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Sohail A, Shehadah A, Chaudhary A, Naseem K, Iqbal A, Khan A, Singh S. Impact of index admission cholecystectomy vs interval cholecystectomy on readmission rate in acute cholangitis: National Readmission Database survey. World J Gastrointest Endosc 2024; 16:350-360. [PMID: 38946855 PMCID: PMC11212518 DOI: 10.4253/wjge.v16.i6.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Elective cholecystectomy (CCY) is recommended for patients with gallstone-related acute cholangitis (AC) following endoscopic decompression to prevent recurrent biliary events. However, the optimal timing and implications of CCY remain unclear. AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database (NRD). METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020. Our primary outcome was all-cause 30-d readmission rates, and secondary outcomes included in-hospital mortality, length of stay (LOS), and hospitalization cost. RESULTS Among the 124964 gallstone-related AC hospitalizations, only 14.67% underwent the same admission CCY. The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group (5.56% vs 11.50%). Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attributable to surgery. Although the most common reason for readmission was sepsis in both groups, the second most common reason was AC in the interval CCY group. CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission. These readmissions can potentially be prevented by performing same-admission CCY in appropriate patients, which may reduce subsequent hospitalization costs secondary to readmissions.
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Affiliation(s)
- Abdullah Sohail
- Department of Internal Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa, IA 52242, United States
| | - Ahmed Shehadah
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, United States
| | - Ammad Chaudhary
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, United States
| | - Khadija Naseem
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195-0001, United States
| | - Amna Iqbal
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, United States
| | - Ahmad Khan
- Department of Gastroenterology and Hepatology, Case Western Reserve University Hospital, Cleveland, OH 44106, United States
| | - Shailendra Singh
- Division of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, WV 26505, United States
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Qi S, Xu J, Yan C, He Y, Chen Y. Early versus delayed laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography: A meta-analysis. Medicine (Baltimore) 2023; 102:e34884. [PMID: 37682128 PMCID: PMC10489342 DOI: 10.1097/md.0000000000034884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSES Patients with cholecysto- and choledocholithiasis usually undergo endoscopic retrograde cholangiopancreatography (ERCP)/-endoscopic sphincterotomy followed by laparoscopic cholecystectomy (LC). However, differences in the timing of LC after the ERCP may alter the post-operative outcomes. The aim of this study was to compare the effect of early (≤3 days) or delayed LC (>3 days) following ERCP on the post-operative outcomes. METHODS A comprehensive search of the 3 databases PubMed, EMBASE and the Cochrane Library was performed. Articles related to LC at different time-points after ERCP were retrieved. Dichotomous and continuous outcomes were analyzed by risk ratio (RR) and mean difference, and RevMan was used to analyze each group. RESULTS A total of 7 studies, including 5 randomized controlled studies and 2 retrospective studies, involved a total of 711 patients. There were 332 patients in early LC group and 379 in delayed LC group. The conversion rate was lower in the early LC group compared to the delayed LC group (RR 0.38, 95% confident interval 0.19 to 0.74, P = .005, I2 = 0%). Early LC resulted in a shorter operation time (RR -6.2, 95% CI -27.2 to -5.2, P = .004, I2 = 97%) and fewer complications (RR 0.48, 95% CI 0.29 to 0.79, P = .004, I2 = 17%). Subgroup analysis found that there were no significant differences in the conversion rate (RR 0.61, 95% CI 0.25 to 1.45, P = .26, I2 = 0%) or complications between the early LC group and the delayed group who underwent LC after 1 month. CONCLUSION Early LC after ERCP is the preferred treatment for patients with concurrent cholecysto- and choledocholithiasis due to improved clinical outcomes as compared to those who undergo delayed LC.
