810, USA.
| | - Shawn Liechty
- Department of General Surgery, Danbury Hospital, Nuvance Health, 24 Hospital Ave, Danbury, CT, 06810, USA
| | - Emi Manuia
- Department of General Surgery, Danbury Hospital, Nuvance Health, 24 Hospital Ave, Danbury, CT, 06810, USA
| | - Stephanie Stroever
- Department of General Surgery, Danbury Hospital, Nuvance Health, 24 Hospital Ave, Danbury, CT, 06810, USA
| | - Marc Casasanta
- Department of General Surgery, Danbury Hospital, Nuvance Health, 24 Hospital Ave, Danbury, CT, 06810, USA
| | - Daniel Kleiner
- Department of General Surgery, Danbury Hospital, Nuvance Health, 24 Hospital Ave, Danbury, CT, 06810, USA
| |
Collapse
|
20
|
Vedachalam S, Jalil S, Krishna SG, Porter K, Li N, Kelly SG, Conteh L, Mumtaz K. Call for action: Increased healthcare utilization with growing use of percutaneous cholecystectomy tube over initial cholecystectomy in cirrhotics. Hepatobiliary Pancreat Dis Int 2022; 21:56-62. [PMID: 34420884 DOI: 10.1016/j.hbpd.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Acute calculous cholecystitis (ACC) is frequently seen in cirrhotics, with some being poor candidates for initial cholecystectomy. Instead, these patients may undergo percutaneous cholecystostomy tube (PCT) placement. We studied the healthcare utilization and predictors of cholecystectomy and PCT in patients with ACC. METHODS The National Database was queried to study all cirrhotics and non-cirrhotics with ACC between 2010-2014 who underwent initial PCT (with or without follow-up cholecystectomy) or cholecystectomy. Cirrhotic patients were divided into compensated and decompensated cirrhosis. Independent predictors and outcomes of initial PCT and failure to undergo subsequent cholecystectomy were studied. RESULTS Out of 919 189 patients with ACC, 13 283 (1.4%) had cirrhosis. Among cirrhotics, cholecystectomy was performed in 12 790 (96.3%) and PCT in the remaining 493 (3.7%). PCT was more frequent in cirrhotics (3.7%) than in non-cirrhotics (1.4%). Multivariate analyses showed increased early readmissions [odds ratio (OR) = 2.12, 95% confidence interval (CI): 1.43-3.13, P < 0.001], length of stay (effect ratio = 1.39, 95% CI: 1.20-1.61, P < 0.001), calendar-year hospital cost (effect ratio = 1.34, 95% CI: 1.28-1.39, P < 0.001) and calendar-year mortality (hazard ratio = 1.89, 95% CI: 1.07-3.29, P = 0.030) in cirrhotics undergoing initial PCT compared to cholecystectomy. Decompensated cirrhosis (OR = 2.25, 95% CI: 1.67-3.03, P < 0.001) had the highest odds of getting initial PCT. Cirrhosis, regardless of compensated (OR = 0.56, 95% CI: 0.34-0.90, P = 0.020) or decompensated (OR = 0.28, 95% CI: 0.14-0.59, P < 0.001), reduced the chances of getting a subsequent cholecystectomy. CONCLUSIONS Cirrhotic patients undergo fewer cholecystectomy incurring initial PCT instead. Moreover, the rates of follow-up cholecystectomy are lower in cirrhotics. Increased healthcare utilization is seen with initial PCT amongst cirrhotic patients. This situation reflects suboptimal management of ACC in cirrhotics and a call for action.
Collapse
Affiliation(s)
- Srikanth Vedachalam
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Sajid Jalil
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Somashaker G Krishna
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Na Li
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Sean G Kelly
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Lanla Conteh
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Khalid Mumtaz
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| |
Collapse
|
21
|
Chen BQ, Chen GD, Xie F, Li X, Mao X, Jia B. Percutaneous cholecystostomy as a definitive treatment for moderate and severe acute acalculous cholecystitis: a retrospective observational study. BMC Surg 2021; 21:439. [PMID: 34961498 PMCID: PMC8713395 DOI: 10.1186/s12893-021-01411-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In this study, we aimed to investigate risk factors for the relapse of moderate and severe acute acalculous cholecystitis (AAC) patients after initial percutaneous cholecystostomy (PC) and to identify the predictors of patient outcomes when choosing PC as a definitive treatment for AAC. MATERIALS AND METHODS The study population comprised 44 patients (median age 76 years; range 31-94 years) with moderate or severe AAC who underwent PC without subsequent cholecystectomy. According to the results of follow-up (followed for a median period of 17 months), the data of patients with recurrence versus no recurrence were compared. Patients were divided into the death and non-death groups based on patient status within 60 days after PC. RESULTS Twenty-one (47.7%) had no recurrence of cholecystitis during the follow-up period after catheter removal (61-1348 days), six (13.6%) experienced recurrence of cholecystitis after PC, and 17 (38.6%) patients died during the indwelling tube period (5-60 days). The multivariate analysis showed that coronary heart disease (CHD) or congestive heart failure (odds ratio [OR] 26.50; 95% confidence interval [CI] 1.21-582.06; P = 0.038) was positively correlated with recurrence. The age-adjusted Charlson comorbidity index (OR 1.53; 95% CI 1.08-2.17; P = 0.018) was independently associated with 60-day mortality after PC. CONCLUSIONS Our results suggest that CHD or congestive heart failure was an independent risk factor for relapse in moderate and severe AAC patients after initial PC. AAC patients with more comorbidities had worse outcomes.
Collapse
Affiliation(s)
- Bai-Qing Chen
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Guo-Dong Chen
- Department of Radiology, Panjin Liaohe Oilfield Gem Flower Hospital, 26 Yingbin Road, Xinglongtai District, Panjin, 124010, China
| | - Feng Xie
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China.
| | - Xue Li
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Xue Mao
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Bao Jia
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| |
Collapse
|
22
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
23
|
Chon HK, Park C, Park DE, Kim TH. Efficacy and safety of conversion of percutaneous cholecystostomy to endoscopic transpapillary gallbladder stenting in high-risk surgical patients. Hepatobiliary Pancreat Dis Int 2021; 20:478-84. [PMID: 34340921 DOI: 10.1016/j.hbpd.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
Collapse
|
24
|
Ábrahám S, Tóth I, Benkő R, Matuz M, Kovács G, Morvay Z, Nagy A, Ottlakán A, Czakó L, Szepes Z, Váczi D, Négyessy A, Paszt A, Simonka Z, Petri A, Lázár G. Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years' experience at a tertiary care centre. Surg Endosc 2021; 36:2850-2860. [PMID: 34415432 PMCID: PMC9001534 DOI: 10.1007/s00464-021-08573-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022]
Abstract
Background Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. Patients and Methods We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male–female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient’s performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. Results PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79–20.56), clinical progression (OR 7.62; CI 2.64–22.05) and the need for emergency CCY (OR 14.75; CI 3.07–70.81) were mostly determined by AC severity grade. Conclusion PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.
