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Slama EM, Hosseini M, Staszak RM, Setya VR. Open Cholecystostomy Under Local Anesthesia for Acute Cholecystitis in the Elderly and High-Risk Surgical Patients. Am Surg 2021; 88:434-438. [PMID: 34734555 DOI: 10.1177/00031348211050593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The morbidity and mortality rates associated with cholecystectomy for acute cholecystitis are higher in the critically ill elderly population. As an alternative to cholecystectomy, we report the results of treatment of acute cholecystitis in the elderly after open cholecystolithotomy with cholecystostomy tube placement under local anesthesia. METHODS A case series was performed on 5 patients from August 2007 to April 2010 who presented with acute cholecystitis and underwent an open cholecystolithotomy and tube placement. Thirty-day mortality, intra- and immediate-postoperative complications, clinical improvement after drainage, additional biliary procedures needed, and outcome after cholecystostomy tube removal were recorded. RESULTS Open cholecystolithotomy and tube placement were performed successfully in all patients and permitted resolution of the acute attack in all after a mean period of 3.75 days. Thirty-day mortality was 0%. Patients did not experience any intraoperative complications. We observed 100% rate of successful short-term outcomes in our patients including resolution pain, and objectively, normalization of leukocytosis, and defervescence. None of the patients required emergency cholecystectomy. All patients had their cholecystostomy tubes removed at a mean postoperative day 27. There were no cases of biliary leakage or tube dislodgement. There were no recurrences of acute cholecystitis within the mean follow-up of 20.75 months. DISCUSSION Emergency open cholecystolithotomy and cholecystostomy tube placement represent an effective, safe, and definitive alternative treatment strategy for acute gallstone cholecystitis in selected elderly patients with a mortality rate of 0% in the authors' experience.
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Affiliation(s)
- Eliza M Slama
- Department of Surgery, 21963Ascension Saint Agnes Hospital, Baltimore, MD, USA
| | - Motahar Hosseini
- Department of Cardiothoracic Surgery, 4352Mayo Clinic, Rochester, MN, USA
| | - Ryan M Staszak
- Department of Trauma, Acute Care, and Critical Care Surgery, 328945Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Viney R Setya
- Department of Surgery, 21963Ascension Saint Agnes Hospital, Baltimore, MD, USA
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Yao P, Chang Z, Liu Z. Factors influencing failure to undergo interval cholecystectomy after percutaneous cholecystostomy among patients with acute cholecystitis: a retrospective study. BMC Gastroenterol 2021; 21:410. [PMID: 34711183 PMCID: PMC8555182 DOI: 10.1186/s12876-021-01989-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/20/2021] [Indexed: 02/07/2023] Open
Abstract
Background Percutaneous cholecystostomy (PC) with interval cholecystectomy is an effective treatment modality in high-risk patients with acute cholecystitis. However, some patients still fail to undergo interval cholecystectomy after PC, with the reasons rarely reported. Hence, this study aimed to explore the factors that prevent a patient from undergoing interval cholecystectomy. Methods Data from patients with acute cholecystitis who had undergone PC from January 1, 2017 to December 31, 2019 in our hospital were retrospectively collected. The follow-up endpoint was the patient undergoing cholecystectomy. Patients who failed to undergo cholecystectomy were followed up every three months until death. Univariate and multivariate analyses were performed to analyze the factors influencing failure to undergo interval cholecystectomy. A nomogram was used to predict the numerical probability of non-interval cholecystectomy. Results Overall, 205 participants were identified, and 67 (32.7%) did not undergo cholecystectomy during the follow-up period. Multivariate analysis revealed that having a Tokyo Guidelines 2018 (TG18) grade III status (odds ratio [OR]: 3.83; 95% confidence interval [CI]: 1.27–11.49; p = 0.017), acalculous cholecystitis (OR: 4.55; 95% CI: 1.59–12.50; p = 0.005), an albumin level < 28 g/L (OR: 4.15; 95% CI: 1.09–15.81; p = 0.037), and a history of malignancy (OR: 4.65; 95% CI: 1.62–13.37; p = 0.004) were independent risk factors for a patient’s failure to undergo interval cholecystectomy. Among them, the presence of a history of malignancy exhibited the highest influence in the nomogram for predicting non-interval cholecystectomy. Conclusions Having a TG18 grade III status, acalculous cholecystitis, severe hypoproteinemia, and a history of malignancy influence the failure to undergo cholecystectomy after PC in patients with acute cholecystitis.
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Affiliation(s)
- Peng Yao
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Zhihui Chang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China.
| | - Zhaoyu Liu
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
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Flynn DJ, Memel Z, Hernandez-Barco Y, Visrodia KH, Casey BW, Krishnan K. Outcomes of EUS-guided transluminal gallbladder drainage in patients without cholecystitis. Endosc Ultrasound 2021; 10:381-386. [PMID: 34677160 PMCID: PMC8544015 DOI: 10.4103/eus-d-21-00040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives: Cholecystectomy is the gold standard for most gallbladder-related disease. However, many patients with gallbladder disease are poor surgical candidates. Current nonsurgical gallbladder drainage (GBD) methods include percutaneous cholecystostomy and endoscopic ultrasound-guided transluminal GBD (EUS-GBD). Outcomes for EUS-GBD for the treatment of noncholecystitis (NC) gallbladder disease have not been defined. Materials and Methods: Cases were identified using procedural data from a quaternary academic hospital for endoscopic procedures from 2015 to 2020. Patients who underwent EUS-GBD for acute cholecystitis, biliary colic, gallstone pancreatitis, and secondary prevention of gallstone disease were included. Results: Fifty-five cases of EUS-GBD were identified over the 5-year study period. Forty-one cases were performed for acute cholecystitis, and 15 were performed for other NC indications. Indications for NC drainage included primary treatment of symptomatic biliary colic and secondary prevention of gallstone pancreatitis and choledocholithiasis. There was no statistically significant difference in complications, mortality, or reintervention requirements. There was a 13.3% rate of immediate complications in the NC group, which were all medically managed. Conclusions: EUS-GBD appears to be a safe and effective way to manage gallstone disease in nonsurgical candidates with NC gallbladder-related disease. Overall complications and readmissions were infrequent. Complication rates were similar to those published in patients who underwent EUS-GBD for acute cholecystitis.
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Affiliation(s)
- Duncan J Flynn
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Zoe Memel
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Brenna W Casey
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Kumar Krishnan
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
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Madhusudhan KS, Jineesh V, Keshava SN. Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures. Indian J Radiol Imaging 2021; 31:421-440. [PMID: 34556927 PMCID: PMC8448229 DOI: 10.1055/s-0041-1734222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Percutaneous biliary interventions are among the commonly performed nonvascular radiological interventions. Most common of these interventions is the percutaneous transhepatic biliary drainage for malignant biliary obstruction. Other biliary procedures performed include percutaneous cholecystostomy, biliary stenting, drainage for bile leaks, and various procedures like balloon dilatation, stenting, and large-bore catheter drainage for bilioenteric or post-transplant anastomotic strictures. Although these procedures are being performed for ages, no standard guidelines have been formulated. This article attempts at preparing guidelines for performing various percutaneous image-guided biliary procedures along with discussion on the published evidence in this field.
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Affiliation(s)
| | - Valakkada Jineesh
- Department of Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (Thiruvananthapuram), Kerala, India
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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] [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.
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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
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Jandura DM, Puli SR. Efficacy and safety of endoscopic transpapillary gallbladder drainage in acute cholecystitis: An updated meta-analysis. World J Gastrointest Endosc 2021; 13:345-355. [PMID: 34512882 PMCID: PMC8394187 DOI: 10.4253/wjge.v13.i8.345] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous transhepatic gallbladder drainage has been the most frequently performed treatment for acute cholecystitis for patients who are not candidates for surgery. Endoscopic transpapillary gallbladder drainage (ETGBD) has evolved into an alternative treatment. There have been numerous retrospective and prospective studies evaluating ETGBD for acute cholecystitis, though results have been variable.
AIM To evaluate the efficacy and safety of ETGBD in the treatment of inoperable patients with acute cholecystitis.
METHODS We performed a systematic review of major literature databases including PubMed, OVID, Science Direct, Google Scholar (from inception to March 2021) to identify studies reporting technical and clinical success, and post procedure adverse events in ETGBD. Weighted pooled rates were then calculated using fixed effects models for technical and clinical success, and post procedure adverse events, including recurrent cholecystitis.
RESULTS We found 21 relevant articles that were then included in the study. In all 1307 patients were identified. The pooled technical success rate was 82.62% [95% confidence interval (CI): 80.63-84.52]. The pooled clinical success rate was found to be 94.87% (95%CI: 93.54-96.05). The pooled overall complication rate was 8.83% (95%CI: 7.42-10.34). Pooled rates of post procedure adverse events were bleeding 1.03% (95%CI: 0.58-1.62), perforation 0.78% (95%CI: 0.39-1.29), peritonitis/bile leak 0.45% (95%CI: 0.17-0.87), and pancreatitis 1.98% (95%CI: 1.33-2.76). The pooled rates of stent occlusion and migration were 0.39% (95%CI: 0.13-0.78) and 1.3% (95%CI: 0.75-1.99) respectively. The pooled rate of cholecystitis recurrence following ETGBD was 1.48% (95%CI: 0.92-2.16).
CONCLUSION Our meta-analysis suggests that ETGBD is a feasible and efficacious treatment for inoperable patients with acute cholecystitis.
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Affiliation(s)
- David M Jandura
- Department of Gastroenterology, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
| | - Srinivas R Puli
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
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57
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The Importance of Early Management of Severe Biliary Infection: Current Concepts. Int Surg 2021. [DOI: 10.9738/intsurg-d-20-00046.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Background
The incidence of biliary infections is rising worldwide and has become one of the main reasons for emergency admissions.
Methods
This is a narrative review of the literature emphasizing news concepts related to the early management of biliary diseases.
Results
The bacteriology is frequently polymicrobial, with a progressive increase of multidrug resistant bacteria. The form of presentation is variable, and the mortality rate may reach 20%. When cholecystitis or cholangitis is suspected, ultrasound is the gold standard imaging test. Depending on the severity of presentation, local resistances, and risk factors for multiresistant organisms, the most appropriate empirical antibiotic treatment must be initiated. In acute cholecystitis, cholecystectomy plays the main therapeutic role. In patients not suitable for surgery, percutaneous cholecystostomy is a valid alternative for source control. Treatment of severe cholangitis is based on the drainage of the bile duct and antibiotic therapy.