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Affiliation(s)
- Sheng Qi
- General Surgery, The People’s Hospital of Jiangyou, Sichuan Province, China
| | - Jie Xu
- Hepatobiliary Surgery, The People’s Hospital of Jiangyou, Sichuan Province, China
| | - Chao Yan
- Hepatobiliary Surgery, The People’s Hospital of Jiangyou, Sichuan Province, China
| | - Yanan He
- Hepatobiliary Surgery, The People’s Hospital of Jiangyou, Sichuan Province, China
| | - Yao Chen
- Hepatobiliary Surgery, The People’s Hospital of Jiangyou, Sichuan Province, China
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Toogood K, Pike T, Coe P, Everett S, Huggett M, Paranandi B, Bassi V, Toogood G, Smith A. The role of cholecystectomy following endoscopic sphincterotomy and bile duct stone removal. Ann R Coll Surg Engl 2023; 105:607-613. [PMID: 35950513 PMCID: PMC10471440 DOI: 10.1308/rcsann.2022.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Choledocholithiasis is common, with patients usually treated with endoscopic retrograde cholangiopancreatography (ERCP) and subsequent cholecystectomy to remove the presumed source of common bile duct (CBD) stones. However, previous investigations into the management of patients following ERCP have focused on recurrent CBD stones, negating the risks of cholecystectomy. This article appraises the role of cholecystectomy following successful endoscopic clearance of bile duct stones. METHODS Patients undergoing ERCP and CBD clearance for choledocholithiasis at St James's University Hospital January 2015-December 2018 were included. Patients were divided into those who received cholecystectomy and those managed non-operatively. Readmissions, operative morbidity, mortality and treatment costs were investigated. RESULTS Eight hundred and forty-four patients received ERCP and CBD clearance with 3.9 years follow-up. Two hundred and nine patients underwent cholecystectomy with 15% requiring complex surgery. Three hundred and seventy-three patients were non-operatively managed. Unplanned readmissions occurred in 15% following ERCP, mostly within two years. There was no difference in readmissions between the two groups. Accounting for the entire patient pathway, non-operative management was less expensive. CONCLUSIONS The majority of patients do not require readmission following ERCP for CBD stones, and cholecystectomy did not reduce the risk of readmission. Few patients have recurrent CBD stones, but complex biliary surgery is frequently required. Routine cholecystectomy following ERCP needs to be re-evaluated and a more stratified approach to future risk developed.
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Affiliation(s)
| | | | - P Coe
- St James’s University Hospital, UK
| | | | | | | | - V Bassi
- St James’s University Hospital, UK
| | | | - A Smith
- St James’s University Hospital, UK
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Hu L, Shi X, Wang A. Comparison of different time intervals between laparoscopic cholecystectomy to endoscopic retrograde cholangiopancreatography for patients with cholecystolithiasis complicated by choledocholithiasis. Front Surg 2023; 9:1110242. [PMID: 37007627 PMCID: PMC10050469 DOI: 10.3389/fsurg.2022.1110242] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/29/2022] [Indexed: 03/17/2023] Open
Abstract
BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is a common strategy for treatment of patients with gallstones with co-existing stones in the common bile duct (CBD). We conducted this study to compare the effect of different time intervals between ERCP and LC.MethodsA total of 214 patients who underwent elective LC after ERCP for gallstones and CBD stones between January 2015 and May 2021 were retrospectively reviewed. We compared the hospital stay, operation time, perioperative morbidity, and conversion rate to open cholecystectomy, according to the interval between ERCP and ERCP and LC, namely, one day, 2–3 days, and 4 days or more. A generalized linear model was used to analyze the differences among the groups for outcomes.ResultsThere were a total of 214 patients with 52, 80, and 82 patients in group 1, group 2, and group 3 respectively. These groups did not differ significantly in terms of major complications or conversion to open surgery (p = 0.503 and p = 0.358, respectively). The generalized linear model showed that operation times in group 1 and group 2 were similar (odds ratio (OR) 0.144, 95% confidence interval (CI) 12.597, 8.511, p = 0.704), while operation time was significantly longer in group 3 than in group 1 (OR 4.005, 95% CI, 0.217, 20.837, p = 0.045). Post-cholecystectomy hospital stay was similar among the three groups, while post-ERCP hospital stay was significantly longer in group 3 compared with group 1.ConclusionWe recommend that LC be performed within three days after ERCP to reduce operating time and hospital stay.
