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Liu H, Lu Y, Shen K, Zhou M, Mao X, Li R. Advances in the management of gallbladder polyps: establishment of predictive models and the rise of gallbladder-preserving polypectomy procedures. BMC Gastroenterol 2024; 24:7. [PMID: 38166603 PMCID: PMC10759486 DOI: 10.1186/s12876-023-03094-7] [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: 05/24/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
Gallbladder polyps are a common biliary tract disease whose treatment options have yet to be fully established. The indication of "polyps ≥ 10 mm in diameter" for cholecystectomy increases the possibility of gallbladder excision due to benign polyps. Compared to enumeration of risk factors in clinical guidelines, predictive models based on statistical methods and artificial intelligence provide a more intuitive representation of the malignancy degree of gallbladder polyps. Minimally invasive gallbladder-preserving polypectomy procedures, as a combination of checking and therapeutic approaches that allow for eradication of lesions and preservation of a functional gallbladder at the same time, have been shown to maximize the benefits to patients with benign polyps. Despite the reported good outcomes of predictive models and gallbladder-preserving polypectomy procedures, the studies were associated with various limitations, including small sample sizes, insufficient data types, and unknown long-term efficacy, thereby enhancing the need for multicenter and large-scale clinical studies. In conclusion, the emergence of predictive models and minimally invasive gallbladder-preserving polypectomy procedures has signaled an ever increasing attention to the role of the gallbladder and clinical management of gallbladder polyps.
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Affiliation(s)
- Haoran Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Yongda Lu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Kanger Shen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Ming Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Xiaozhe Mao
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China.
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"Is percutaneous extraction of gallstones safe and effective in high-risk patients? Evidence from a systematic review". Surgeon 2023; 21:99-107. [PMID: 35606261 DOI: 10.1016/j.surge.2022.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/19/2022] [Accepted: 04/14/2022] [Indexed: 12/07/2022]
Abstract
Gallstone disease in high-risk patients presents a management dilemma as cholecystectomy is often not performed due to their co-morbidities. Alternatively, such patients can be managed by percutaneous removal of gallstones. To date, there is paucity of high-quality evidence addressing the safety and efficacy of percutaneous cholecystolithotomy in high-risk patients. We aimed to conduct a systematic review on the feasibility of percutaneous gallstone removal in high-risk patients. METHODS A literature review was conducted using the Cochrane review and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines without setting the time limits to assess the outcomes of percutaneous gallstone removal in high-risk patients. RESULTS Twelve studies were identified. A total of 435 patients underwent percutaneous gallstone removal. Success rate was 91%. Overall complications (including minor and major) were 28%. The mean length of stay was 7 days (range, 1-80). Procedure related mortality was 0.7%. The recurrence rate was 7%. CONCLUSION Percutaneous cholecystolithotomy is a safe and effective technique. Although, it cannot substitute the current standard treatment for gallstones i.e., laparoscopic cholecystectomy. However, it may be considered for the patients who cannot undergo laparoscopic cholecystectomy due to their comorbid conditions.
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Wang B, Huang A, Jiang M, Li H, Bao W, Ding K, Jiang Z, Zhao G, Hu H. Risk Factors for Early Recurrence of Gallstones in Patients Undergoing Laparoscopy Combined With Choledochoscopic Lithotomy: A Single-Center Prospective Study. Front Surg 2021; 8:759390. [PMID: 34901141 PMCID: PMC8651707 DOI: 10.3389/fsurg.2021.759390] [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] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/12/2021] [Indexed: 01/07/2023] Open
Abstract
Objective: For patients with gallstones, laparoscopy combined with choledochoscopic lithotomy is a therapeutic surgical option for preservation rather than the removal of the gallbladder. However, postoperative recurrence of gallstones is a key concern for both patients and surgeons. This prospective study was performed to investigate the risk factors for early postoperative recurrence of gallstones. Methods: The clinical data of 466 patients were collected. Each patient was followed up for up to 2 years. The first follow-up visit occurred 4 months after the operation, and a follow-up visit was carried out every 6 months thereafter. The main goal of each visit was to confirm the presence or absence of gallbladder stones. The factors associated with gallstone recurrence were analyzed by univariate analysis and Cox regression. Results: In total, 466 eligible patients were included in the study, and 438 patients (180 men and 258 women) completed the 2-year postoperative follow-up. The follow-up rate was 94.0%. Recurrence of gallstones was detected in 5.71% (25/438) of the patients. Univariate analysis revealed five risk factors for the recurrence of gallstones. Multivariate Cox regression analysis showed that multiple gallstones, a gallbladder wall thickness of ≥4 mm, and a family history of gallbladder stones were the three predictive factors for postoperative recurrence of gallstones (P < 0.05). Conclusion: The overall 2-year recurrence rate of gallstones after the operation was 5.71%. Multiple gallstones, a gallbladder wall thickness of ≥4 mm, and a family history of gallstones were the three risk factors associated with early postoperative recurrence of gallstones.