Conclusions
Biliary infections are serious conditions that can lead to sepsis and death. The introduction of new internationally accepted guidelines, based on clinical presentation, laboratory tests, and imaging, provides a platform for their timely diagnosis and management. Early severity assessment, initiation of intravenous antibiotics, and source control are fundamental to improving morbidity and mortality.
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58
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Hung YL, Chen HW, Tsai CY, Chen TC, Wang SY, Sung CM, Hsu JT, Yeh TS, Yeh CN, Jan YY. The optimal timing of interval laparoscopic cholecystectomy following percutaneous cholecystostomy based on pathological findings and the incidence of biliary events. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:751-759. [PMID: 34129718 DOI: 10.1002/jhbp.1012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of biliary events (BE) following percutaneous cholecystostomy (PC) in acute cholecystitis (AC) patients is high. Therefore, definitive laparoscopic cholecystectomy (LC) is recommended. We aimed to investigate the optimal timing of LC following PC with regard to the clinical course and pathological findings. METHODS All 744 AC patients with PC were included. The incidence and median number of BE were investigated with the concept of competing risks. The 344 patients with interval LC were divided into two groups based on the pathological findings of resected gallbladders: the acute/acute-and-chronic group (AANC group) (n = 221) and the chronic group (n = 123). A comparative analysis of the demographic data and perioperative outcomes was performed. RESULTS Among the 744 AC patients with PC, 142 patients experienced recurrent BE. The cumulative incidence of BE was 26.6%, and the median time to recurrence was 67.5 days. The PC-to-LC days of the chronic group were longer than those of the AANC group (73.51 vs 63.00, P < .001). The multivariate analysis indicated that the operation time was longer in the AANC group than in the chronic group (P = .040). CONCLUSION In terms of the clinical course and sequential pathological changes in the gallbladder, a 9- to 10-week interval after PC is the optimal timing for LC.
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Affiliation(s)
- Yu-Liang Hung
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Huan-Wu Chen
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chun-Yi Tsai
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Tse-Ching Chen
- Department of Anatomic Pathology, College of Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Chang-Mu Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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Complications of cholecystitis: a comprehensive contemporary imaging review. Emerg Radiol 2021; 28:1011-1027. [PMID: 34110530 DOI: 10.1007/s10140-021-01944-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 01/12/2023]
Abstract
Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting to the emergency department. Ultrasound, computed tomography, HIDA scans, and magnetic resonance imaging are increasingly utilized to evaluate suspected cases. The prognosis of acute cholecystitis is usually excellent with timely diagnosis and management. However, complications associated with cholecystitis pose a considerable challenge to the clinician and radiologist. Complications of acute cholecystitis may result from secondary bacterial infection or mural ischemia secondary to increased intramural pressure. The recognized subtypes of complicated cholecystitis are hemorrhagic, gangrenous, and emphysematous cholecystitis, as well as gallbladder perforation. Acute acalculous cholecystitis is a form of cholecystitis that occurs as a complication of severe illness in the absence of gallstones or without gallstone-related inflammation. Complicated cholecystitis may cause significant morbidity and mortality, and early diagnosis and recognition play a pivotal role in the management and early surgical planning. As appropriate utilization of imaging resources plays an essential role in diagnosis and management, the emergency radiologist should be aware of the spectrum of complications related to cholecystitis and the characteristic imaging features. This article aims to offer a comprehensive contemporary review of clinical and cross-sectional imaging findings of complications associated with cholecystitis. In conclusion, cross-sectional imaging is pivotal in identifying the complications related to cholecystitis. Preoperative detection of this complicated cholecystitis can help the care providers and operating surgeon to be prepared for a potentially more complicated procedure and course of recovery.
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60
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Imamovic A, Wagner D, Kornprat P, Bacher H, Werkgartner G, Mischinger HJ. Laparoscopic cholecystectomy in critically ill patients. Eur Surg 2021. [DOI: 10.1007/s10353-021-00717-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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61
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Image-guided percutaneous cholecystostomy: a comprehensive review. Ir J Med Sci 2021; 191:727-738. [PMID: 34021480 DOI: 10.1007/s11845-021-02655-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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.
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62
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Huang H, Zhang H, Yang D, Wang W, Zhang X. Percutaneous cholecystostomy versus emergency cholecystectomy for the treatment of acute calculous cholecystitis in high-risk surgical patients: a meta-analysis and systematic review. Updates Surg 2021; 74:55-64. [PMID: 33991327 DOI: 10.1007/s13304-021-01081-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/03/2021] [Indexed: 12/07/2022]
Abstract
The present meta-analysis was performed to compare the efficacy and safety of percutaneous cholecystostomy (PC) versus emergency cholecystectomy (EC) for the treatment of acute calculous cholecystitis (ACC) in high-risk surgical patients. Literature searches for eligible studies were performed using MEDLINE, EMBASE and the Cochrane Library. Quality assessment was conducted in each study. Meta-analyses were performed to demonstrate the pooled effects of relative risk (RR) with 95% confidence intervals (CI). A total of 8960 patients from 6 studies were finally included. PC resulted in increased risks of mortality (RR = 2.87; CI = 1.33-6.18; p = 0.007) and readmission rate (RR = 4.70; CI = 3.30-6.70; p < 0.00001) as compared with EC. No significant difference was detected between PC and EC in terms of morbidity, severe complication rate or hospitalization length. Moreover, PC was associated with significantly higher risks of mortality (RR = 7.47; CI = 1.88-29.72; p = 0.004), morbidity (RR = 3.71; 95% CI = 1.78-7.75; p = 0.0005), readmission rate (RR = 7.91; CI = 3.80-16.49; p < 0.00001), and hospitalization length (WMD = 6.92; CI = 5.89-7.95; p < 0.00001) when directly compared with laparoscopic cholecystectomy (LC). Therefore, EC is superior to PC for the treatment of ACC in high-risk surgical patients, and LC is the preferred surgical strategy.
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Affiliation(s)
- Hejing Huang
- Department of Ultrasound, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Hang Zhang
- Department of Ultrasound, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Dejun Yang
- Department of Gastrointestinal Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Weijun Wang
- Department of Gastrointestinal Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China.
| | - Xin Zhang
- Department of Gastrointestinal Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China.
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63
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Utilization and Outcomes of Cholecystostomy and Cholecystectomy in Patients Admitted With Acute Cholecystitis: A Nationwide Analysis. AJR Am J Roentgenol 2021; 216:1558-1565. [PMID: 33881898 DOI: 10.2214/ajr.20.23156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. The purpose of this study was to report national utilization trends and outcomes after percutaneous cholecystostomy, cholecystectomy, or no intervention among patients admitted to hospitals with acute cholecystitis. MATERIALS AND METHODS. The Nationwide Inpatient Sample was queried from 2005 to 2014. Admissions were identified and stratified into treatment groups of percutaneous cholecystostomy, cholecystectomy, and no intervention on the basis of International Classification of Diseases, 9th revision, codes. Outcomes, including length of stay, inpatient mortality, and complications including hemorrhage and bile peritonitis, were identified. Multivariate analysis was performed to identify mortality risk by treatment type after adjustment for baseline comorbidities and risk of mortality. RESULTS. Among 2,550,013 patients (58.6% women, 41.4% men; mean age, 55.9 years) admitted for acute cholecystitis over the study duration, 73,841 (2.9%) patients underwent percutaneous cholecystostomy, 2,005,728 (78.7%) underwent cholecystectomy, and 459,585 (18.0%) did not undergo either procedure. Use of percutaneous cholecystostomy increased from 2985 procedures in 2005 to 12,650 in 2014. The percutaneous cholecystostomy cohort had a higher mean age (70.6 years) than the other two groups (cholecystectomy, 53.8 years; no intervention, 62.5 years), a higher mean comorbidity index (cholecystostomy, 3.74; cholecystectomy, 1.77; no intervention, 2.65), and a higher mean risk of mortality index (cholecystostomy, 2.88; cholecystectomy, 1.45; no intervention, 2.07) (p < .05). Unadjusted inpatient all-cause mortality was 10.1% in the percutaneous cholecystostomy, 0.8% in the cholecystectomy, and 5.2% in the no intervention cohorts. After adjustment for baseline mortality risk, percutaneous cholecystostomy (odds ratio, 0.78; 95% CI, 0.76-0.81) and cholecystectomy (odds ratio, 0.42; 95% CI, 0.41-0.43) were associated with reduced mortality compared with no intervention. CONCLUSION. Use of percutaneous cholecystostomy is increasing among patients admitted with acute cholecystitis. After adjustment for baseline comorbidities, percutaneous cholecystostomy is associated with improved odds of survival compared with no intervention.
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Hung YL, Sung CM, Fu CY, Liao CH, Wang SY, Hsu JT, Yeh TS, Yeh CN, Jan YY. Management of Patients With Acute Cholecystitis After Percutaneous Cholecystostomy: From the Acute Stage to Definitive Surgical Treatment. Front Surg 2021; 8:616320. [PMID: 33937313 PMCID: PMC8083985 DOI: 10.3389/fsurg.2021.616320] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Percutaneous cholecystostomy (PC) has become an important procedure for the treatment of acute cholecystitis (AC). PC is currently applied for patients who cannot undergo immediate laparoscopic cholecystectomy. However, the management following PC has not been well-reviewed. The efficacy of PC tubes has already been indicated, and compared to complications of other invasive biliary procedures, complications related to PC are rare. Following the resolution of AC, patients who can tolerate anesthesia and the surgical risk should undergo interval cholecystectomy to reduce the recurrence of biliary events. For patients unfit for surgery, whether owing to comorbidities, anesthesia risks, or surgical risks, expectant management may be applied; however, a high incidence of recurrence has been noted. In addition, several interesting issues, such as the indications for cholangiography via the PC tube, removal or maintenance of the PC catheter before definitive treatment, and timing of elective surgery, are all discussed in this review, and a relevant decision-making flowchart is proposed. PC is an effective and safe intervention, whether as expectant treatment or bridge therapy to definitive surgery. High-level evidence of post-PC care is still necessary to modify current practices.
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Affiliation(s)
- Yu-Liang Hung
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Mu Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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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] [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.
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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.