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Affiliation(s)
- Lingbo Hu
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Enze Hospital, Taizhou Enze Medical Center (Group), Zhejiang, China
| | - Xingpeng Shi
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Enze Hospital, Taizhou Enze Medical Center (Group), Zhejiang, China
| | - Aidong Wang
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Enze Hospital, Taizhou Enze Medical Center (Group), Zhejiang, China
- Correspondence: Aidong Wang
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Liu H, Pan W, Yan G, Li Z. A retrospective cohort study on the optimal interval between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Medicine (Baltimore) 2022; 101:e29728. [PMID: 35801791 PMCID: PMC9259109 DOI: 10.1097/md.0000000000029728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) are the most important procedures for patients with choledocholithiasis and gallstones. Many studies recommend early LC after ERCP; however, there is still no consensus on the optimal interval between the two. The purpose of this study was to investigate the appropriate timing of LC after ERCP in patients with choledocholithiasis and cholecystolithiasis. We retrospectively reviewed all ERCPs in our institution from November 2014 to August 2021. All eligible 261 patients were divided into ERCP-LC1 (≤3 days), ERCP-LC2 (3-7 days), and ERCP-LC3 (>7 days). We also reviewed 90 patients with elective LC as the LC group. Procedures, treatment outcomes, and postoperative adverse events were evaluated. In a total of 1642 ERCPs, 261 eligible patients were divided into ERCP-LC1 (n = 102), ERCP-LC2 (n = 113), and ERCP-LC3 (n = 46). The ERCP-LC groups had no difference in operation time, postoperative adverse events, and open conversion rate with the LC group, but the total hospital stay and hospital stay after LC were longer than the LC group. There were no differences between the ERCP-LC groups in operation time, hospital stay after LC, open conversion rate, postoperative adverse events, and efficacy. However, LC within 7 days and even 3 days after ERCP had significant advantages in improvement in total length of stay and medical expenses. Furthermore, we also found an increased risk of gallbladder gangrene and perforation in LC >7 days after ERCP. LC within 7 days and even 3 days after ERCP is a safe, effective, and economical method for patients with choledocholithiasis and gallstones.
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Affiliation(s)
- Huan Liu
- Department of General Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan City, China
- * Correspondence: Huan Liu, Department of General Surgery, Zhongshan Hospital of Traditional Chinese Medicine, No. 3 Kangxin Rd., West District, Zhongshan City, Guangdong Province 528400, China (e-mail: )
| | - Wenjun Pan
- Department of General Surgery, Liaoyang Central Hospital, China Medical University, Liaoyang City, Liaoning Province, China
| | - Guoqiang Yan
- Department of General Surgery, Liaoyang Central Hospital, China Medical University, Liaoyang City, Liaoning Province, China
| | - Zhongmin Li
- Department of General Surgery, Liaoyang Central Hospital, China Medical University, Liaoyang City, Liaoning Province, China
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Zhao H, Zhang J. Effect of Endoscopic Retrograde Cholangiopancreatography Lithotomy Combined with Laparoscopic Cholecystectomy on Pain and Prognosis of Patients with Gallstones and Extrahepatic Bile Duct Stones. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:9450159. [PMID: 35795764 PMCID: PMC9252623 DOI: 10.1155/2022/9450159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022]
Abstract
Objective The researchers aim to assess how endoscopic retrograde cholangiopancreatography lithotomy and laparoscopic cholecystectomy affected pain and prognosis in individuals with gallstones and extrahepatic bile duct stones. Methods Researchers studied 100 persons with gallstones and extrahepatic bile duct stones from January 2016 to August 2021. They were split into two groups: control and observation. The control group underwent open cholecystectomy + choledocholithotomy + T-tube drainage. There were ERCP + lithotomy + Laparoscopic cholecystectomy procedures conducted on the observation group of patients (LC). The operation time, incision size, and bleeding volume; stone clearance rate and stone recurrence rate; visual analogue scale (VAS); Eating time, exhaust time, out of bed activity time, and postoperative hospital stay; the two groups' difficulties were contrasted and studied. Results The observation group's operation duration was much longer than the control group's, and the incision size and bleeding volume were significantly reduced in the observation group. When it came to recurrence, there was a significant difference between the observation group (2.0%) and the control group (4.0%), even though stone clearance did not differ substantially (20.00%). The VAS scores 3 and 7 days after surgery were significantly different between the observation and control groups. The observation group's eating time, exhaustion, activity time, and postoperative hospital stay were much shorter than the control group's; complications occurred at a lower rate (20%) in the observation group than in the control group (34%). Conclusion When gallstones and extrahepatic bile-duct stones are removed using laparoscopic lithotomy and laparoscopic cystoscopy (LC), the operation indices are improved and the risk of recurrence of stones is reduced and reducing the occurrence of complications, all of which improve patient outcomes and deserve to be considered a clinical reference.