Collapse
Affiliation(s)
- Szabolcs Ábrahám
- Department of Surgery, University of Szeged, Szeged, Hungary. .,Department of Surgery, University of Szeged, Albert Szent-Györgyi Health Centre, Semmelweis u. 8., 6725, Szeged, Hungary.
| | - Illés Tóth
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Ria Benkő
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary.,Central Pharmacy and Emergency Care Department, University of Szeged, Szeged, Hungary.,Central Pharmacy Department, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary.,Central Pharmacy and Emergency Care Department, University of Szeged, Szeged, Hungary
| | | | - Zita Morvay
- Radiology Department, University of Szeged, Szeged, Hungary
| | - András Nagy
- Radiology Department, University of Szeged, Szeged, Hungary
| | - Aurél Ottlakán
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | | | - András Négyessy
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Zsolt Simonka
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - András Petri
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| |
Collapse
|
25
|
Cheng Q, Hort A, Yoon P, Loi K. Review of the Endoscopic, Surgical and Radiological Techniques of Treating Choledocholithiasis in Bariatric Roux-en-Y Gastric Bypass Patients and Proposed Management Algorithm. Obes Surg 2021. [PMID: 34350533 DOI: 10.1007/s11695-021-05627-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/17/2021] [Accepted: 07/22/2021] [Indexed: 01/22/2023]
Abstract
Choledocholithiasis in post-surgical bariatric Roux-en-Y gastric bypass patients presents a significant challenge secondary to altered anatomy. We aim to review the existing management options including either endoscopic, surgical, percutaneous or hybrid means. Current literature suggests reasonably successful cannulation rates for single- or double-balloon ERCP ranging from 50 to 70% and 63-83%, respectively. The hybrid technique of laparoscopic transgastric ERCP has gained popularity with success rates ranging from 90 to 100%. Conventional laparoscopic techniques like transcystic duct and transcholedochal bile duct exploration are still useful options (i.e. high success rates of 81-100% and 83-96%, respectively). The role of percutaneous transhepatic choledochography remains limited although it can help with rapid bile duct decompression. If feasible, treatment pathways should progress from least to more invasive options as required.
Collapse
|
26
|
Choudhury SR, Gupta P, Garg S, Kalra N, Kang M, Sandhu MS. Image-guided percutaneous cholecystostomy: a comprehensive review. Ir J Med Sci 2021. [PMID: 34021480 DOI: 10.1007/s11845-021-02655-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
Acute cholecystitis (AC) is a common emergency condition with severity ranging from mild to severe. Gallstones and critical illnesses are the common predisposing factors. Mild AC is primarily managed with medical therapy and early cholecystectomy. Moderate and severe AC require individualized treatment with a preference for early cholecystectomy. However, cholecystectomy may not always be feasible due to co-morbidities. Hence, this group of patients needs minimally invasive methods to drain the gallbladder (GB). Percutaneous cholecystostomy (PC) is the image-guided drainage of GB in the setting of moderate to severe AC. There are different approaches to PC. The technical aspects, success, and complications of PC as well as management of cholecystostomy catheter after the patient recovers from the acute episode should be thoroughly understood by the interventional radiologist. We present an extensive up-to-date review of the essential aspects of PC including indications, contraindications, techniques, and outcomes, including complications and success rates.
Collapse
|
27
|
González-Castillo AM, Sancho-Insenser J, De Miguel-Palacio M, Morera-Casaponsa JR, Membrilla-Fernández E, Pons-Fragero MJ, Pera-Román M, Grande-Posa L. Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines. World J Emerg Surg 2021; 16:24. [PMID: 33975601 PMCID: PMC8111736 DOI: 10.1186/s13017-021-00368-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. METHODS Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. RESULTS The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7-12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34-12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02-1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5-28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). CONCLUSIONS Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. TRIAL REGISTRATION Retrospectively registered and recorded in Clinical Trials. NCT04744441.
Collapse
Affiliation(s)
- Ana María González-Castillo
- Department of Surgery, Autonomous University of Barcelona, Passeig Marítim de la Barceloneta, 25-29, 08003, Barcelona, Spain.
- General Surgery Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
| | - Juan Sancho-Insenser
- Department of Surgery, Autonomous University of Barcelona, Passeig Marítim de la Barceloneta, 25-29, 08003, Barcelona, Spain
- General Surgery Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Maite De Miguel-Palacio
- General Surgery Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Josep-Ricard Morera-Casaponsa
- Department of Surgery, Autonomous University of Barcelona, Passeig Marítim de la Barceloneta, 25-29, 08003, Barcelona, Spain
| | - Estela Membrilla-Fernández
- Department of Surgery, Autonomous University of Barcelona, Passeig Marítim de la Barceloneta, 25-29, 08003, Barcelona, Spain
- General Surgery Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - María-José Pons-Fragero
- General Surgery Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Miguel Pera-Román
- Department of Surgery, Autonomous University of Barcelona, Passeig Marítim de la Barceloneta, 25-29, 08003, Barcelona, Spain
- General Surgery Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Luis Grande-Posa
- Department of Surgery, Autonomous University of Barcelona, Passeig Marítim de la Barceloneta, 25-29, 08003, Barcelona, Spain
- General Surgery Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| |
Collapse
|
28
|
Bejarano González N, Romaguera Monzonís A, Rebasa Cladera P, García Monforte N, Labró Ciurans M, Badia Closa J, Criado Paredes E, García Borobia FJ. Is percutaneous cholecystostomy safe and effective in acute cholecystitis? Analysis of adverse effects associated with the technique. Cir Esp 2021; 100:S0009-739X(21)00124-X. [PMID: 33902894 DOI: 10.1016/j.ciresp.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The main objective of our study is to assess the safety and efficacy of percutaneous cholecystostomy for the treatment of acute cholecystitis, determining the incidence of adverse effects in patients undergoing this procedure. MATERIAL AND METHOD Observational study with consecutive inclusion of all patients diagnosed with acute cholecystitis for 10 years. The main variable studied was morbidity (adverse effects) collected prospectively. Minimum one-year follow-up of patients undergoing percutaneous cholecystostomy. RESULTS Of 1223 patients admitted for acute cholecystitis, 66 patients required percutaneous cholecystostomy. 21% of these have presented some adverse effect, with a total of 22 adverse effects. Only 5 of these effects, presented by 5 patients (7.6%), could have been attributed to the gallbladder drainage itself. The mortality associated with the technique is 1.5%. After cholecystostomy, one third of the patients (22 patients) have undergone cholecystectomy. Urgent surgery was performed due to failure of percutaneous treatment in 2 patients, and delayed in another 2 patients due to recurrence of the inflammatory process. The rest of the cholecystectomized patients underwent scheduled surgery, and the procedure could be performed laparoscopically in 16 patients (72.7%). CONCLUSION We consider percutaneous cholecystostomy as a safe and effective technique because it is associated with a low incidence of morbidity and mortality, and it should be considered as a bridge or definitive alternative in those patients who do not receive urgent cholecystectomy after failure of conservative antibiotic treatment.