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Current Management of Acute Calculous Cholecystitis. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-020-00282-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Kurata M, Iwashita Y, Ohyama T, Endo I, Hibi T, Umezawa A, Suzuki K, Watanabe M, Asai K, Mori Y, Higashida M, Kumamoto Y, Shindoh J, Yoshida M, Honda G, Misawa T, Abe Y, Nagakawa Y, Toyota N, Yamada S, Norimizu S, Matsumura N, Sata N, Sunagawa H, Ito M, Takeda Y, Nakamura Y, Rikiyama T, Higuchi R, Gocho T, Ueno K, Kumagai Y, Kanaji S, Takada T, Yamamoto M. Assembling a library of typical surgery video clips to construct a system for assessing the surgical difficulty of laparoscopic cholecystectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:255-262. [PMID: 33260262 DOI: 10.1002/jhbp.871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/08/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND To explore best practices for acute cholecystitis, it is necessary to construct a system to assess the difficulty of laparoscopic cholecystectomy (LC) based on intraoperative findings. In this study, multiple evaluators assessed videos of LC to assemble a library of typical video clips for 25 intraoperative findings. METHODS We have previously identified 25 items that contribute to surgical difficulty in LC. For each item, roughly 30-second video clips were submitted from videos of LC performed at member institutions. We then selected one typical video from the collected clips based on simple tabulation of the instances of agreement. Inter-rater agreement was assessed with Fleiss's κ and Gwet's agreement coefficient (AC). RESULTS Except in the case of two assessment items ("edematous change" and "easy bleeding"), κ or AC significantly exceeded 0.5 and the typical videos were judged to be applicable. For the two remaining items, the evaluation was repeated after clarifying the definitions of positive and negative findings. Eventually, they were recognized as typical. The completed video clip library contains 31 clips and is divided into five categories (http://www.jshbps.jp/modules/project/index.php?content_id=13). CONCLUSIONS This clip library may be highly useful in clinical settings as a more objective standard for assessing surgical difficulty in LC.
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Affiliation(s)
- Masanao Kurata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | | | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Akiko Umezawa
- Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Manabu Watanabe
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaharu Higashida
- Department of Digestive Surgery, Kawasaki Medical School, Okayama, Japan
| | - Yusuke Kumamoto
- Department of General, Pediatric and Hepatobiliary-Pancreatic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junichi Shindoh
- Hepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Goro Honda
- Department of Gastroenterological Surgery, New Tokyo Hospital, Matsudo, Japan
| | - Takeyuki Misawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Naoyuki Toyota
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.,Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitama, Japan
| | | | - Shinji Norimizu
- Department of Surgery, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | | | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi, Japan
| | | | - Masahiro Ito
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Aichi, Japan
| | - Yutaka Takeda
- Department of Suregery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takeshi Gocho
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kimihiko Ueno
- Department of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Surgery, Kobe Medical Center, Kobe, Japan
| | - Yuko Kumagai
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi, Japan
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Lyu Y, Li T, Wang B, Cheng Y, Chen L, Zhao S. Comparison of Three Methods of Gallbladder Drainage for Patients with Acute Cholecystitis Who Are at High Surgical Risk: A Network Meta-Analysis and Systematic Review. J Laparoendosc Adv Surg Tech A 2021; 31:1295-1302. [PMID: 33416417 DOI: 10.1089/lap.2020.0897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Percutaneous gallbladder drainage (PTGBD), endoscopic ultrasound-guided gallbladder drainage (EUSGBD), and endoscopic transpapillary gallbladder drainage (ETGBD) are used for the treatment of patients with acute cholecystitis who are at high surgical risk. However, it is unclear which procedure is associated with the best outcomes. Methods: We systematically searched records in PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov up to March 1, 2020. Studies that compared at least two of PTGBD, ETGBD, and EUSGBD were included. Results: A total of 13 studies were included in the present analyses. PTGBD, EUSGBD, and ETGBD were associated with similar clinical success, adverse event, recurrent cholecystitis, reintervention, and mortality rates. PTGBD was associated with a higher technical success rate than EUSGBD (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.40-1.41) or ETGBD (OR = 0.73, 95% CI = 0.35-1.53). EUSGBD was associated with the highest probability of clinical success (67.5%), and the lowest prevalences of adverse events (57.0%) and recurrent cholecystitis (60.9%). ETGBD was associated with the best reintervention outcomes (81.8%). Conclusions: Compared with PTGBD and ETGBD, EUSGBD appears to be preferable with respect to both safety and efficacy for the treatment of patients with acute cholecystitis who are at high surgical risk.
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Affiliation(s)
- Yunxiao Lyu
- Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Ting Li
- Department of Personnel Office, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Bin Wang
- Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Yunxiao Cheng
- Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Liang Chen
- Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Sicong Zhao
- Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, P.R. China
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Woodward SG, Rios-Diaz AJ, Zheng R, McPartland C, Tholey R, Tatarian T, Palazzo F. Finding the Most Favorable Timing for Cholecystectomy after Percutaneous Cholecystostomy Tube Placement: An Analysis of Institutional and National Data. J Am Coll Surg 2021; 232:55-64. [DOI: 10.1016/j.jamcollsurg.2020.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 02/08/2023]
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Frailty Predicts Morbidity and Mortality After Laparoscopic Cholecystectomy for Acute Cholecystitis: An ACS-NSQIP Cohort Analysis. J Gastrointest Surg 2021; 25:932-940. [PMID: 32212087 PMCID: PMC7222970 DOI: 10.1007/s11605-020-04570-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/03/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current guidelines recommend laparoscopic cholecystectomy be offered for patients with acute cholecystitis except those deemed as high risk. Few studies have examined the impact of frailty on outcomes for patients undergoing laparoscopic cholecystectomy. Therefore, the aim of this study was to determine the association of frailty with postoperative morbidity and mortality in patients undergoing laparoscopic cholecystectomy for acute cholecystitis. METHODS Patients undergoing laparoscopic cholecystectomy for acute cholecystectomy were identified from 2005 to 2010 in the American College of Surgeons National Surgical Quality Improvement Project (NSQIP). The Modified Frailty Index (mFI) was used a surrogate for frailty, and patients were stratified as non-frail (mFI 0), low frailty (mFI 1-2), intermediate frailty (mFI 3-4) and high frailty (mFI ≥ 5). Univariable and multivariable analyses were performed. Receiver operator curves (ROC) and an area under the curve (AUC) were generated to determine accuracy of mFI in predicting postoperative morbidity and mortality. RESULTS Of the 6898 patients undergoing laparoscopic cholecystectomy, 3245 (47%) patients were non-frail. There were 2913 (42%) patients with low-frailty, 649 (9%) patients with intermediate frailty, and 91 (2%) with high frailty. Clavien IV complications were higher for intermediate frail patients (OR 1.81, 95% CI 1.00-3.28, p = 0.050) and high-frail patients (OR 4.59, 95% CI 1.98-10.7, p < 0.001). Additionally, mortality was higher for patients with intermediate frailty (OR 4.69, 95% CI 1.37-16.0, p = 0.014) and high frailty (OR 12.2, 95% CI 2.67-55.5, p = 0.001). The mFI had excellent accuracy for mortality (AUC = 0.83) and Clavien IV complications (AUC = 0.73). CONCLUSION Frailty is associated with postoperative morbidity and mortality in patients undergoing laparoscopic cholecystectomy for acute cholecystitis.
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Markopoulos G, Mulita F, Kehagias D, Tsochatzis S, Lampropoulos C, Kehagias I. Outcomes of percutaneous cholecystostomy in elderly patients: a systematic review and meta-analysis. PRZEGLAD GASTROENTEROLOGICZNY 2021; 16:188-195. [PMID: 34584579 PMCID: PMC8456769 DOI: 10.5114/pg.2020.100658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Percutaneous cholecystostomy (PC) represents a management option to control sepsis in patients with acute cholecystitis, who are unable to tolerate surgery. AIM This review aimed to evaluate the outcomes of elderly patients treated with PC and compare it with emergent cholecystectomy. MATERIAL AND METHODS An electronic search of the Embase, Medline Web of Science, and Cochrane databases was performed. Percutaneous cholecystostomy was used as the reference group, and weighted mean differences (WMD) were calculated for the effect of PC on continuous variables, and pooled odds ratios (POR) were calculated for discrete variables. RESULTS There were 20 trials included in this review. Utilisation of PC was associated with significantly increased mortality (POR = 4.85; 95% CI: 1.02-7.30; p = 0.0001) and increased re-admission rates (POR = 2.95; 95% CI: 2.21-3.87; p < 0.0001). CONCLUSIONS This pooled analysis established that patients treated with PC appear to have increased mortality and readmission rates relative to those managed with cholecystectomy.
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Affiliation(s)
- George Markopoulos
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Dimitris Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | | | - Ioannis Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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Mu P, Lin Y, Zhang X, Lu Y, Yang M, Da Z, Gao L, Mi N, Li T, Liu Y, Wang H, Wang F, Leung JW, Yue P, Meng W, Zhou W, Li X. The evaluation of ENGBD versus PTGBD in high-risk acute cholecystitis: A single-center prospective randomized controlled trial. EClinicalMedicine 2021; 31:100668. [PMID: 33385126 PMCID: PMC7772541 DOI: 10.1016/j.eclinm.2020.100668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Gallbladder drainage plays a key role in the management of acute cholecystitis (AC) patients. Percutaneous transhepatic gallbladder drainage (PTGBD) is commonly used while endoscopic naso-gallbladder drainage (ENGBD) serves as an alternative. METHODS A single center, prospective randomized controlled trial was performed. Eligible AC patients were randomly assigned to ENGBD or PTGBD group. Randomization was a computer-generated list with 1:1 allocation. All patients received cholecystectomy 2-3 months after drainage. The primary endpoint was abdominal pain score, and the intention-to-treat population was analyzed. (ClinicalTrials.gov: NCT03701464). FINDINGS Between Oct 1, 2018 and Feb 29, 2020, 22 out of 61 consecutive AC patients were enrolled in the final analysis. The mean abdominal pain scores before drainage, and at 24, 48, and 72 h after drainage in ENGBD were 6.9 ± 1.1, 4.3 ± 1.2, 2.2 ± 0.8 and 1.5 ± 0.5, respectively, while those of PTGBD were 7.4 ± 1.2, 6.2 ± 1.2, 5.3 ± 1.0 and 3.7 ± 0.9; and the mean gallbladder area tenderness scores were 8.4 ± 1.2, 5.7 ± 0.9, 3.5 ± 0.7, 2.5 ± 0.5 for ENGBD and 8.6 ± 0.9, 7.3 ± 1.0, 7.4 ± 0.5, 4.8 ± 0.9 for PTGBD. The mean abdominal pain and gallbladder area tenderness scores of the ENGBD significantly decreased than the PTGBD (group × time interaction P<0.001, respectively). ENGBD group presented lower post-operative hemorrhage and abdominal drainage tube placement rates (median (IQR) 15[5-20] vs 40[20-70]ml, 3vs9, P = 0.03), and pathological grade and lymphocyte count were observed (P = 0.004) between groups. No adverse events were observed in 3 months follow-up. INTERPRETATION Compared to PTGBD, ENGBD group presented less pain, better gallbladder pathological grades and less surgical difficulties during cholecystectomy procedures. FUNDING National Natural Science Foundation of China (82060551).