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Affiliation(s)
- Hui Zhao
- Department of Gastroenterology, Huzhou Central Hospital, Huzhou 313000, China
- Department of Gastroenterology, Affiliated Central Hospital Huzhou University, Huzhou 313000, China
| | - Jian Zhang
- Department of Hepatobiliary Surgery, Huzhou Central Hospital, Huzhou 313000, China
- Department of Hepatobiliary Surgery, Affiliated Central Hospital Huzhou University, Huzhou 313000, China
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Vaccari S, Minghetti M, Lauro A, Bellini MI, Ussia A, Khouzam S, Marino IR, Cervellera M, D'Andrea V, Tonini V. Destiny for Rendezvous: Is Cholecysto/Choledocholithiasis Better Treated with Dual- or Single-Step Procedures? Dig Dis Sci 2022; 67:1116-1127. [PMID: 35318553 DOI: 10.1007/s10620-022-07450-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 02/05/2023]
Abstract
Biliary lithiasis is common worldwide, affecting almost 20% of the general population, though few experience symptoms. The frequency of choledocholithiasis in patients with symptomatic cholelithiasis is estimated to be 10-33%, depending on patients' age. Unlike gallbladder lithiasis, the medical and surgical treatment of common bile duct stones is uncertain, having changed over the last few years. The prior gold standard treatment for cholelithiasis and choledocholithiasis was open cholecystectomy with bile duct clearance, choledochotomy, and/or surgical sphincterotomy. In the last 10-15 years, new treatment approaches to the complex pathology of choledocholithiasis have emerged with the advent of endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic surgery, and advanced diagnostic procedures. Although ERCP followed by laparoscopic cholecystectomy is the preferred mode of management, a single-step strategy (laparo-endoscopic rendezvous) has gained acceptance due to lesser morbidity and a lower risk of iatrogenic damage. Given the above, a tailored approach relying on careful evaluation of the disease is necessary in order to minimize complication risks and overall costs. Yet, the debate remains open, with no consensus on the superiority of laparo-endoscopic rendezvous to more conventional approaches.
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Affiliation(s)
- S Vaccari
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - M Minghetti
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - A Lauro
- Department of Surgical Sciences, Sapienza University, Rome, Italy.
| | - M I Bellini
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - A Ussia
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - S Khouzam
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - I R Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cervellera
- Department of General Surgery, Ospedale Santissima Annunziata, Taranto, Italy
| | - V D'Andrea
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - V Tonini
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
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Hoilat GJ, Hoilat JN, Abu-Zaid A, Raleig J, Tot J, Mandal A, Sostre V, Carvounis C, Sapkota B. Impact of early cholecystectomy on the readmission rate in patients with acute gallstone cholangitis: a retrospective single-centre study. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000705. [PMID: 34330787 PMCID: PMC8327811 DOI: 10.1136/bmjgast-2021-000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/18/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND AIMS The pathogenesis of acute cholangitis (AC) occurs with biliary obstruction followed by bacterial growth in the bile duct. The leading cause of AC is obstructing gallstones. There have been conflicting theories about the optimal timing for cholecystectomy following AC. The aim of this study is to assess the impact of early cholecystectomy on the 30-day readmission rate, 30-day mortality, 90-day readmission rate and the length of hospital stay. METHODS This retrospective study was performed between January 2015 and January 2021 in a high-volume tertiary referral teaching hospital. Included patients were 18 years or older with a definitive diagnosis of acute gallstone cholangitis who underwent endoscopic retrograde cholangiopancreatography (ERCP) with complete clearance of the bile duct as an index procedure. We divided the patients into two groups: patients who underwent ERCP alone and those who underwent ERCP with laparoscopic cholecystectomy (LC) on the same admission (ERCP+LC). Data were extracted from electronic medical records. The primary endpoint of the study was the 30-day readmission rate. RESULTS A total of 114 patients with AC met the inclusion criteria of the study. The ERCP+LC group had significantly lower rates of 30-day readmission (2.2% vs 42.6%, p<0.001), 90-day readmission (2.2% vs 30.9%, p<0.001) and 30-day mortality (2.2% vs 16.2%, p=0.017) when compared with the ERCP group. In a multivariate logistic regression analysis, patients in the ERCP+LC group had 90% lower odds of 30-day readmission compared with patients who did not undergo LC during admission (OR=0.1, 95% CI (0.032 to 0.313), p<0.001). CONCLUSION Performing LC on same day admission was associated with a decrease in 30-day and 90-day readmission rate as well as 30-day mortality.
