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Thomaidou E, Karlafti E, Didagelos M, Megari K, Argiriadou E, Akinosoglou K, Paramythiotis D, Savopoulos C. Acalculous Cholecystitis in COVID-19 Patients: A Narrative Review. Viruses 2024; 16:455. [PMID: 38543820 PMCID: PMC10976146 DOI: 10.3390/v16030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 05/23/2024] Open
Abstract
Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5-10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19.
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Affiliation(s)
- Evanthia Thomaidou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Eleni Karlafti
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Matthaios Didagelos
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
- 1st Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Kalliopi Megari
- CITY College, University of York Europe Campus, 54626 Thessaloniki, Greece;
| | - Eleni Argiriadou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Karolina Akinosoglou
- Department of Medicine, University General Hospital of Patras, 26504 Rio, Greece;
| | - Daniel Paramythiotis
- First Propaedeutic Department of Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Christos Savopoulos
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Bozada-Gutiérrez K, Trejo-Avila M, Chávez-Hernández F, Parraguirre-Martínez S, Valenzuela-Salazar C, Herrera-Esquivel J, Moreno-Portillo M. Surgical treatment of acute cholecystitis in patients with confirmed COVID-19: Ten case reports and review of literature. World J Clin Cases 2022; 10:1296-1310. [PMID: 35211563 PMCID: PMC8855198 DOI: 10.12998/wjcc.v10.i4.1296] [Citation(s) in RCA: 2] [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: 07/27/2021] [Revised: 10/16/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Research concerning postoperative outcomes of confirmed coronavirus disease 2019 (COVID-19) patients revealed unfavorable postoperative results with increased morbidity, pulmonary complications and mortality. Case reports have suggested that COVID-19 is associated with more aggressive presentation of acute cholecystitis. The aim of the present study is to describe the perioperative assessment and postoperative outcomes of ten patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with concomitant acute cholecystitis who underwent cholecystectomy.
CASE SUMMARY We report a total of 10 SARS-CoV-2 positive patients with concomitant acute cholecystitis that underwent cholecystectomy. Six patients were males, the mean age was 47.1 years. Nine patients had moderate acute cholecystitis, and one patient had severe acute cholecystitis. All patients were treated with urgent/early laparoscopic cholecystectomy. Regarding the Parkland grading scale, two patients received a Parkland grade of 3, two patients received a Parkland grade of 4, and six patients received a Parkland grade of 5. Eight patients required a bail-out procedure. Four patients developed biliary leakage and required endoscopic retrograde cholangiopancreatography with biliary sphincterotomy. After surgery, five patients developed acute respiratory distress syndrome (ARDS) and required intensive care unit (ICU) admission. One patient died after cholecystectomy due to ARDS complications. The mean total length of stay (LOS) was 18.2 d. The histopathology demonstrated transmural necrosis (n = 5), vessel obliteration with ischemia (n = 3), perforation (n = 3), and acute peritonitis (n = 10).
CONCLUSION COVID-19 patients with acute cholecystitis had difficult cholecystectomies, high rates of ICU admission, and a prolonged LOS.
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Affiliation(s)
- Katya Bozada-Gutiérrez
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | - Mario Trejo-Avila
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | - Fátima Chávez-Hernández
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | | | - Carlos Valenzuela-Salazar
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | - Jesús Herrera-Esquivel
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | - Mucio Moreno-Portillo
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
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Marocchi G, Lisotti A, Fusaroli P. Endoscopic Techniques for Gallbladder Drainage: Never without My Endoscopic Ultrasound. Gut Liver 2021; 15:634-636. [PMID: 33935048 PMCID: PMC8283293 DOI: 10.5009/gnl210074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 12/07/2022] Open
Affiliation(s)
- Gianmarco Marocchi
- Gastrointestinal Unit, Department of Medical and Surgical Sciences, Hospital of Imola, University of Bologna, Imola, Italy
| | - Andrea Lisotti
- Gastrointestinal Unit, Department of Medical and Surgical Sciences, Hospital of Imola, University of Bologna, Imola, Italy
| | - Pietro Fusaroli
- Gastrointestinal Unit, Department of Medical and Surgical Sciences, Hospital of Imola, University of Bologna, Imola, Italy