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Affiliation(s)
- Peilei Mu
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yanyan Lin
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xianzhuo Zhang
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yawen Lu
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Man Yang
- Department of Gastroenterology, Songgang People's Hospital, Shenzhen, Guangdong, China
| | - Zijian Da
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Long Gao
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Ningning Mi
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Tianya Li
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Ying Liu
- Foreign Languages Department of Lanzhou University, Lanzhou, China
| | - Haiping Wang
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, Gansu, China
| | - Fang Wang
- Department of Pathology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Joseph W. Leung
- Division of Gastroenterology and Hepatology, University of California, Davis Medical Center and Sacramento Veterans Affairs Medical Center, Sacramento, CA, United States
| | - Ping Yue
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Corresponding authors at: The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
| | - Wenbo Meng
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, Gansu, China
- Corresponding authors at: The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
| | - Wence Zhou
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, Gansu, China
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xun Li
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, Gansu, China
- The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
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Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S, Boerna D, Coccolini F, Tufo A, Di Martino M, Leung J, Sartelli M, Ceresoli M, Maier RV, Poiasina E, De Angelis N, Magnone S, Fugazzola P, Paolillo C, Coimbra R, Di Saverio S, De Simone B, Weber DG, Sakakushev BE, Lucianetti A, Kirkpatrick AW, Fraga GP, Wani I, Biffl WL, Chiara O, Abu-Zidan F, Moore EE, Leppäniemi A, Kluger Y, Catena F, Ansaloni L. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg 2020; 15:61. [PMID: 33153472 PMCID: PMC7643471 DOI: 10.1186/s13017-020-00336-x] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. MATERIALS AND METHODS The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see https://www.gradeworkinggroup.org/ ). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached. RESULTS The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal. CONCLUSIONS, KNOWLEDGE GAPS AND RESEARCH RECOMMENDATIONS ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.
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Affiliation(s)
- Michele Pisano
- General Surgery I, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Niccolò Allievi
- General Surgery I, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | | | - Djamila Boerna
- Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Federico Coccolini
- General Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Andrea Tufo
- HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK
| | | | - Jeffrey Leung
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Marco Ceresoli
- Department of General and Emergency Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ronald V. Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Elia Poiasina
- General Surgery I, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Nicola De Angelis
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital and University Paris-Est, Creteil, France
| | - Stefano Magnone
- General Surgery I, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paola Fugazzola
- General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Ciro Paolillo
- Emergency Room Brescia Spedali Civili General Hospital, Brescia, Italy
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center-CECORC, Riverside University Health System Medical Center, Moreno Valley, CA USA
| | | | - Belinda De Simone
- Department of General Surgery, Azienda USL-IRCSS di Reggio Emilia, Guastalla Hospital, Guastalla, Italy
| | - Dieter G. Weber
- Department of General Surgery Royal Perth Hospital, The University of Western Australia, Perth, Australia
| | - Boris E. Sakakushev
- Research Institute at Medical University Plovdiv/University Hospital St George, Plovdiv, Bulgaria
| | | | - Andrew W. Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Gustavo P. Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Imitaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Osvaldo Chiara
- General Surgery Trauma Team ASST-GOM Niguarda, Milan, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine, UAE University, Al Ain, UAE
| | - Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO USA
| | - Ari Leppäniemi
- Abdominal Center Helsinki University Hospital, Helsinki, Finland
| | - Yoram Kluger
- Department of General Surgery, the Rambam Academic Hospital, Haifa, Israel
| | - Fausto Catena
- Emergency Surgery, University Parma Hospital, Parma, Italy
| | - Luca Ansaloni
- General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
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Garcés-Albir M, Martín-Gorgojo V, Perdomo R, Molina-Rodríguez JL, Muñoz-Forner E, Dorcaratto D, Ortega J, Sabater L. Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy? J Gastrointest Surg 2020; 24:2579-2586. [PMID: 31792903 DOI: 10.1007/s11605-019-04424-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/25/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate whether percutaneous cholecystostomy (PC) for the treatment of acute calculous cholecystitis (ACC) has better results than emergency cholecystectomy (EC) in elderly and high-risk surgical patients. METHODS Patients ≥ 70 years and/or ≥ ASA-PS 3 with ACC treated with PC or EC between 2005 and 2016 were retrospectively reviewed. Both techniques were compared regarding morbi-mortality, hospital stay, complications and readmissions. A subgroup analysis in higher risk patients (≥ 70 years plus ≥ ASA-PS 3) was also performed. A binary logistic regression analysis for outcome variables to calculate the OR was carried out. RESULTS A total of 461 patients were included in the study. The results of PC were worse compared to EC: 30-day mortality (8.6 vs. 1.7%, OR 18.4), 90-day mortality (10.4 vs. 2.1%, OR 10.3), length of stay (days) (13.21 ± 8.2 vs. 7.48 ± 7.67, OR 8.7) and readmission rate (35.1 vs. 12.6%, OR 4.7). Complications were lower for PC (14 vs. 22.6%, OR 0.41), but there were no significant differences in the number of severe complications (Clavien-Dindo ≥ III). Higher-risk subgroup analysis (n = 193; PC = 128, EC = 65) showed similar results to the whole series. Patients with ACC for more than 3 days had more risk of severe complications in both groups (OR 2.26; OR 2.76). CONCLUSION PC was associated with an increased risk of mortality at 30 and 90 days, more readmissions and longer hospital stay. Although PC presents a lower risk of complications, the percentage of severe complications (Clavien-Dindo ≥ III) does not show significant differences.
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Affiliation(s)
- Marina Garcés-Albir
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain.
| | - Víctor Martín-Gorgojo
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Raúl Perdomo
- Department of Surgery, Hospital Maciel, 11000, Montevideo, Uruguay
| | | | - Elena Muñoz-Forner
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Dimitri Dorcaratto
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Joaquín Ortega
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Luis Sabater
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
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75
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Devane AM, Annam A, Brody L, Gunn AJ, Himes EA, Patel S, Tam AL, Dariushnia SR. Society of Interventional Radiology Quality Improvement Standards for Percutaneous Cholecystostomy and Percutaneous Transhepatic Biliary Interventions. J Vasc Interv Radiol 2020; 31:1849-1856. [PMID: 33011014 DOI: 10.1016/j.jvir.2020.07.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- A Michael Devane
- Department of Radiology, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, South Carolina.
| | - Aparna Annam
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado; Interventional Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Lynn Brody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Sheena Patel
- Society of Interventional Radiology, Fairfax, Virginia
| | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Sean R Dariushnia
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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76
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Percutaneous Cholecystostomy Placement in Cases of Non-operative Cholecystitis: A Retrospective Cohort Analysis. World J Surg 2020; 44:4077-4085. [PMID: 32860139 DOI: 10.1007/s00268-020-05752-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acute (calculous) cholecystitis (AC) is an extremely common surgical presentation, managed by cholecystectomy. Percutaneous cholecystostomy (PC) is an alternative; however, its safety and efficacy, along with subsequent cholecystectomy, are underreported in South Africa, where patients often present late and access to emergency operating theatre is constrained. The aim of the study was to demonstrate the outcomes of PC in patients with AC not responding to antimicrobials. MATERIALS AND METHODS A retrospective cohort review of patient records, who underwent PC in Groote Schuur Hospital, Cape Town, between May 2013 and July 2016, was performed. Patients with PC for malignancy or acalculous cholecystitis were excluded. Technical success, clinical response, procedure-related morbidity and mortality were recorded. Interval LC parameters were investigated. RESULTS Technical success and clinical improvement was seen in 29 of 37 patients (78.38%) who had PC. Malposition (8.11%) was the most common complication. Two patients required emergency surgery (5.4%), while one tube was dislodged. Median tube placement duration was 25 days (range 1-211). Post-procedure, 16 patients (43.24%) went on to have LC, of which 50% (eight patients) required conversion to open surgery and 25% (four) had subtotal cholecystectomy. Median surgical time was 130 min. There were no procedure-related mortalities but eight patients (21.62%) died in the 90-day period following tube insertion. CONCLUSION In patients with AC, PC is safe, with high technical success and low complication rate. Subsequent cholecystectomy should be performed, but is usually challenging. The requirement for PC may predict a more complex disease process.
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77
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Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy. Ann Surg 2020; 272:3-23. [PMID: 32404658 DOI: 10.1097/sla.0000000000003791] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND BDI is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI. METHODS Literature reviews were conducted for 18 key questions across 6 broad topics around cholecystectomy directed by a steering group and subject experts from 5 surgical societies (Society of Gastrointestinal and Endoscopic Surgeons, Americas Hepato-Pancreato-Biliary Association, International Hepato-Pancreato-Biliary Association, Society for Surgery of the Alimentary Tract, and European Association for Endoscopic Surgery). Evidence-based recommendations were formulated using the grading of recommendations assessment, development, and evaluation methodology. When evidence-based recommendations could not be made, expert opinion was documented. A number of recommendations for future research were also documented. Recommendations were presented at a consensus meeting in October 2018 and were voted on by an international panel of 25 experts with greater than 80% agreement considered consensus. RESULTS Consensus was reached on 17 of 18 questions by the guideline development group and expert panel with high concordance from audience participation. Most recommendations were conditional due to low certainty of evidence. Strong recommendations were made for (1) use of intraoperative biliary imaging for uncertainty of anatomy or suspicion of biliary injury; and (2) referral of patients with confirmed or suspected BDI to an experienced surgeon/multispecialty hepatobiliary team. CONCLUSIONS These consensus recommendations should provide guidance to surgeons, training programs, hospitals, and professional societies for strategies that have the potential to reduce BDIs and positively impact patient outcomes. Development of clinical and educational research initiatives based on these recommendations may drive further improvement in the quality of surgical care for patients undergoing cholecystectomy.