Collapse
Affiliation(s)
- Natalia Bejarano González
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España.
| | - Andreu Romaguera Monzonís
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Pere Rebasa Cladera
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Neus García Monforte
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Meritxell Labró Ciurans
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Cirugía General y del Aparato Digestivo, Althaia Xarxa Assistencial Universitària, Manresa, Barcelona, España
| | - Jesús Badia Closa
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Eva Criado Paredes
- Unidad de Radiología Vascular Intervencionista, Servicio de Radiología, UDIAT Centro Diagnóstico, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Francisco Javier García Borobia
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| |
Collapse
|
29
|
Barabino M, Piccolo G, Trizzino A, Fedele V, Ferrari C, Nicastro V, Pisani Ceretti A, De Nicola E, Mariani NM, Giovenzana M, Scifo G, Mazza M, Vercelli R, Santambrogio R, Luigiano C, Opocher E. COVID-19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy. BMC Surg 2021; 21:180. [PMID: 33823831 PMCID: PMC8022294 DOI: 10.1186/s12893-021-01137-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 03/09/2021] [Indexed: 12/16/2022] Open
Abstract
Background COVID-19 pandemic has impacted the Italian National Health Care system at many different levels, causing a complete reorganization of surgical wards. In this context, our study retrospectively analysed the management strategy for patients with acute cholecystitis. Methods We analysed all patients admitted to our Emergency Department for acute cholecystitis between February and April 2020 and we graded each case according to 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. We focused on patients submitted to cholecystostomy during the acute phase of pandemic and their subsequent disease evolution. Results Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II, 8 grade III). According to Tokyo Guidelines (2018), patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage (PC) and laparoscopic cholecystectomy (LC) in 29.7%, 21.6% and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to bedside percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous cholecystostomy was of 87.5%. The mean post-procedural hospitalization length was 9 days, and no related adverse events were observed apart from transient parietal bleeding, conservatively treated. Once discharged, two patients required readmission because of acute biliary symptoms. Median time of drainage removal was 43 days and only 50% patients thereafter underwent cholecystectomy. Conclusions Percutaneous cholecystostomy has shown to be an effective and safe treatment thus acquiring an increased relevance in the first phase of the pandemic. Nowadays, considering we are forced to live with the SARS-CoV-2 virus, PC should be considered as a virtuous, alternative tool for potentially all COVID-19 positive patients and selectively for negative cases unresponsive to conservative therapy and unfit for surgery.
Collapse
Affiliation(s)
- Matteo Barabino
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Gaetano Piccolo
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Arianna Trizzino
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Veronica Fedele
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Carlo Ferrari
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy.
| | - Vincenzo Nicastro
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Andrea Pisani Ceretti
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Enrico De Nicola
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Nicolò Maria Mariani
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Marco Giovenzana
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Giovanna Scifo
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Massimiliano Mazza
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Ruggero Vercelli
- Department of Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Roberto Santambrogio
- Unit of General Surgery, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20121, Milan, Italy
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Enrico Opocher
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| |
Collapse
|
30
|
McCarty TR, Chouairi F, Hathorn KE, Sharma P, Muniraj T, Thompson CC. Healthcare Disparities in the Management of Acute Cholecystitis: Impact of Race, Gender, and Socioeconomic Factors on Cholecystectomy vs Percutaneous Cholecystostomy. J Gastrointest Surg 2021; 25:880-886. [PMID: 33629232 DOI: 10.1007/s11605-021-04959-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND While percutaneous cholecystostomy (PC) is a recommended treatment strategy in lieu of cholecystectomy (CCY) for acute cholecystitis among patients who may not be considered good surgical candidates, reports on disparities in treatment utilization remain limited. The aim of this study was to investigate the role of demographic, clinical, and socioeconomic factors in treatment of acute cholecystitis. METHODS Patients with a diagnosis of acute cholecystitis who underwent CCY versus PC were reviewed from the U.S. Nationwide Inpatient Sample (NIS) database between 2008-2014. Measured variables including age, race/ethnicity, Charlson comorbidity index (CCI), hospital type/region, insurance payer, household income, length of stay (LOS), hospital cost, and mortality were compared using chi-square and ANOVA. Multivariable logistic regression was performed to identify specific predictors of cholecystitis treatment. RESULTS A total of 1,492,877 patients (CCY:n=1,435,255 versus PC:n=57,622) were analyzed. The majority of patients that received PC were at urban teaching hospitals (65.2%). LOS was significantly longer with higher associated costs for PC [(11.1±11.0 versus 4.5±5.3 days; P<0.001) and ($99577±138850 versus $48399±58330; P<0.001)]. Mortality was also increased for patients that received PC compared to CCY (8.8% versus 0.6%; P<0.001). Multivariable regression demonstrated multiple socioeconomic and healthcare-related factors influencing the utilization of PC including male gender, Black or Asian race/ethnicity, Medicare payer status, urban hospital location, and household income (all P<0.001). CONCLUSION Although patients receiving PC had higher CCI scores, multiple socioeconomic and healthcare related factors appeared to also influence this treatment decision. Additional studies to investigate these disparities are indicated to improve outcomes for all individuals with this condition.