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Affiliation(s)
- Bo Wang
- Center of Gallbladder Diseases, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Anhua Huang
- Center of Gallbladder Diseases, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Jiang
- Center of Gallbladder Diseases, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haidong Li
- Center of Gallbladder Diseases, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenqing Bao
- Center of Gallbladder Diseases, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kan Ding
- Center of Gallbladder Diseases, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhaoyan Jiang
- Center of Gallbladder Diseases, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gang Zhao
- Center of Gallbladder Diseases, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hai Hu
- Center of Gallbladder Diseases, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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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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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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Wang W, Wang W, Liu B, Li Y. Fluoroscopy-guided percutaneous lithotripsy using FREDDY laser for giant gallstones: Preliminary experience. Lasers Surg Med 2021; 54:392-398. [PMID: 34463963 DOI: 10.1002/lsm.23477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Percutaneous treatment of symptomatic cholelithiasis with large gallstones remains a challenge. We aimed to evaluate the efficacy and safety of a new method for the removal of giant gallstones with percutaneous lithotripsy using a frequency-doubled double-pulse neodymium: YAG (FREDDY) laser. MATERIALS AND METHODS This study included 16 patients (7 males, 9 females; mean age, 63.4 ± 14.9 years) with giant gallstones who experienced the recurrence of cholecystitis and were not eligible for operation. The percutaneous transcystic approach was established using an 8-French sheath. A 6-French steerable sheath were inserted through the sheath. FREDDY laser lithotripsy was performed to break the stones into fragments. The stone fragments were extracted through the 6-French sheath or pushed into the duodenum using a balloon catheter. Cholecystography was performed before removing the catheter. Follow-up ultrasound or computed tomography examination were performed. RESULTS Gallstone clearance was accomplished in 16 (100%) patients at the initial assessment. Eleven patients underwent one session, and five patients underwent two sessions. Residual stones were found in 3 (18.8%) patients during the follow-up period. Peritonitis was found in two (12.5%) patients and hemocholecyst was detected in one (6.3%) patient. No procedure-related deaths occurred. CONCLUSION Percutaneous lithotripsy using a FREDDY laser may be an effective and safe alternative choice for treating giant gallstones, especially for patients who are not eligible for cholecystectomy.
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Affiliation(s)
- Wujie Wang
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Wei Wang
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
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Antalek M, Riaz A, Nemcek AA. Gallbladder: Role of Interventional Radiology. Semin Intervent Radiol 2021; 38:330-339. [PMID: 34393343 DOI: 10.1055/s-0041-1731371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Percutaneous cholecystostomy is an established procedure for the management of patients with acute cholecystitis and with significant medical comorbidities that would make laparoscopic cholecystectomy excessively risky. In this review, we will explore the role of percutaneous cholecystostomy in the management of acute cholecystitis as well as other applications in the management of biliary pathology. The indications, grading, technical considerations, and postprocedure management in the setting of acute cholecystitis are discussed. In addition, we will discuss the potential role of percutaneous cholecystostomy in the management of gallstones and biliary strictures, in establishing internal biliary drainage, and in a joint setting with other clinicians such as gastroenterologists in the management of complex biliary pathology.
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Affiliation(s)
- Matthew Antalek
- Division of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ahsun Riaz
- Division of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Albert A Nemcek
- Division of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
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Raymond CJ, Khayat M, Chick JFB, Srinivasa RN. Endoscopy as an Adjunct to Image-Guided Interventions: A New Frontier in Interventional Radiology. Tech Vasc Interv Radiol 2019; 22:119-124. [PMID: 31623750 DOI: 10.1053/j.tvir.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Endoscopy is an underutilized technique in the practice of interventional radiology. The objectives of this article are to discuss potential uses of interventional radiology-operated endoscopy and to outline basic endoscopy setup and equipment uses. Endoscopy represents a new frontier to the fluoroscopically-guided procedures in biliary, gastrointestinal, and genitourinary disease that interventional radiologists commonly perform. It shows promise to improve interventional radiology procedure success rates and reduce procedure-associated risk for patients. Endoscopy has been traditionally performed by gastroenterologists and urologists and is relatively new in the practice of interventional radiology. The hand-eye coordination and manual dexterity required to perform standard image-guided procedures places interventional radiologists in a unique position to introduce endoscopy into standard practice. A focused and collaborative effort is needed by interventional radiologists to learn the techniques required to successfully integrate endoscopy into practice.