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78
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Posner H, Widmer J. EUS guided gallbladder drainage. Transl Gastroenterol Hepatol 2020; 5:41. [PMID: 32632392 DOI: 10.21037/tgh.2019.12.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/27/2019] [Indexed: 12/21/2022] Open
Abstract
Cholecystectomy is the gold standard treatment for acute cholecystitis, but it may not be appropriate for patients with significant comorbidities. Percutaneous gallbladder drainage (PT-GBD) and endoscopic transpapillary gallbladder drainage (ET-GBD) are alternatives with good technical and clinical success rates, but are limited by technical challenges and the need for definitive therapy. EUS-guided gallbladder drainage (EUS-GBD) is quickly becoming the preferred modality of treatment at expert centers in this cohort of patients due to increased efficacy and minimal adverse events. Technicalities of the procedure, including selection of access site, should be informed by the ultimate needs and anatomy of each patient. With the evolution of new stents and accessories, including a cautery-enhanced lumen apposing metal stent deployment system, success rates and adverse events are favorable. A review of published case series demonstrates an overall clinical success rate of approximately 97% for EUS-GBD. The most common complication is pneumoperitoneum, so the evolution of self-expanding LAMS is promising. EUS-GBD has been successfully described in cases where definitive therapy or a bridge to cholecystectomy is needed. As the procedure's applications continue to evolve, there should be greater discussion about specific details including access site and stent selection.
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Affiliation(s)
- Hannah Posner
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, NY, USA
| | - Jessica Widmer
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, NY, USA
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79
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Sagami R, Hayasaka K, Ujihara T, Nakahara R, Murakami D, Iwaki T, Katsuyama Y, Harada H, Tsuji H, Sato T, Nishikiori H, Murakami K, Amano Y. Feasibility of endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis patients receiving antithrombotic therapy. Ann Gastroenterol 2020; 33:391-397. [PMID: 32624660 PMCID: PMC7315717 DOI: 10.20524/aog.2020.0496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) as a treatment for patients with acute cholecystitis has been shown to obtain high technical and clinical success rates and a low recurrence rate. However, the safety of EUS-GBD for patients receiving antithrombotic therapy (ATT) has not been proven. The aim was to evaluate the safety and efficacy of EUS-GBD in patients receiving ATT. Methods Twelve patients with acute cholecystitis associated with gallstones who were receiving antithrombotic therapy and underwent EUS-GBD were enrolled in this retrospective study. Patients with grade II or III cholecystitis who had failed endoscopic transpapillary GBD (ETGBD) or developed recurrence after multiple ETGBD procedures underwent urgent drainage by EUS-GBD. The primary outcome was the rate of bleeding complications after the procedure and the secondary outcomes were the technical and clinical success rates, complications, and recurrence. Results Eleven (91.6%) patients underwent EUS-GBD with continuation of ATT (at least 1 agent). Five of 12 patients (41.7%) were receiving more than 1 agent for ATT. The rate of bleeding complications was 0% and the technical success rate was 100%, even though some patients had high-grade (severe) cholecystitis and/or several underlying diseases. Early complications were found in 2 (16.7%) patients. The clinical success rate was 91.7% (11/12). There were no recurrences of cholecystitis during the follow-up period (mean 261 [range 5-650] days). Conclusions EUS-GBD yielded high technical and clinical success rates and a low recurrence rate. No patients receiving ATT developed bleeding complications. EUS-GBD might be a good option for patients on ATT.
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Affiliation(s)
- Ryota Sagami
- Department of Gastroenterology, Oita San-ai Medical Center, Oita (Ryota Sagami Hiroaki Tsuji, Takao Sato, Hidefumi Nishikiori)
| | - Kenji Hayasaka
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Tetsuro Ujihara
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Ryotaro Nakahara
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Daisuke Murakami
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Tomoyuki Iwaki
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Yasushi Katsuyama
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Hiroaki Tsuji
- Department of Gastroenterology, Oita San-ai Medical Center, Oita (Ryota Sagami Hiroaki Tsuji, Takao Sato, Hidefumi Nishikiori)
| | - Takao Sato
- Department of Gastroenterology, Oita San-ai Medical Center, Oita (Ryota Sagami Hiroaki Tsuji, Takao Sato, Hidefumi Nishikiori)
| | - Hidefumi Nishikiori
- Department of Gastroenterology, Oita San-ai Medical Center, Oita (Ryota Sagami Hiroaki Tsuji, Takao Sato, Hidefumi Nishikiori)
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University (Kazunari Murakami)
| | - Yuji Amano
- Department of Endoscopy, New Tokyo Hospital, Chiba (Yuji Amano), Japan
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Beburishvili AG, Panin SI, Zyubina EN, Nesterov SS, Puzikova AV. [Cholecystostomy in acute cholecystitis in modern surgical practice]. Khirurgiia (Mosk) 2020:44-48. [PMID: 32573531 DOI: 10.17116/hirurgia202006144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To improve the results of treatment of acute cholecystitis. MATERIAL AND METHODS A historical cohort study (1965-2016) included 1248 patients with acute obstructive cholecystitis and 154 patients with acute obstructive cholecystitis combined with ductal complications and obstructive jaundice. Cholecystostomy was used in all patients. A systematic review of the evidence base on the use of cholecystostomy in high-risk patients was carried out. RESULTS Cholecystostomy through laparotomy was performed in 240 patients for the period 1965-1981. Overall mortality was 3.6%. Staged treatment strategy has been applied since 1982. Laparoscopic cholecystostomy followed by cholecystectomy through laparotomy was performed in 225 patients for the period from 1982 to 1992. Overall mortality rate was 3.2%. Laparoscopic cholecystostomy (n=617) followed by staged laparoscopic cholecystectomy has been applied for the period from 1993 to 2007. Overall mortality decreased up to 1.1%. Indications for laparoscopic cholecystostomy and staged treatment have been limited since 2008 (n=166). Overall mortality rate was 0.6%. The maximum postoperative mortality after cholecystostomy in some years reached 14.8%. Simultaneous surgeries through laparotomy in patients with acute obstructive cholecystitis and ductal complications were followed by mortality rate 8%, staged laparoscopic cholecystostomy and other minimally invasive technologies (endoscopic papillosphincterotomy with lithoextraction and laparoscopic cholecystectomy) - 4.7%. CONCLUSION External drainage of the gallbladder is more effective as additional method within staged minimally invasive treatment of complicated cholecystitis rather separate operation. Further analysis of treatment of high-risk patients with acute cholecystitis (as most often selected for cholecystostomy) is required considering the absence of evidence base on this issue.
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Affiliation(s)
- A G Beburishvili
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
| | - S I Panin
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
| | - E N Zyubina
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
| | - S S Nesterov
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
| | - A V Puzikova
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
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81
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Identification of risk factors for obstructive cholecystitis following placement of biliary stent in unresectable malignant biliary obstruction: a 5-year retrospective analysis in single center. Surg Endosc 2020; 35:2679-2689. [DOI: 10.1007/s00464-020-07694-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/09/2020] [Indexed: 12/21/2022]
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82
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Campanile FC, Podda M, Arezzo A, Botteri E, Sartori A, Guerrieri M, Cassinotti E, Muttillo I, Pisano M, Brachet Contul R, D'Ambrosio G, Cuccurullo D, Bergamini C, Allaix ME, Caracino V, Petz WL, Milone M, Silecchia G, Anania G, Agrusa A, Di Saverio S, Casarano S, Cicala C, Narilli P, Federici S, Carlini M, Paganini A, Bianchi PP, Salaj A, Mazzari A, Meniconi RL, Puzziello A, Terrosu G, De Simone B, Coccolini F, Catena F, Agresta F. Acute cholecystitis during COVID-19 pandemic: a multisocietary position statement. World J Emerg Surg 2020; 15:38. [PMID: 32513287 PMCID: PMC7278255 DOI: 10.1186/s13017-020-00317-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022] Open
Abstract
Following the spread of the infection from the new SARS-CoV2 coronavirus in March 2020, several surgical societies have released their recommendations to manage the implications of the COVID-19 pandemic for the daily clinical practice. The recommendations on emergency surgery have fueled a debate among surgeons on an international level.We maintain that laparoscopic cholecystectomy remains the treatment of choice for acute cholecystitis, even in the COVID-19 era. Moreover, since laparoscopic cholecystectomy is not more likely to spread the COVID-19 infection than open cholecystectomy, it must be organized in such a way as to be carried out safely even in the present situation, to guarantee the patient with the best outcomes that minimally invasive surgery has shown to have.
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Affiliation(s)
- Fabio Cesare Campanile
- Division of General Surgery, San Giovanni Decollato-Andosilla Hospital, Civita Castellana, ASL VT, Italy
| | - Mauro Podda
- Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, Policlinico Universitario di Monserrato "Duilio Casula" University of Cagliari, SS 554, Km 4,500, Monserrato, 09042, Cagliari, Italy.