Collapse
Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Kelly E Hathorn
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Prabin Sharma
- Section of Gastroenterology, Yale-New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Thiruvengadam Muniraj
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| |
Collapse
|
31
|
Imanzadeh A, Kokabi N, Pourjabbar S, Latich I, Pollak J, Kim H, Gunabushanam G. Safety and Efficacy of Percutaneous Cholecystostomy for Emphysematous Cholecystitis. J Clin Imaging Sci 2020; 10:9. [PMID: 32257585 PMCID: PMC7110106 DOI: 10.25259/jcis_145_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/10/2020] [Indexed: 12/15/2022] Open
Abstract
Objective: The objective of the study was to evaluate the safety and efficacy of percutaneous cholecystostomy (PC) in treating critically ill patients with emphysematous cholecystitis who were deemed poor surgical candidates. Materials and Methods: The Institutional Review Board exemption was obtained for this retrospective study. Patients with emphysematous cholecystitis who were deemed to be poor operative candidates by the treating surgeon and underwent PC placement between May 2008 and April 2017 at a single institution were identified through a medical records search. Demographics, laboratory values, imaging data, procedural technique, complications, hospitalization course, clinical outcome, and survival data were obtained. Results: Ten consecutive patients were included, with a mean age of 75.0 ± 12.2 years, including six men and four women. The most common comorbidity was diabetes (60%, 6/10) followed by hypertension (40%, 4/10). Intraluminal or intramural gas as well as gallbladder wall thickening were noted in all patients. Procedure technical success rate was 100%. There was a complete resolution of symptoms in 90% (9/10) of patients at a mean of 2.9 ± 1.4 days post-procedure. Thirty-day survival rate was 90% (9/10); one patient died on the 6th post- procedure day from sepsis. Two more deaths occurred within a year after PC from unrelated causes. About 50% (5/10) of patients underwent elective cholecystectomy at a median interval of 69 days post-procedure. In 40% (4/10) of patients, cholecystostomy was the definitive treatment, with tube removal at a median of 140 days post- procedure. Conclusion: PC appears to be a safe and generally effective alternative management option in patients with emphysematous cholecystitis that is considered very high risk for surgery.
Collapse
Affiliation(s)
- Amir Imanzadeh
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Nima Kokabi
- Department of Interventional Radiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Sarvenaz Pourjabbar
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Igor Latich
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey Pollak
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Hyun Kim
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Gowthaman Gunabushanam
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
32
|
Morales-Maza J, Rodríguez-Quintero JH, Santes O, Hernández-Villegas AC, Clemente-Gutiérrez U, Sánchez-Morales GE, Mier Y Terán-Ellis S, Pantoja JP, Mercado MA. Percutaneous cholecystostomy as treatment for acute cholecystitis: What has happened over the last five years? A literature review. Rev Gastroenterol Mex (Engl Ed) 2019; 84:482-491. [PMID: 31521405 DOI: 10.1016/j.rgmx.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 01/04/2023]
Abstract
Acute cholecystitis is one of the most frequent diseases faced by the general surgeon. In recent decades, different prognostic factors have been observed, and effective treatments described, to improve the results in patients with said pathology (lower morbidity and mortality, shorter hospital stay, and minimum conversion of laparoscopic to open procedures). In general, laparoscopic cholecystectomy is the standard treatment for acute cholecystitis, but it is not exempt from complications, especially in patients with numerous comorbidities or those that are critically ill. Percutaneous cholecystostomy emerged as a less invasive alternative for the treatment of acute cholecystitis in patients with organ failure or a prohibitive surgical risk. Even though it is an effective procedure, its usefulness and precise indications are subjects of debate. In addition, there is little evidence on cholecystostomy catheter management. We carried out a review of the literature covering the main aspects physicians involved in the management of acute cholecystitis should be familiar with.
Collapse
Affiliation(s)
- J Morales-Maza
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - J H Rodríguez-Quintero
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - O Santes
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - A C Hernández-Villegas
- Departamento de Radiología Intervencionista, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - U Clemente-Gutiérrez
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - G E Sánchez-Morales
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - S Mier Y Terán-Ellis
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - J P Pantoja
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - M A Mercado
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México.
| |
Collapse
|
33
|
Requarth JA. Image-Guided Palliative Interventions. Surg Clin North Am 2019; 99:921-939. [PMID: 31446918 DOI: 10.1016/j.suc.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reviews a few surgical palliative care procedures that can be performed by surgeons and interventional radiologists using image-guided techniques. Treatment of recurrent pleural effusions, gastrostomy feeding tube maintenance, percutaneous cholecystostomy, and transjugular intrahepatic portosystemic shunts (TIPS) with embolotherapy of bleeding stomal varices is discussed.
Collapse
Affiliation(s)
- Jay A Requarth
- 1959 North Peacehaven Road, #118, Winston Salem, NC 27106, USA.
| |
Collapse
|
34
|
Abstract
A 67-year-old lady was managed with percutaneous cholecystostomy for severe acute cholecystitis with septic shock. An interval laparoscopic subtotal cholecystectomy was done at 8 weeks. Her post-operative phase was complicated by intra-abdominal abscess requiring radiologically guided percutaneous drain insertion. Five days following the removal of the drain, she presented with a right abdominal wall abscess. A computerized tomography scan showed an abdominal wall ectopically-retained gallstone. The gallstone was retrieved along with drainage of abscess.
Collapse
Affiliation(s)
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
35
|
Boregowda U, Umapathy C, Nanjappa A, Wong H, Desai M, Roytman M, Theethira T, Saligram S. Endoscopic ultrasound guided gallbladder drainage - is it ready for prime time? World J Gastrointest Pharmacol Ther 2018; 9:47-54. [PMID: 30568842 PMCID: PMC6288492 DOI: 10.4292/wjgpt.v9.i6.47] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 10/28/2018] [Accepted: 11/15/2018] [Indexed: 02/06/2023] Open
Abstract
Management of acute cholecystitis includes initial stabilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the severity of cholecystitis or comorbidities will require a temporary measure as a bridge to surgery or permanent nonoperative management to decrease the mortality and morbidity. Most of these patients who require conservative management were managed with percutaneous transhepatic cholecystostomy or trans-papillary drainage of gallbladder drainage with cystic duct stenting through endoscopic retrograde cholangiopancreaticography (ERCP). Although, these conservative measures are effective, they can cause significant discomfort to the patients especially if used as a long-term measure. In view of this, there is a need for further minimally invasive procedures, which is safe, effective and comfortable to patients. Endoscopic ultrasound (EUS) guided gallbladder drainage is a novel method of gallbladder drainage first described in 2007[1]. Over the last decade, EUS guided gallbladder drainage has evolved as an effective alternative to percutaneous cholecystostomy and trans-papillary gallbladder drainage. Our goal is to review available literature regarding the scope of EUS guided gallbladder drainage as a viable alternative to percutaneous cholecystostomy or cystic duct stenting through ERCP among patients who are not suitable for cholecystectomy.