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Lisotti A, Napoleon B, Fabbri C, Anderloni A, Linguerri R, Bacchilega I, Fusaroli P. Treatment of acute cholecystitis in high-risk surgical patients. Systematic review of the literature according to the levels of evidence. Minerva Gastroenterol (Torino) 2021; 68:154-161. [PMID: 33793158 DOI: 10.23736/s2724-5985.21.02854-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Acute cholecystitis (AC) is the most common biliary stone disease complication. While there is consensus regarding cholecystectomy for AC, gallbladder drainage is indicated in elderly or high-risk surgical patients. We systematically reviewed available evidence in the field of EUS-guided gallbladder drainage (EUS-GBD) for AC in high-risk surgical patients. The studies were classified according to their level of evidence (LE) according to the Oxford Centre for Evidence Based Medicine classification. Literature search retrieved 175 manuscripts; most of them were expert opinions (LE V, no. 53) or caseseries (LE IV, no. 29). There was no meta-analysis of RCT (LE Ia), while two randomized controlled trials (LE Ib) demonstrated that EUS-GBD was superior to percutaneous trans-hepatic-GBD (PT-GBD) regarding longterm outcomes (adverse events, recurrent cholecystitis, and reintervention). Several meta-analyses of cohort studies (LE IIa, no. 11) were designed to compare the three available drainage strategies (endoscopic, echoendoscopic and percutaneous) and to assess the pooled risk of adverse events. Comparison between surgery and EUS-GBD was done in a single retrospective study with a propensity score analysis (LE III). The outcomes of conversion from PT-GBD to EUS-GBD were covered by few retrospective studies (LE III). Several manuscripts (no. 69) were published on EUS-GBD as a rescue strategy in case of malignant biliary obstruction. The levels of evidence of EUS-GBD in the literature have evolved from initial descriptive studies to recent randomized controlled trials and meta-analysis of cohort studies. While several articles addressed the comparison among different techniques for GBD, in our opinion some topics and questions have not been adequately investigated. are still debated.
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Affiliation(s)
- Andrea Lisotti
- Gastroenterology Unit, Department of Medical and Surgical Sciences, Hospital of Imola, University of Bologna, Bologna, Italy -
| | - Bertrand Napoleon
- Département de Gastroentérologie, Hôpital privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Carlo Fabbri
- Gastroenterology Unit, Forli-Cesena Hospital, AUSL Romagna, Forli-Cesena, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center (IRCCS), Rozzano, Milan, Italy
| | | | - Igor Bacchilega
- Intensive Care Unit, Hospital of Imola, Imola, Bologna, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Department of Medical and Surgical Sciences, Hospital of Imola, University of Bologna, Bologna, Italy
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Lisotti A, Linguerri R, Bacchilega I, Cominardi A, Marocchi G, Fusaroli P. EUS-guided gallbladder drainage in high-risk surgical patients with acute cholecystitis-procedure outcomes and evaluation of mortality predictors. Surg Endosc 2021; 36:569-578. [PMID: 33507383 PMCID: PMC7842173 DOI: 10.1007/s00464-021-08318-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/09/2021] [Indexed: 02/06/2023]
Abstract
Background Recent evidences suggest that gallbladder drainage is the treatment of choice in elderly or high-risk surgical patients with acute cholecystitis (AC). Despite better outcomes compared to other approaches, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is burdened by high mortality. The aim of the study was to evaluate predictive factors for mortality in high-risk surgical patients who underwent EUS-GBD for AC. Methods A retrospective analysis of a prospectively maintained database was performed. Electrocautery-enhanced lumen-apposing metal stents were used; all recorded variables were evaluated as potential predictive factors for mortality. Results Thirty-four patients underwent EUS for suspected AC and 25 (44% male, age 78) were finally included. Technical, clinical success rate and adverse events rate were 92%, 88%, and 16%, respectively. 30-day and 1-year mortality were 12% and 32%. On univariate analysis, age-adjusted Charlson Comorbidity Index (CCI) (OR 20.8[4–68.2]), acute kidney injury (AKI) (OR 21.4[2.6–52.1]) and clinical success (OR 8.9[1.2–11.6]) were related to 30-day mortality. On multivariate analysis, CCI and AKI were independently related to long-term mortality. Kaplan–Meier curves showed an increased long-term mortality in patients with CCI > 6 (hazard ratio 7.6[1.7–34.6]) and AKI (hazard ratio 11.3[1.4–91.5]). Conclusions Severe comorbidities and AKI were independent predictive factors confirming of long-term mortality after EUS-GBD. Outcomes of EUS-GBD appear more influenced by patients’ conditions rather than by procedure success. Supplementary Information The online version of this article (10.1007/s00464-021-08318-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Lisotti
- Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Via Montericco 4, 40026, Imola, BO, Italy.
| | | | | | - Anna Cominardi
- Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Via Montericco 4, 40026, Imola, BO, Italy
| | - Gianmarco Marocchi
- Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Via Montericco 4, 40026, Imola, BO, Italy
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Via Montericco 4, 40026, Imola, BO, Italy
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