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili di Brescia, Montichiari, Italy
| | - Alberto Sartori
- Department of General Surgery, Ospedale di Montebelluna, Montebelluna, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Elisa Cassinotti
- Chirurgia Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irnerio Muttillo
- Department of General and Emergency Surgery, Ospedale San Filippo Neri, Roma, Italy
| | - Marcello Pisano
- Department of General Surgery, Ospedale San Marcellino di Muravera, Cagliari, Italy
| | - Riccardo Brachet Contul
- Department of General and Emergency Surgery, Ospedale Regionale Umberto Parini, Aosta, Italy
| | - Giancarlo D'Ambrosio
- Department of General Surgery, Surgical Specialties and Organ Transplantation, Rome, Italy
| | - Diego Cuccurullo
- Department of General Surgery, Ospedali dei Colli Monaldi Hospital, Naples, Italy
| | | | | | | | - Wanda Luisa Petz
- Department of Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, University La Sapienza of Rome, Latina, Italy
| | - Gabriele Anania
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Antonino Agrusa
- Department of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | | | - Salvatore Casarano
- Operating theatre, Pia Fondazione Panico Hospital, Tricase, Lecce, Italy
| | - Caterina Cicala
- Operating theatre, Fondazione Policlinico Gemelli IRCSS, Rome, Italy
| | - Piero Narilli
- Division of General Surgery, Casa di Cura Nuova Itor, Rome, Italy
| | - Sara Federici
- Division of General Surgery, Casa di Cura Nuova Itor, Rome, Italy
| | | | - Alessandro Paganini
- Department of Surgery "Paride Stefanini", La Sapienza University of Rome, Rome, Italy
| | - Paolo Pietro Bianchi
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Adelona Salaj
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Andrea Mazzari
- Department of Mini-Invasive and General Surgery, Cristo Re Hospital, Rome, Italy
| | | | | | - Giovanni Terrosu
- Department of General Surgery, Clinica Chirurgica, University of Udine, Udine, Italy
| | - Belinda De Simone
- Department of Visceral Surgery, Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Federico Coccolini
- Emergency Surgery Unit and Trauma Center, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
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Teoh AYB, Kitano M, Itoi T, Pérez-Miranda M, Ogura T, Chan SM, Serna-Higuera C, Omoto S, Torres-Yuste R, Tsuichiya T, Wong KT, Leung CH, Chiu PWY, Ng EKW, Lau JYW. Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1). Gut 2020; 69:1085-1091. [PMID: 32165407 DOI: 10.1136/gutjnl-2019-319996] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The optimal management of acute cholecystitis in patients at very high risk for cholecystectomy is uncertain. The aim of the current study was to compare endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) to percutaneous cholecystostomy (PT-GBD) as a definitive treatment in these patients under a randomised controlled trial. DESIGN Consecutive patients suffering from acute calculous cholecystitis but were at very high-risk for cholecystectomy were recruited. The primary outcome was the 1-year adverse events rate. Secondary outcomes include technical and clinical success, 30-day adverse events, pain scores, unplanned readmissions, re-interventions and mortalities. RESULTS Between August 2014 to February 2018, 80 patients were recruited. EUS-GBD significantly reduced 1 year adverse events (10 (25.6%) vs 31 (77.5%), p<0.001), 30-day adverse events (5 (12.8%) vs 19 (47.5%), p=0.010), re-interventions after 30 days (1/39 (2.6%) vs 12/40 (30%), p=0.001), number of unplanned readmissions (6/39 (15.4%) vs 20/40 (50%), p=0.002) and recurrent cholecystitis (1/39 (2.6%) vs 8/40 (20%), p=0.029). Postprocedural pain scores and analgesic requirements were also less (p=0.034). The technical success (97.4% vs 100%, p=0.494), clinical success (92.3% vs 92.5%, p=1) and 30-day mortality (7.7% vs 10%, p=1) were statistically similar. The predictor to recurrent acute cholecystitis was the performance of PT-GBD (OR (95% CI)=5.63 (1.20-53.90), p=0.027). CONCLUSION EUS-GBD improved outcomes as compared to PT-GBD in those patients that not candidates for cholecystectomy. EUS-GBD should be the procedure of choice provided that the expertise is available after a multi-disciplinary meeting. Further studies are required to determine the long-term efficacy. TRIAL REGISTRATION NUMBER NCT02212717.
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Affiliation(s)
- Anthony Y B Teoh
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Manuel Pérez-Miranda
- Gastroenterology and Hepatology, University Hospital Rio Hortega, Valladolid, Spain
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Takatuki, Japan
| | | | - Carlos Serna-Higuera
- Gastroenterology and Hepatology, University Hospital Rio Hortega, Valladolid, Spain
| | - Shunsuke Omoto
- Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan
| | - Raul Torres-Yuste
- Gastroenterology and Hepatology, University Hospital Rio Hortega, Valladolid, Spain
| | - Takayoshi Tsuichiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Ka Tak Wong
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Ho Leung
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Wai Yan Chiu
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Enders Kwok Wai Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - James Yun Wong Lau
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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84
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Santos D, Ledet CR, Limmer A, Gibson H, Badgwell B. Use of non-operative treatment and interval cholecystectomy for cholecystitis in patients with cancer. Trauma Surg Acute Care Open 2020; 5:e000439. [PMID: 32420452 PMCID: PMC7223470 DOI: 10.1136/tsaco-2020-000439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/03/2020] [Accepted: 04/17/2020] [Indexed: 11/04/2022] Open
Abstract
Background Early cholecystectomy (EC) for acute cholecystitis (AC) is standard. Often patients with cancer are not EC candidates and require non-surgical treatments. We analyzed factors associated with non-surgical treatments and progression to interval cholecystectomy (IC). Materials and methods We performed a case-control study reviewing consults for AC from 2001 to 2017 in a tertiary cancer center. Study patients had cancer, abdominal pain, and positive imaging studies. Univariate analysis and regression modeling evaluated associations between non-surgical management, resolution of AC, and IC. Results 206 patients met the criteria. 20 underwent EC, 132 took antibiotics (ABX), and were treated with 54 percutaneous cholecystostomy tubes (PCTs). AC resolution was higher with PCT versus ABX (94% vs. 80%, p=0.02). Univariate analysis revealed higher absolute neutrophil counts (ANCs) and longer length of stay in PCT, and logistic regression revealed independent associations of abdominal malignancy (OR=6.66, 95% CI 1.36 to 32.6, p=0.09), abdominal radiation (OR=0.09, 95% CI 0.02 to 0.53, p<0.01), and PCT with resolution of AC (OR=4.89, 95% CI 1.18 to 20.2, p=0.01). IC rate was 43%, and median time to IC after was 45 to 67 days. Multivariate analysis revealed nausea/vomiting and increasing platelets are independently associated with IC. Recent chemotherapy increases odds of IC in the presence of rising ANC (OR=1.14, 95% CI 1.00 to 1.30, p=0.05). Conclusion PCT has a higher success rate of resolving AC than ABX. Abdominal malignancy increases odds of resolution; abdominal radiation decreases odds. Nausea/vomiting and recent chemotherapy, coupled with rising ANC are associated with IC, but less than 50% of patients return for operation. PCT may not be a bridge to IC in our population.Level of evidence II.
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Affiliation(s)
- David Santos
- Department of Surgical Oncology, UTMDACC, Houston, Texas, USA
| | | | - Angela Limmer
- Department of Surgical Oncology, UTMDACC, Houston, Texas, USA
| | - Heather Gibson
- Department of Surgical Oncology, UTMDACC, Houston, Texas, USA
| | - Brian Badgwell
- Department of Surgical Oncology, UTMDACC, Houston, Texas, USA
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85
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Fugazza A, Colombo M, Repici A, Anderloni A. Endoscopic Ultrasound-Guided Gallbladder Drainage: Current Perspectives. Clin Exp Gastroenterol 2020; 13:193-201. [PMID: 32523368 PMCID: PMC7237126 DOI: 10.2147/ceg.s203626] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/13/2020] [Indexed: 12/15/2022] Open
Abstract
According to the recently updated Tokyo Guidelines, laparoscopic cholecystectomy still represents the gold standard for the treatment of acute cholecystitis. However, fragile patients, due to comorbidities or poor clinical conditions, have a high surgical risk. In such cases, percutaneous or endoscopic gallbladder drainage is considered the treatment of choice. In particular, endoscopic ultrasound-guided gallbladder drainage with the placement of specifically designed stents is now considered an alternative option. In addition, the opening of an access door to the lumen of the gallbladder could offer new opportunities for the endoscopic treatment of gallbladder diseases. The purpose of this review is to provide an update on the latest available evidence in the literature regarding the endoscopic ultrasound-guided gallbladder drainage.
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Affiliation(s)
- Alessandro Fugazza
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy
| | - Matteo Colombo
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy.,Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy.,Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy
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86
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Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy. Surg Endosc 2020; 34:2827-2855. [PMID: 32399938 DOI: 10.1007/s00464-020-07568-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bile duct injury (BDI) is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI. METHODS Literature reviews were conducted for 18 key questions across six broad topics around cholecystectomy directed by a steering group and subject experts from five surgical societies (SAGES, AHPBA IHPBA, SSAT, and EAES). Evidence-based recommendations were formulated using the GRADE methodology. When evidence-based recommendations could not be made, expert opinion was documented. A number of recommendations for future research were also documented. Recommendations were presented at a consensus meeting in October 2018 and were voted on by an international panel of 25 experts with greater than 80% agreement considered consensus. RESULTS Consensus was reached on 17 of 18 questions by the Guideline Development Group (GDG) and expert panel with high concordance from audience participation. Most recommendations were conditional due to low certainty of evidence. Strong recommendations were made for (1) use of intraoperative biliary imaging for uncertainty of anatomy or suspicion of biliary injury; and (2) referral of patients with confirmed or suspected BDI to an experienced surgeon/multispecialty hepatobiliary team. CONCLUSION These consensus recommendations should provide guidance to surgeons, training programs, hospitals, and professional societies for strategies that have the potential to reduce BDIs and positively impact patient outcomes. Development of clinical and educational research initiatives based on these recommendations may drive further improvement in the quality of surgical care for patients undergoing cholecystectomy.
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87
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Safety of Percutaneous Cholecystostomy Early Removal: A Retrospective Cohort Study. Surg Laparosc Endosc Percutan Tech 2020; 30:410-415. [PMID: 32398449 DOI: 10.1097/sle.0000000000000799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION There are no strong recommendations regarding the management of percutaneous cholecystostomy (PC). The aim of this study was to assess the safety of early PC removal in terms of complications and recurrent disease. MATERIALS AND METHODS Retrospective observational study of consecutive patients who underwent PC for acute cholecystitis from January 2012 to December 2017. We first evaluated PC-related complications and recurrent disease in patients whose drainage was removed as inpatients (IPR) or as outpatients (OPR). Patients were then divided into 2 groups according to the timing of PC removal: G1 with the PC removed within the first 7 days after its collocation and G2 with the PC removed after 7 days. RESULTS We included 151 patients. Patients in the OPR group had their catheters removed after 52 days (26 to 67 d) while the IPR group after 8 days (6 to 11 d); P<0.001. No difference was seen regarding complications, recurrent disease rate, or readmissions.G1 was comprised of 56 patients (37.1%), whereas G2 had 95 (62.9%). When G1 was compared with G2, no differences were seen in terms of complications. However, G1 presented a shorter duration of antibiotic treatment with 11 days (8 to 14 d) versus 15 days (12 to 23 d) in G2; P<0.001, but had a higher rate of recurrent disease 32.1% versus 14.7% in G2; P=0.014 and a higher rate of readmission 30.3% versus 13.6% in G2; P=0.019. CONCLUSIONS Removal of the PC during the index admission was not associated with a higher risk of complications. However, the PC removal before 7 days could be related to an increase in recurrent disease and readmissions.