Collapse
Affiliation(s)
- Umesha Boregowda
- Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93721, United States
| | - Chandraprakash Umapathy
- Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93721, United States
| | - Arpitha Nanjappa
- Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93721, United States
| | - Helen Wong
- Department of Gastroenterology and Hepatology, VA Central California Healthcare System, Fresno, CA 93703, United States
| | - Madhav Desai
- Department of Gastroenterology and Hepatology, Kansas University Medical Center, Kansas City, Kansas 66160, United States
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93721, United States
| | - Thimmaiah Theethira
- Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93721, United States
| | - Shreyas Saligram
- Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93721, United States
- Department of Gastroenterology and Hepatology, VA Central California Healthcare System, Fresno, CA 93703, United States
| |
Collapse
|
36
|
Affiliation(s)
- Francesca M Dimou
- Department of Surgery, University of South Florida, 13220 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
| | - Taylor S Riall
- Department of Surgery, University of Arizona, 1501 North Campbell Avenue, Room 4237, PO Box 245131, Tucson, AZ 85724-5131, USA.
| |
Collapse
|
37
|
Bhatt MN, Ghio M, Sadri L, Sarkar S, Kasotakis G, Narsule C, Sarkar B. Percutaneous Cholecystostomy in Acute Cholecystitis-Predictors of Recurrence and Interval Cholecystectomy. J Surg Res 2018; 232:539-46. [PMID: 30463770 DOI: 10.1016/j.jss.2018.06.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
Collapse
|
38
|
Lu P, Chan CL, Yang NP, Chang NT, Lin KB, Lai KR. Outcome comparison between percutaneous cholecystostomy and cholecystectomy: a 10-year population-based analysis. BMC Surg 2017; 17:130. [PMID: 29212485 PMCID: PMC5719669 DOI: 10.1186/s12893-017-0327-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/24/2017] [Indexed: 12/15/2022] Open
Abstract
Background Controversy surrounding the role of percutaneous cholecystostomy (PC) is fed by the absence of large amounts of data concerning its outcomes, and many authors have maintained that there is no evidence to support a recommendation for PC rather than cholecystectomy (CCS) in elderly or critically ill patients with acute cholecystitis (AC). Methods We conducted this study by tracking trends in the utilization and outcomes of PC and CCS using longitudinal health research data in Taiwan. Results Analyses were conducted on 236,742 patients, 11,184 of whom had undergone PC and 225,558 of whom had undergone CCS. Average annual percentage changes (AAPCs) from 2003 to 2012 increased significantly by 18.34% each year for PC and by 2.82% each year for CCS. The subset analyzes showed that the mortality rates were far higher in patients underwent PC than in patients underwent CCS in all subgroups, which increased from a minimum of 1.45-fold to a maximum of 34.22-fold. The gap of the mortality rates between PC group and CCS group narrowed as the patients aged and with the seriousness of the diseases increased. Most patients with PC or CCS who died in-hospital or within 30 days after discharge were 70 years of age or older, and a large number of them received a CCI score of at least 1. The AAPCs of the overall mortality rates from 2003 to 2012 decreased by 6.78% each year for PC and by 7.33% each year for CCS. PC was related to a higher rate of cholecystitis recurrence and readmission for complications, but a lower rate of in-hospital complications and routine discharge than CCS, and 36.41% of all patients treated with PC underwent subsequent CCS. Additionally, the patients with PC experienced longer hospital stays and generated higher costs than the patients with CCS. Conclusion Patients who underwent PC demonstrated poorer prognoses than did patients who underwent CCS. The role of PC in the Tokyo guidelines may be overstated; it is not as safe as the Tokyo guidelines have suggested in moderate-grade cholecystitis cases, and it should be limited to only the elderly and sicker patients.
Collapse
Affiliation(s)
- Ping Lu
- School of Economics and Management, Xiamen University of Technology, Xiamen, 361024, China.,Department of Information Management, Yuan Ze University, Taoyuan, 32003, Taiwan
| | - Chien-Lung Chan
- Department of Information Management, Yuan Ze University, Taoyuan, 32003, Taiwan.,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, 32003, Taiwan
| | - Nan-Ping Yang
- Department of Surgery, Keelung Hospital, Ministry of Health and Welfare, Keelung, 20147, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Nien-Tzu Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
| | - Kai-Biao Lin
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, 32003, Taiwan.,School of Computer & Information Engineering, Xiamen University of Technology, Xiamen, 361024, China
| | - K Robert Lai
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, 32003, Taiwan. .,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, 32003, Taiwan.
| |
Collapse
|
39
|
Abstract
The gold standard for treatment of acute cholecystitis is laparoscopic cholecystectomy. However, cholecystectomy is often not suitable for surgically unfit patients who are too frail due to various co-morbidities. As such, several less invasive endoscopic treatment modalities have been developed to control sepsis, either as a definitive treatment or as a temporizing modality until the patient is stable enough to undergo cholecystectomy at a later stage. Recent developments in endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with endoscopic ultrasound EUS-specific stents having lumen-apposing properties have demonstrated potential as a definitive treatment modality. Furthermore, advanced gallbladder procedures can be performed using the stents as a portal. With similar effectiveness as percutaneous transhepatic cholecystostomy and lower rates of adverse events reported in some studies, EUS-GBD has opened exciting possibilities in becoming the next best alternative in treating acute cholecystitis in surgically unfit patients. The aim of this review article is to provide a summary of the various methods of gallbladder drainage GBD with particular focus on EUS-GBD and the many new prospects it allows.
Collapse
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
| |
Collapse
|
40
|
Abbas SH, Ghazanfar MA, Gordon-Weeks AN, Reddy SR, Soonawalla Z, Silva MA. Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary. Dig Surg 2017; 35:171-176. [PMID: 28704814 DOI: 10.1159/000477780] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) accounts for 5-10% of cases of acute cholecystitis. The advantage of interval cholecystectomy for patients with AAC is unclear. Therefore, a retrospective analysis of patients diagnosed with AAC at our institution was performed over a 5-year period. METHODS Patients were identified via hospital coding using the keywords "acalculous cholecystitis, cholecystostomy and gall bladder perforation." Follow-up data was obtained by performing a retrospective review of the patients' hospital records. RESULTS A total of 33 patients with AAC were identified and followed for a median period of 18 months. The median age at presentation was 70 (10-96) and American Society of Anesthesiologists (ASA) grade was 3 (1-5). Twenty-three patients (70%) were treated with antibiotics alone, 7 patients (21%) with percutaneous cholecystostomy and 3 patients (9%) with laparoscopic cholecystectomy. The 90-day mortality rate was 30% with significant correlation to comorbid status, as all deaths occurred in ASA grade 3-5 individuals (p = 0.020). Two patients (6%) developed recurrent AAC and were managed non-operatively. CONCLUSION Antibiotics and cholecystostomy were the mainstay of AAC management, and comorbid status influenced related mortality. Our results suggest that it appears safe to avoid interval cholecystectomy in patients who recover from AAC, as they are typically high-risk surgical candidates.