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Affiliation(s)
- Gilles Jadd Hoilat
- Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | | | - Ahmed Abu-Zaid
- Department of Pharmacology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Julia Raleig
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Joseph Tot
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Amrenda Mandal
- Gastroenterology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Vanessa Sostre
- Gastroenterology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Christos Carvounis
- Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Bishnu Sapkota
- Gastroenterology, SUNY Upstate Medical University, Syracuse, New York, USA.,Gastroenterology, Syracuse VA Medical Center, Syracuse, New York, USA
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The Impact of Laparoscopic Cholecystectomy on 30-Day Readmission Rate for Acute Cholangitis Patients: A Single-Center Study. Dig Dis Sci 2021; 66:861-865. [PMID: 32248392 DOI: 10.1007/s10620-020-06240-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/25/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Laparoscopic cholecystectomy (LC) following acute gallstone cholangitis reduces the recurrence of biliary symptoms; however, the timing of LC has not been determined yet. The aim of our study was to evaluate the impact of performing LC during admission on the 30-day readmission rate. METHODS We conducted a retrospective cohort study of acute gallstone cholangitis patients who underwent endoscopic clearance (EC) of the bile duct through endoscopic retrograde cholangiopancreatography between April 2013 and May 2018. Patients were classified into two groups: EC only group and EC followed by LC during admission (EC + LC) group. The primary outcome was the 30-day readmission rate. RESULTS A total of 95 patients with acute cholangitis were included in the analysis. Of these patients, 35 patients (36.8%) underwent LC during admission. The 30-day readmission rate was significantly lower in the EC + LC group compared to the EC group (2.9% vs. 26.7%, P 0.003). In a multivariate regression analysis, patients who underwent LC during admission had 90% lower odds of readmission within 30 days compared to patients who did not (OR 0.1, 95% CI (0.01-0.9), P 0.04). CONCLUSIONS Performing laparoscopic cholecystectomy during admission for acute gallstone cholangitis patients following endoscopic clearance of the bile duct significantly reduced the 30-day readmission rate without affecting the length of stay.
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Favaro MDL, Moran SBS, Iamarino APM, Herrero BM, Gabor S, Ribeiro Junior MAF. During which period should we avoid cholecystectomy in patients who underwent endoscopic retrograde cholangiopancreatography? EINSTEIN-SAO PAULO 2020; 18:eAO5393. [PMID: 33111809 PMCID: PMC9586429 DOI: 10.31744/einstein_journal/2020ao5393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/16/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the period during which we should avoid cholecystectomy after endoscopic retrograde cholangiopancreatography. METHODS A retrospective analysis of electronic medical charts of 532 patients undergoing endoscopic retrograde cholangiopancreatography, between March 2013 and December 2017. RESULTS Approximately one-third of patients underwent the procedure between 4 and 30 days after endoscopic retrograde cholangiopancreatography. The conversion rate was 3.8%. The need for abdominal drainage and the finding of biliary tract injury after surgery were observed in 15.1% and 1.9% of patients, respectively. The length of stay was significantly shorter among patients undergoing surgery more than 30 days after endoscopic retrograde cholangiopancreatography. These patients had a median length of stay of one day, whereas the median length of stay in the group undergoing the procedure between 4 and 30 days after endoscopic retrograde cholangiopancreatography was 2 days. CONCLUSION The period during which we should avoid cholecystectomy is between 4 and 30 days after endoscopic retrograde cholangiopancreatography.
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Affiliation(s)
| | | | | | | | - Silvio Gabor
- Universidade de Santo Amaro, São Paulo, SP, Brazil
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