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88
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See T. Acute biliary interventions. Clin Radiol 2020; 75:398.e9-398.e18. [DOI: 10.1016/j.crad.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/13/2019] [Indexed: 02/06/2023]
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Søreide JA, Fjetland A, Desserud KF, Greve OJ, Fjetland L. Percutaneous cholecystostomy - An option in selected patients with acute cholecystitis. Medicine (Baltimore) 2020; 99:e20101. [PMID: 32384483 PMCID: PMC7440289 DOI: 10.1097/md.0000000000020101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
While urgent percutaneous cholecystostomy (PC) was introduced as an alternative to acute surgical treatment for acute cholecystitis (AC), the current place of PC in the treatment algorithm for AC is challenged. We evaluate demographics and outcomes of PC in routine clinical practice in a population-based cohort.Retrospective evaluation of consecutive patients treated with PC for AC between 2000 and 2015. The severity of cholecystitis was graded according to the 2013 Tokyo Guidelines.One hundred forty-nine patients were included (82; 55% males) (median age of 72.5 years; range, 21-92). The Tokyo Guidelines criteria of 2013 (TG13) severity grade distribution was 4%, 61.7%, and 34.2% for grades I, II, and III, respectively. No difference was observed between males and females with regard to age, American Society of Anesthesiologists (ASA) score, comorbidities, or previous history of cholecystitis. PC was successfully performed in all but 1 patient, and complications were few and minor. Less than half (48.3%) of all patients subsequently received definitive surgical treatment, mostly (83.3%) laparoscopy. No or minor complications were encountered in 58 (80.6%) patients. Operated patients were significantly younger (P = <.001) and had lower ASA scores (P = .005), less comorbidities (P < .001), and had more seldomly a severe grade 3 cholecystitis (P < .001) than non-operated patients.PC is useful in selected patients with AC. However, since only a half of the patients eventually received definitive surgical treatment, a better routine decision-making based on proper criteria may enable an improved allocation of the individual patient for tailored treatment according to the disease severity, the patient's comorbidity burden, and also to the treatment options available at the institution to prevent overutilization of a non-definitive treatment approach. Comprehension of this responsibility should be acknowledged by hospitals with an emergency surgical service, although the clinical decision-making remains a challenge of the responsible surgeon on call.
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Affiliation(s)
- Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger
- Department of Clinical Medicine, University of Bergen, Bergen
| | - Anja Fjetland
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger
| | - Kari F. Desserud
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger
| | - Ole Jakob Greve
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Lars Fjetland
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
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90
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Torres Yuste R, Garcia-Alonso FJ, Sanchez-Ocana R, Cimavilla Roman M, Peñas Herrero I, Carbajo AY, De Benito Sanz M, Mora Cuadrado N, De la Serna Higuera C, Perez-Miranda M. Safety and efficacy of endoscopic ultrasound-guided gallbladder drainage combined with endoscopic retrograde cholangiopancreatography in the same session. Dig Endosc 2020; 32:608-615. [PMID: 31608503 DOI: 10.1111/den.13562] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/09/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging option for acute cholecystitis in non-surgical candidates. Combining endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones with EUS-GBD in a single session might become a non-surgical management strategy to comprehensively treat gallstone disease in selected patients. METHODS Single-center retrospective cohort study comparing outcomes between EUS-GBD alone (group A) and single-session ERCP combined with EUS-GBD (group B). Consecutive patients who underwent EUS-GBD with a lumen-apposing metal stent (LAMS) between June 2011 and August 2018 were analyzed. Exclusion criteria were subjects included in randomized clinical trials, patients who had had ERCP within 5 days of EUS-GBD, patients in whom ERCP or EUS-GBD was carried out for salvage of one or the other procedure, and patients who underwent concurrent EUS-guided biliary drainage. RESULTS One hundred and nine consecutive patients underwent EUS-GBD with LAMS during the study period. Seventy-one patients satisfied the inclusion criteria and 34 patients were in group A and 37 in group B. Baseline characteristics were similar in both groups. There were no significant differences in technical (97.1% vs 97.3%; P = 0.19) and clinical success rates (88.2% vs 94.6%; P = 0.42) of EUS-GBD in group A versus group B. Rate of adverse events was similar in both groups, five (14.7%) in group A versus five (13.5%) in group B. CONCLUSIONS Single-session EUS-GBD combined with ERCP has comparable rates of technical and clinical success to EUS-GBD alone. A combined EUS-GBD and ERCP procedure does not appear to increase adverse events and makes possible comprehensive treatment of gallstone disease by purely endoscopic means.
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Affiliation(s)
- Raul Torres Yuste
- Gastroenterology Department, University Hospital Rio Hortega, Valladolid, Spain
| | | | - Ramón Sanchez-Ocana
- Gastroenterology Department, University Hospital Rio Hortega, Valladolid, Spain
| | | | - Irene Peñas Herrero
- Gastroenterology Department, University Hospital Rio Hortega, Valladolid, Spain
| | - Ana Yaiza Carbajo
- Gastroenterology Department, University Hospital Rio Hortega, Valladolid, Spain
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91
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Diaconescu B, Uranues S, Fingerhut A, Vartic M, Zago M, Kurihara H, Latifi R, Popa D, Leppäniemi A, Tilsed J, Bratu M, Beuran M. The Bucharest ESTES consensus statement on peritonitis. Eur J Trauma Emerg Surg 2020; 46:1005-1023. [PMID: 32303796 DOI: 10.1007/s00068-020-01338-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/27/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Peritonitis is still an important health problem associated with high morbidity and mortality. A multidisciplinary approach to the management of patients with peritonitis may be an important factor to reduce the risks for patients and improve efficiency, outcome, and the cost of care. METHODS Expert panel discussion on Peritonitis was held in Bucharest on May 2017, during the 17th ECTES Congress, involving surgeons, infectious disease specialists, radiologists and intensivists with the goal of defining recommendations for the optimal management of peritonitis. CONCLUSION This document is an updated presentation of management of peritonitis and represents the summary of the final recommendations approved by a panel of experts.
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Affiliation(s)
- Bogdan Diaconescu
- Anatomy Department, Carol Davila University of Medicine and Phamacy, Bucharest, Romania.
| | - Selman Uranues
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.,Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, P.R. China
| | - Mihaela Vartic
- Intensive Care Unit, Emergency Clinic Hospital Bucharest, Bucharest, Romania
| | - Mauro Zago
- General and Emergency Surgery Division, Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Hayato Kurihara
- Emergency Surgery and Trauma Section, Department of General Surgery, Humanitas Clinical and Research Hospital Head, Milan, Italy
| | - Rifat Latifi
- Westchester Medical Center, Valhalla, New York, USA
| | - Dorin Popa
- Surgery Department, University Hospital Linkoping, Linköping, Sweden
| | - Ari Leppäniemi
- Division of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Jonathan Tilsed
- Honorary Senior Lecturer Hull York Medical School, Chairman UEMS Division of Emergency Surgery, Heslington, UK
| | - Matei Bratu
- Anatomy Department, Carol Davila University of Medicine and Phamacy, Bucharest, Romania
| | - Mircea Beuran
- Surgery Department, Carol Davila University of Medicine and Phamacy, Bucharest, Romania
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92
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Kuan LL, Oyebola T, Mavilakandy A, Dennison AR, Garcea G. Retrospective Analysis of Outcomes Following Percutaneous Cholecystostomy for Acute Cholecystitis. World J Surg 2020; 44:2557-2561. [DOI: 10.1007/s00268-020-05491-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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93
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Cystic Duct Embolization with Chemical Gallbladder Ablation for the Treatment of Acute Calculous Cholecystitis in High-Risk Patients: A Prospective Single-Center Study. J Vasc Interv Radiol 2020; 31:644-648. [DOI: 10.1016/j.jvir.2019.12.806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/12/2019] [Accepted: 12/30/2019] [Indexed: 01/17/2023] Open
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94
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Hung YL, Chong SW, Cheng CT, Liao CH, Fu CY, Hsieh CH, Yeh TS, Yeh CN, Jan YY, Wang SY. Natural Course of Acute Cholecystitis in Patients Treated With Percutaneous Transhepatic Gallbladder Drainage Without Elective Cholecystectomy. J Gastrointest Surg 2020; 24:772-779. [PMID: 30945085 DOI: 10.1007/s11605-019-04213-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/18/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative treatment for acute cholecystitis (AC). We aimed to understand the natural course of AC in patients treated with PTGBD but without later definitive treatments, such as laparoscopic cholecystectomy. METHODS This was a retrospective study of the period from June 2010 to December 2016, during which time 2371 patients were diagnosed with AC and 625 received PTGBD treatment. Among the 625 patients, 237 received no definitive treatment. A biliary event after the initial AC episode was the outcome of interest. In addition, the competing risk of death unrelated to biliary causes was present in the cohort. Therefore, a competing risk model was applied for analysis. RESULTS The cumulative incidence of biliary events was 29.8% with a median of 4.27 months, while the competing event, i.e., death unrelated to a biliary event, was noted in 14.9% of patients with a median 23.54 months. The risk factors of biliary events were prolonged PTGBD indwelling and an abnormal PTGBD cholangiogram. The risk factors of death unrelated to a biliary event included a high Charlson comorbidity index and the initial AC severity. CONCLUSIONS Definitive cholecystectomy is still recommended for patients undergoing PTGBD treatment due to the high incidence of later biliary events. A thorough preoperative evaluation is necessary for those patients before elective cholecystectomy because of the inferior life expectancy and physical status.
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Affiliation(s)
- Yu-Liang Hung
- School of Traditional Chinese Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China
| | - Sio-Wai Chong
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Chi-Tung Cheng
- Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Chi-Hsun Hsieh
- Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Shang-Yu Wang
- Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China.
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China.
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China.
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Kim S, Choi N, Shin M, Jung D. Clinical Safety of Laparoscopic Cholecystectomy in Elderly Patients: A Comparison of Clinical Outcomes in Patients Aged 65 to 79 Years and over 80 Years. JOURNAL OF ACUTE CARE SURGERY 2020. [DOI: 10.17479/jacs.2020.10.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Er S, Berkem H, Özden S, Birben B, Çetinkaya E, Tez M, Yüksel BC. Clinical course of percutaneous cholecystostomies: A cross-sectional study. World J Clin Cases 2020; 8:1033-1041. [PMID: 32258074 PMCID: PMC7103974 DOI: 10.12998/wjcc.v8.i6.1033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/11/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although cholecystectomy is the standard treatment modality, it has been shown that perioperative mortality is approaching 19% in critical and elderly patients. Percutaneous cholecystostomy (PC) can be considered as a safer option with a significantly lower complication rate in these patients.
AIM To assess the clinical course of acute cholecystitis (AC) in patients we treated with PC.
METHODS The study included 82 patients with Grade I, II or III AC according to the Tokyo Guidelines 2018 (TG18) and treated with PC. The patients’ demographic and clinical features, laboratory parameters, and radiological findings were retrospectively obtained from their medical records.