Collapse
Affiliation(s)
- Syed H Abbas
- Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | | | | |
Collapse
|
41
|
Amirthalingam V, Low JK, Woon W, Shelat V. Tokyo Guidelines 2013 may be too restrictive and patients with moderate and severe acute cholecystitis can be managed by early cholecystectomy too. Surg Endosc 2017; 31:2892-2900. [PMID: 27804044 DOI: 10.1007/s00464-016-5300-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/14/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether early laparoscopic cholecystectomy (LC) is safe and feasible for patients diagnosed with moderate (grade 2) and severe (grade 3) acute cholecystitis (AC) according to the Tokyo Guidelines 2013 (TG13). BACKGROUND Early cholecystectomy is the current accepted standard of care for patients with mild (grade 1) and selected grade 2 AC based on TG13. For selected grade 2 and grade 3 AC, early percutaneous cholecystostomy (PC) followed by delayed cholecystectomy is recommended. METHODS Patients diagnosed with AC over a 14-month period were identified and divided into three grades of AC based upon chart review using the grading and severity indicators according to TG13. RESULTS A total of 149 patients underwent emergency LC. Eighty-two (55 %) patients were male. Eighty-four (56.4 %) patients were classified as grade 1 AC, 49 (32.9 %) as grade 2, and 16 (10.7 %) as grade 3. Eighty-three (98.8 %) patients with grade 1 AC underwent emergency LC, and 1 patient (1.2 %) underwent PC followed by emergency LC. The median length of hospital stay for grade 1 AC patients was 2 (1-11) days. There were 2 (2.4 %) readmissions with fever and no additional complications. Among the 65 patients identified with grade 2 or 3 AC, 6 (9.2 %) underwent PC followed by emergency LC. Fifty-nine (90.8 %) patients underwent emergency cholecystectomy: 58 (98.3 %) LC and one (1.7 %) open cholecystectomy. Among the 58 patients with LC, 3 (5.2 %) patients had open conversion and 10 (17.2 %) patients required subtotal cholecystectomy. One patient was converted to open due to bile duct injury and had hepaticojejunostomy repair. Two other patients were converted due to dense adhesions and inability to safely dissect Calot's triangle. The median length of hospital stay was 4 (1-28) days. There was one readmission for ileus. CONCLUSION Severity grading of AC is not the sole determinant of early LC. Patient comorbidity also impacts clinical decision. Confirmation in a larger cohort is warranted.
Collapse
Affiliation(s)
- Vinoban Amirthalingam
- Division of General Surgery-HPB, Department of General Surgery, Tan Tock Seng Hospital, Annex 1, Level 4 General Surgery Office, Singapore, Singapore.
| | - Jee Keem Low
- Division of General Surgery-HPB, Department of General Surgery, Tan Tock Seng Hospital, Annex 1, Level 4 General Surgery Office, Singapore, Singapore
| | - Winston Woon
- Division of General Surgery-HPB, Department of General Surgery, Tan Tock Seng Hospital, Annex 1, Level 4 General Surgery Office, Singapore, Singapore
| | - Vishalkumar Shelat
- Division of General Surgery-HPB, Department of General Surgery, Tan Tock Seng Hospital, Annex 1, Level 4 General Surgery Office, Singapore, Singapore
| |
Collapse
|
42
|
Hermiz SJ, Diegidio P, Garimella R, Ortiz-Pujols S, Yu H, Isaacson A, Mauro MA, Cairns BA, Hultman CS. Acalculous Cholecystitis in Burn Patients: Is There a Role for Percutaneous Cholecystostomy? Clin Plast Surg 2017; 44:567-571. [PMID: 28576245 DOI: 10.1016/j.cps.2017.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Although acute acalculous cholecystitis is uncommon in burn patients, this condition can be rapidly fatal due to delays in diagnosis and treatment and should always be considered in the differential diagnosis when burn patients become septic, develop abdominal pain, or have hemodynamic instability. This article reviews the use of percutaneous cholecystostomy in burn patients as both a diagnostic and therapeutic intervention.
Collapse
Affiliation(s)
- Steven J Hermiz
- Department of Surgery, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Paul Diegidio
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Roja Garimella
- Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Shiara Ortiz-Pujols
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Hyeon Yu
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Ari Isaacson
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Matthew A Mauro
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Bruce A Cairns
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Charles Scott Hultman
- Division of Plastic Surgery, Department of Surgery, University of North Carolina School of Medicine, Suite 7038, Burnett Womack, CB#7195, Chapel Hill, NC 27599, USA.
| |
Collapse
|
43
|
Kim D, Iqbal SI, Ahari HK, Molgaard CP, Flacke S, Davison BD. Expanding role of percutaneous cholecystostomy and interventional radiology for the management of acute cholecystitis: An analysis of 144 patients. Diagn Interv Imaging 2017; 99:15-21. [PMID: 28506680 DOI: 10.1016/j.diii.2017.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/14/2017] [Accepted: 04/22/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE To investigate the rates of interval cholecystectomy and recurrent cholecystitis after initial percutaneous cholecystostomy (PC) and identify predictors of patient outcome after PC. MATERIALS AND METHODS A total of 144 patients with acute cholecystitis who were treated with PC were included. There were 96 men and 48 women, with a mean age of 71±13 (SD) years (range: 25-100 years). Patient characteristics, diagnostic imaging studies and results of laboratory tests at initial presentation, clinical outcomes after the initial PC treatment were reviewed. RESULTS Among the 144 patients, 56 patients were referred for acute acalculous and 88 patients for calculus cholecystitis. Five procedure-related major complications (3.6%) were observed including bile peritonitis (n=3), hematoma (n=1) and abscess formation (n=1). Recurrent acute cholecystitis after initial clinical resolution and PC tube removal was observed in 8 patients (6.0%). The rate of interval cholecystectomy was 33.6% (47/140) with an average interval period of 100±482 (SD) days (range: 3-1017 days). PC was a definitive treatment in 85 patients (60.7%) whereas 39 patients (27.9%) had elective interval cholecystectomy without having recurrent cholecystitis. The clinical outcomes after PC did not significantly differ between patients with calculous cholecystitis and those with acalculous cholecystitis. Multiple prior abdominal operations were associated with higher rates of recurrent cholecystitis. CONCLUSION For both acute acalculous and calculous cholecystitis, PC is an effective and definitive treatment modality for more than two thirds of our study patients over 3.5-year study period with low rates of recurrent disease and interval cholecystectomy.