RESULTS Eighty-two patients, 45 (54.9%) were male, and the median age was 76 (35-98) years. According to TG18, 25 patients (30.5%) had Grade I, 34 (41.5%) Grade II, and 23 (28%) Grade III AC. The American Society of Anesthesiologists (ASA) physical status score was III or more in 78 patients (95.1%). The patients, who had been treated with PC, were divided into two groups: discharged patients and those who died in hospital. The groups statistically significantly differed only concerning the ASA score (P = 0.0001) and WBCC (P = 0.025). Two months after discharge, two patients (3%) were readmitted with AC, and the intervention was repeated. Nine of the discharged patients (13.6%) underwent interval open cholecystectomy or laparoscopic cholecystectomy (8/1) within six to eight weeks after PC. The median follow-up time of these patients was 128 (12-365) wk, and their median lifetime was 36 (1-332) wk.
CONCLUSION For high clinical success in AC treatment, PC is recommended for high-risk patients with moderate-severe AC according to TG18, elderly patients, and especially those with ASA scores of ≥ III. According to our results, PC, a safe, effective and minimally invasive treatment, should be preferred in cases suffering from AC with high risk of mortality associated with cholecystectomy.
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Affiliation(s)
- Sadettin Er
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Hüseyin Berkem
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Sabri Özden
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Birkan Birben
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Erdinç Çetinkaya
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Mesut Tez
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Bülent Cavit Yüksel
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
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Wu PS, Chou CK, Hsieh YC, Chen CK, Lin YT, Huang YH, Hou MC, Lin HC, Lee KC. Antibiotic use in patients with acute cholecystitis after percutaneous cholecystostomy. J Chin Med Assoc 2020; 83:134-140. [PMID: 31868860 DOI: 10.1097/jcma.0000000000000244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Currently, evidence regarding the strategies of antibiotic use in patients with acute cholecystitis after receiving percutaneous cholecystostomy is limited. Hence, we aimed to investigate the outcomes in patients with inoperable acute cholecystitis receiving narrow or broad-spectrum antibiotics after percutaneous cholecystostomy. METHODS A total of 117 patients receiving percutaneous cholecystostomy were categorized into moderate and severe acute cholecystitis defined by the Tokyo guideline and then divided into group A (narrow-spectrum antibiotic use) and group B (broad-spectrum antibiotic use). The clinical outcomes and complications were analyzed. RESULTS In moderate acute cholecystitis (n = 80), group A patients (n = 62) had similar early recurrent rate (11.3% vs 16.7%; p = 0.544) and a shorter length of hospital stay (13.4 ± 8.6 vs 18.6 ± 9.4 days; p = 0.009) as compared with group B patients (n = 18). No in-hospital mortality occurred in moderate acute cholecystitis. In severe acute cholecystitis (n = 37), both groups had similar length of hospital stay (16.3 ± 12.2 vs 20.9 ± 9.5 days; p = 0.051), early recurrent rate (0% vs 16.7%; p = 0.105), and in-hospital mortality rate (5.3% vs 16.7%; p = 0.340). Although group B patients with severe cholecystitis had higher serum levels of alkaline phosphatase (Alk-P) and higher proportion of underlying malignancy, American Society of Anesthesiologists (ASA) class IV and septic shock, the clinical outcomes were not inferior to patients in group A. CONCLUSION In moderate acute cholecystitis after percutaneous cholecystostomy, patients receiving narrow-spectrum antibiotics have comparable clinical outcomes as those treated with broad-spectrum antibiotics. However, in severe acute cholecystitis, broad-spectrum antibiotics might still be necessary to rescue these patients.
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Affiliation(s)
- Pei-Shan Wu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chung-Kai Chou
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, National Yang-Ming University Hospital, Ilan, Taiwan, ROC
| | - Yun-Chen Hsieh
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chun-Ku Chen
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Tsung Lin
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Kuei-Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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98
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Mu P, Yue P, Li T, Bai B, Lin Y, Zhang J, Wang H, Liu Y, Yao J, Meng W, Li X. Comparison of endoscopic naso-gallbladder drainage and percutaneous transhepatic gallbladder drainage in acute suppurative cholecystitis: Study Protocol Clinical Trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e19116. [PMID: 32080085 PMCID: PMC7034714 DOI: 10.1097/md.0000000000019116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Transitional drainage, which is followed by cholecystectomy plays a key role in the management of acute cholecystitis, especially in high-risk surgical patients. Endoscopic naso-gallbladder drainage (ENGBD) is an alternative to percutaneous transhepatic gallbladder drainage (PTGBD) for patients who need temporary drainage. There is a lack of prospective comparison on the relevant outcomes of the two drainage methods during the period of drainage, especially the subsequent cholecystectomy. METHODS This is a randomized controlled two-arm non-blind single center trial. Patients with acute cholecystitis undergo emergent or early cholecystectomy and need drainage will be randomly assigned to group PTGBD or ENGBD. Pain score is defined as the primary endpoint, whereas several secondary endpoints, such as the rates of technical success, clinical remission, open conversion of cholecystectomy will be determined to elucidate more detailed differences between two groups. The general feasibility, safety, and quality checks required for high-quality evidence will be adhered to. DISCUSSION This study would provide the first type A evidence concerning the comparison of ENGBD versus PTGBD in surgically high-risk patients with acute cholecystitis, it will be the first trial designed to determine the impact of two drainage methods on not only peri-drainage but also peri-LC. TRIAL REGISTRATION NCT03701464. Registered on October 10, 2018.
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Affiliation(s)
- Peilei Mu
- The First Clinical Medical School of Lanzhou University
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
| | - Ping Yue
- The First Clinical Medical School of Lanzhou University
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
| | - Tianya Li
- The First Clinical Medical School of Lanzhou University
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
| | - Bing Bai
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
| | - Yanyan Lin
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
| | - Jinduo Zhang
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
| | - Haiping Wang
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation
| | - Ying Liu
- Foreign Languages Department of Lanzhou University
| | - Jia Yao
- Clinical Research and Project Management Office, The First Hospital of Lanzhou University
| | - Wenbo Meng
- The First Clinical Medical School of Lanzhou University
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation
| | - Xun Li
- The First Clinical Medical School of Lanzhou University
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation
- The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
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Reppas L, Arkoudis NA, Spiliopoulos S, Theofanis M, Kitrou PM, Katsanos K, Palialexis K, Filippiadis D, Kelekis A, Karnabatidis D, Kelekis N, Brountzos E. Two-Center Prospective Comparison of the Trocar and Seldinger Techniques for Percutaneous Cholecystostomy. AJR Am J Roentgenol 2020; 214:206-212. [PMID: 31573856 DOI: 10.2214/ajr.19.21685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE. The purpose of this study is to compare the safety and efficacy of the bedside ultrasound (US)-guided trocar technique versus the US- and fluoroscopy-guided Seldinger technique for percutaneous cholecystostomy (PC). SUBJECTS AND METHODS. This prospective noninferiority study compared the bedside US-guided trocar technique for PC (the trocar group; 53 patients [28 men and 25 women]; mean [± SD] age, 74.31 ± 16.19 years) with the US- and fluoroscopy-guided Seldinger technique for PC (the Seldinger group; 52 patients [26 men and 26 women], mean age, 79.92 ± 13.38 years) in consecutive patients undergoing PC at two large tertiary university hospitals. The primary endpoints were technical success and procedure-related complication rates. Secondary endpoints included procedural duration, pain assessment, and clinical success after up to 3 months of follow-up. RESULTS. PC was successfully performed for all 105 patients. The clinical success rate was similar between the two study groups (86.8% in the trocar group vs 76.9% in the Seldinger group; p = 0.09). Mean procedural time was significantly lower in the trocar group than in the Seldinger group (1.77 ± 1.62 vs 4.88 ± 2.68 min; p < 0.0001). Significantly more procedure-related complications were noted in the Seldinger group than in the trocar group (11.5% vs 1.9%; p = 0.02). Among patients in the Seldinger group, bile leak occurred in 7.7%, abscess formation in 1.9%, and gallbladder rupture in 1.9%. No procedure-related death was noted. Minor bleeding occurred in one patient (1.9%) in the trocar group, but the bleeding resolved on its own. The mean pain score during the procedure was significantly lower in the Seldinger group than in the trocar group (3.2 ± 1.77 vs 4.76 ± 2.17; p = 0.01). At 12 hours after the procedure, the mean pain score was significantly lower for patients in the trocar group (0.78 ± 1.0 vs 3.12 ± 1.36; p = 0.0001). CONCLUSION. Use of the bedside US-guided trocar technique for PC was equally effective as the Seldinger technique but was associated with fewer procedure-related complications, required less procedural time, and resulted in decreased postprocedural pain, compared with fluoroscopically guided PC using the Seldinger technique.
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Affiliation(s)
- Lazaros Reppas
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Theofanis
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Panagiotis M Kitrou
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Konstantinos Katsanos
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Filippiadis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexis Kelekis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Karnabatidis
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Safety and feasibility of cholecystectomy in octogenarians. Analysis of a single center series of 316 patients. HPB (Oxford) 2019; 21:1570-1576. [PMID: 31014560 DOI: 10.1016/j.hpb.2019.03.373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cholecystectomy is the treatment of choice for symptomatic cholelithiasis. However, outcomes for patients over 80years of age are not well studied. The primary aim of this study was to describe the safety and feasibility of cholecystectomy, including in the acute setting, in a cohort of patients≥80 years of age. MATERIAL AND METHODS A retrospective study of patients aged≥80 years submitted to cholecystectomy at a single institution from January 2013 to January 2018 was performed. Severity of acute cholecystitis was graded according to the updated Tokyo Guidelines 18. Early cholecystectomy was defined as being performed within the first 48h after admission and delayed when performed beyond 48h of the admission. RESULTS In total 316 patients underwent cholecystectomy. The indication was acute cholecystitis in 113 (36%) patients. Of the 316 patients 289 (92%) were attempted laparoscopically and 30 (10%) were converted to open. Major complications occurred in 44 patients (14%) and mortality rate was 4%. No bile duct injuries were observed. For those patients with mild or moderate acute cholecystitis (n = 103), there was no differences in outcomes when comparing early vs delayed surgery. CONCLUSION Cholecystectomy in patients≥80 years of age is safe and feasible. Outcomes did not differ between early and delayed surgery for mild/moderate acute cholecystitis.
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