Collapse
Affiliation(s)
- D Kim
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA.
| | - S I Iqbal
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA
| | - H K Ahari
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA
| | - C P Molgaard
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA
| | - S Flacke
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA
| | - B D Davison
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA
| |
Collapse
|
44
|
Loftus TJ, Collins EM, Dessaigne CG, Himmler AN, Mohr AM, Thomas RM, Hobson CE, Sarosi GA Jr, Zingarelli WJ. Percutaneous cholecystostomy: prognostic factors and comparison to cholecystectomy. Surg Endosc 2017; 31:4568-75. [PMID: 28409378 DOI: 10.1007/s00464-017-5517-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 03/14/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Data regarding long-term outcomes following percutaneous cholecystostomy (PC) are limited, and comparisons to cholecystectomy (CCY) are lacking. We hypothesized that chronic disease burden would predict 1-year mortality following PC, and that outcomes following PC and CCY would be similar when controlling for preprocedural risk factors. METHODS We performed a 10-year retrospective cohort analysis of patients with acute cholecystitis managed by PC (n = 114) or CCY (n = 234). Treatment response was assessed by systemic inflammatory response syndrome (SIRS) criteria at PC/CCY and 72 h later. Logistic regression identified predictors of 30-day and 1-year mortality following PC. PC and CCY patients were matched by age, Tokyo Guidelines (TG13) cholecystitis severity grade, and VASQIP calculator predicted mortality (n = 42/group). RESULTS The presence of SIRS at 72 h following PC was associated with 30-day mortality [OR 8.9 (95% CI 2.6-30)]. SIRS at 72 h was present in and 21.4% of all PC patients, significantly higher than unmatched CCY patients (4.7%, p = 0.048). Independent predictors of 1-year mortality following PC were DNR status [19.7 (2.1-186)], disseminated cancer [7.5 (2.1-26)], and congestive heart failure [3.9 (1.4-11)]. PC patients with none of these risk factors had 17.9% 90-day mortality and no deaths after 90 days; late deaths continued to occur among patients with DNR, CHF, or disseminated cancer. At baseline, PC patients had greater acute and chronic disease burden than CCY patients. After matching, PC and CCY patients had similar age (69 vs. 70 years), TG13 grade (2.4 vs. 2.4), and predicted 30-day mortality (5.5 vs. 6.8%). Matched PC patients had higher 30-day mortality (14.3 vs. 2.4%, p = 0.109) and 180-day mortality (28.6 vs. 7.1%, p = 0.048). CONCLUSIONS Treatment response to PC predicted 30-day mortality; DNR status, and chronic diseases predicted 1-year mortality. Although the matching procedure did not eliminate selection bias, PC was associated with persistent systemic inflammation and higher long-term mortality than CCY.
Collapse
|
45
|
Abstract
Background & Objective: Biliary cysts in pregnant women are a complex medical issue, especially when complicated with cholangitis. It is a serious and life-threatening diagnosis that can seriously endanger both the expectant mother and the fetus. However, during pregnancy, surgical treatment would lead to further complications and higher fetal mortality. Here, we propose a novel therapeutic approach that would be safe for both mother and child during pregnancy, with a definitive treatment postponed until after delivery. Methods: In this retrospective study we have summarized the clinical course of six adult patients diagnosed with choledochal cysts during pregnancy. Treatment was conducted in two stages, firstly, percutaneous cholecystostomy under ultrasound guidance and sustained negative pressure suction until delivery, and secondly, selective choledochal cyst excision when the patients recovered from delivery. Results: All the six patients gave birth to healthy babies. Four patients had Type-I choledochal cysts, and underwent Roux-en-Y hepaticojejunostomy surgery. Two patients had a Type-IV choledochal cyst. The first patient with Type-IV choledochal cyst underwent anastomosis between the secondary hepatic bile duct and jejunum and the second patient underwent laparoscopic cyst internal drainage. No serious complications were recorded after gallbladder drainage or during the perioperative period. Conclusions: Based on our single-centre experience we can conclude that treatment of choledochal cyst with cholangitis during pregnancy can be conducted safely and efficiently through the two stages strategy that we proposed in this paper. The first stage should be percutaneous cholecystostomy followed by elective surgical treatment following delivery.
Collapse
Affiliation(s)
- Baoxing Jia
- Baoxing Jia, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Ludong Tan
- Ludong Tan, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Zhe Jin
- Zhe Jin, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yahui Liu
- Yahui Liu, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
46
|
Zarour S, Imam A, Kouniavsky G, Lin G, Zbar A, Mavor E. Percutaneous cholecystostomy in the management of high-risk patients presenting with acute cholecystitis: Timing and outcome at a single institution. Am J Surg 2017; 214:456-461. [PMID: 28237047 DOI: 10.1016/j.amjsurg.2017.01.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/15/2017] [Accepted: 01/29/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cholecystectomy is the standard of care in acute cholecystitis (AC). Percutaneous cholecystostomy (PC) is an effective alternative for high-risk surgical cases. METHODS A retrospective analysis is presented of AC patients treated with PC drainage at a single tertiary institution over a 21 month period, assessing outcome and complications. RESULTS Of 119 patients, 103 had clinical improvement after PC insertion. There were 7 peri-procedural deaths (5.9%), all in elderly high-risk cases. Overall, 56/103 cases (54%) were definitively managed with PC drainage with 41 patients (40%) undergoing an elective cholecystectomy (75% performed laparoscopically). The timing of PC insertion did not affect AC resolution or drain-related complications, although more patients underwent an elective cholecystectomy if PC placement was delayed (>24 h after admission). CONCLUSIONS In AC, drainage by a PC catheter is a safe and effective procedure. It may be used either as a bridge to elective cholecystectomy or in selected cases as definitive therapy.
Collapse
Affiliation(s)
- Shiri Zarour
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel.
| | - Ashraf Imam
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel.
| | - Guennadi Kouniavsky
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel.
| | - Guy Lin
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel.
| | - Andrew Zbar
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel.
| | - Eli Mavor
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel.
| |
Collapse
|
47
|
Abstract
The gold standard for the management of acute cholecystitis is laparoscopic cholecystectomy. In patients that are not fit for surgery, percutaneous cholecystostomy is the standard treatment. However, the procedure is only a temporary measure for controlling gallbladder symptoms and it is frequently associated with morbidities. Recently, endoscopic options for management of acute cholecystitis have been developed. The approach avoids the need for a percutaneous drain and may allow endoscopic treatment of the gallstone. The aim of this article is to provide an overview on the current status of endoscopic management of acute cholecystitis.
Collapse
|
48
|
Bollu BK, Dawrant MJ, Thacker K, Thomas G, Chenapragadda M, Gaskin K, Shun A. Inspissated bile syndrome; Safe and effective minimally invasive treatment with percutaneous cholecystostomy in neonates and infants. J Pediatr Surg 2016; 51:2119-2122. [PMID: 27712892 DOI: 10.1016/j.jpedsurg.2016.09.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Inspissated bile syndrome (IBS) is a rare cause of obstructive jaundice in neonates and infants with several treatment options reported. We present our experience with the use of minimally invasive ultrasound-guided percutaneous cholecystostomy drain catheter placement with ongoing saline lavage in neonates and infants. METHODS Retrospective chart review of patients treated with percutaneous cholecystostomy, from February 2010 till June 2015. We reviewed the technical and clinical success along with complications of the procedure. RESULTS There were 6 patients, mean age 17weeks (range 4-40). Most had significant risk factors for IBS presenting with biliary obstruction. A total of 7 procedures performed on the 6 patients, with a technical success rate of 6/7. One patient required cannulation of the intrahepatic biliary system. Drains were flushed for a median of 26days (10-70). Clinical success was achieved in all patients. 3 had displacement of the drain, one of which required re-insertion. Another developed a small sub-hepatic collection post procedure with pyrexia. On long term follow up one was found to have a forme fruste choledochal cyst. CONCLUSION Centers with suitable interventional radiology services ultrasound-guided percutaneous cholecystostomy drain catheter placement with ongoing saline lavage is a safe and effective minimally invasive treatment for IBS in neonates and infants.
Collapse
Affiliation(s)
- Bapesh K Bollu
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, Australia.
| | - Michael J Dawrant
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, Australia
| | - Kunal Thacker
- Department of Gastroenterology, The Children's Hospital at Westmead, Sydney, Australia
| | - Gordon Thomas
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, Australia
| | | | - Kevin Gaskin
- Department of Gastroenterology, The Children's Hospital at Westmead, Sydney, Australia
| | - Albert Shun
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, Australia
| |
Collapse
|
49
|
Boules M, Haskins IN, Farias-Kovac M, Guerron AD, Schechtman D, Samotowka M, O'Rourke CP, McLennan G, Walsh RM, Morris-Stiff G. What is the fate of the cholecystostomy tube following percutaneous cholecystostomy? Surg Endosc 2016; 31:1707-1712. [PMID: 27519595 DOI: 10.1007/s00464-016-5161-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/27/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Cholecystectomy is the preferred treatment for acute cholecystitis with percutaneous cholecystostomy (PC) considered an alternative therapy in severely debilitated patients. The aim of this study was to evaluate the efficacy and outcomes of PC at a tertiary referral center. METHODS We retrospectively reviewed all patients that had undergone PC from 2000 to 2014. Data collected included baseline demographics, comorbidities, details of PC placement and management, and post-procedure outcomes. The Charlson comorbidity index (CCI) was calculated for all patients at the time of PC. RESULTS Four hundred and twenty-four patients underwent PC placement from 2000 to 2014, and a total of 380 patients had long-term data available for review. Within this cohort, 223 (58.7 %) of the patients were male. The mean age at the time of PC placement was 65.3 ± 14.2 years of age, and the mean CCI was 3.2 ± 2.1 for all patients. One hundred and twenty-five (32.9 %) patients went on to have a cholecystectomy following PC placement. Comparison of patients who underwent PC followed by surgical intervention revealed that they were significantly younger (p = 0.0054) and had a lower CCI (p < 0.0001) compared to those who underwent PC alone. CONCLUSIONS PC placement appears to be a viable, long-term alternative to cholecystectomy for the management of biliary disease in high-risk patients. Old and frail patients benefit the most, and in this cohort PC may be the definitive treatment.
Collapse
Affiliation(s)
- M Boules
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA.
| | - I N Haskins
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| | - M Farias-Kovac
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| | - A D Guerron
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| | - D Schechtman
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| | - M Samotowka
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| | - C P O'Rourke
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - G McLennan
- Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - R M Walsh
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| | - G Morris-Stiff
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| |
Collapse
|
50
|
Schaefer CM, Towbin RB, Aria DJ, Kaye RD. Safety and effectiveness of percutaneous cholecystostomy in critically ill children who are immune compromised. Pediatr Radiol 2016; 46:1040-5. [PMID: 26886916 DOI: 10.1007/s00247-016-3562-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/04/2016] [Accepted: 01/24/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acalculous cholecystitis is known to develop in critically ill patients without cystic duct obstruction. In the past, treatment for acalculous cholecystitis has been cholecystectomy; however, many children who are critically ill are Percutaneous cholecystostomy is likely the procedure of choice in this subgroup of patients. OBJECTIVE To assess the safety and effectiveness of percutaneous cholecystostomy in critically ill and immune-compromised children with acalculous cholecystitis. MATERIALS AND METHODS Retrospective review of immune-compromised and critically ill children who underwent percutaneous cholecystostomy between 2006 and 2013. Diagnostic imaging performed included ultrasound, CT and hepatobiliary scintigraphy. Every percutaneous cholecystostomy was performed using imaging guidance. RESULTS Ten critically ill and immune-compromised children with acalculous cholecystitis underwent percutaneous cholecystostomy. Seven boys and 3 girls, ranging in age from 10 months to 15 years 8 months, were treated. Six of the immune-compromised children had received a bone marrow transplant for leukemia (5 children) or severe combined immunodeficiency (SCID) (1 child), and ranged from 18 to 307 days post bone marrow transplant at the time of their percutaneous cholecystostomy. Of the remaining four immune-compromised children with acalculous cholecystitis who underwent percutaneous cholecystostomy, two had leukemia, one had SCID and lymphoma, and the fourth was undergoing treatment for undifferentiated germ cell tumor. The 10 percutaneous gallbladder drains were placed using a transhepatic approach, except one unintentional transperitoneal approach. There were no complications. Three gallbladder drains were removed in Interventional Radiology. Those three patients had a return to normal gallbladder function and didn't require cholecystectomy. Two drains were removed during cholecystectomy and another as an outpatient. Four patients died in the hospital due to multiorgan system failure, with indwelling gallbladder drains. CONCLUSION Percutaneous cholecystostomy is a safe procedure in immune-compromised and critically ill children with acalculous cholecystitis. Percutaneous cholecystostomy may obviate the need for future cholecystectomy.
Collapse
|