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Affiliation(s)
- Clifford J Raymond
- Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mamdouh Khayat
- Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195
| | - Ravi N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, UCLA Medical Center, Los Angeles, CA
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9
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Srinivasa RN, Pampati R, Patel N, Srinivasa RN, Hage AN, Chick JFB. Interventional Radiology-Operated Endoscopy: Indications, Implementation, and Innovation. Semin Intervent Radiol 2019; 35:477-485. [PMID: 30728664 DOI: 10.1055/s-0038-1676327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ravi N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan.,Division of Vascular and Interventional Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Rudra Pampati
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Nishant Patel
- Radiology Imaging Associates Endovascular, Englewood, Colorado
| | - Rajiv N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Anthony N Hage
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
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Portincasa P, van Erpecum KJ, Di Ciaula A, Wang DQH. The physical presence of gallstone modulates ex vivo cholesterol crystallization pathways of human bile. Gastroenterol Rep (Oxf) 2019; 7:32-41. [PMID: 30792864 PMCID: PMC6375352 DOI: 10.1093/gastro/goy044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/15/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cholesterol crystallization is an essential step toward gallstone formation. Although model bile studies showed that competition occurs between the gallstone surface and the surrounding aqueous phase for cholesterol molecules available for crystallization, this has not been investigated in human bile. METHODS Fresh gallbladder bile was obtained during laparoscopic cholecystectomy from 13 patients with cholesterol (n = 10) or pigment (n = 3) stones. Small cholesterol gallstones were collected from another two patients. Both native and ultrafiltered bile with or without added gallstones was analysed by polarized light microscopy for the presence of arc-like and needle-like anhydrous cholesterol crystals and classic cholesterol monohydrate crystals. Weight of the added stones was evaluated before and after 21 days of bile incubation. RESULTS In unfiltered bile, the presence of stones was associated with a trend towards less anhydrous cholesterol crystals, but significantly more aggregated cholesterol monohydrate crystals. In ultrafiltered bile, the presence of stones tended to inhibit the formation of arc-like or needle-like crystals and was associated with significantly greater amounts of both plate-like and aggregated cholesterol monohydrate crystals. After 21 days of the incubation, stone weight was decreased in both unfiltered (-4.5 ± 1.6%, P = 0.046) and ultrafiltered bile (-6.5 ± 1.5%, P = 0.002). Bile from pigment-stone patients was clear in the absence of stones, but showed early appearance of plate-like and aggregated cholesterol monohydrate crystals in all samples to which cholesterol gallstones were added. CONCLUSIONS The physical presence of cholesterol gallstones in both native and filtered bile greatly influences cholesterol crystallization pathways. Whereas cholesterol monohydrate crystals increase, anhydrous cholesterol crystals tend to be inhibited. Detachment of solid cholesterol crystals from the gallstone surface may explain these findings.
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Affiliation(s)
- Piero Portincasa
- Division of Internal Medicine, Department of Biomedical Sciences and Human Oncology, University Medical School, Bari, Italy
- Corresponding author. Division of Internal Medicine, Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University Medical School, Policlinico, Piazza Giulio Cesare 11, Bari, 70124, Italy. Tel: +39-80-5478892; Fax: +39-80-5478232;
| | - Karel J van Erpecum
- Department of Gastroenterology, University Medical Center, Utrecht, The Netherlands
| | - Agostino Di Ciaula
- Division of Internal Medicine, Hospital of Bisceglie, ASL BAT, Bisceglie, Italy
| | - David Q -H Wang
- Department of Medicine, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Jung GS, Kim YJ, Yun JH, Park JG, Yun BC, Han BH, Lee SU, Kim YH. Percutaneous Transcholecystic Removal of Common Bile Duct Stones: Case Series in 114 Patients. Radiology 2018; 290:238-243. [PMID: 30226454 DOI: 10.1148/radiol.2018173043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose To evaluate the safety and effectiveness of percutaneous transcholecystic removal of common bile duct (CBD) stones in 114 patients. Materials and Methods This retrospective study was approved by the institutional review board. From September 2011 through February 2017, 114 consecutive patients (68 men, 46 women; mean age, 73 years) underwent percutaneous transcholecystic removal of CBD stones. All patients had acute cholangitis or cholecystitis. Stones were extracted through a 12-F sheath by using a Wittich nitinol stone basket uder fluoroscopic guidance. Technical success rates, complications, and long-term follow-up were evaluated. Results Technical success was achieved in 96 of 114 (84.2%) patients. In 18 patients, stone removal was unsuccessful due to failure of cystic duct cannulation (n = 11), proximal migration of the CBD stone (n = 3), multiple CBD stones (n = 3), and low insertion of the cystic duct (n = 1). No major procedure-related complications were seen. During the mean follow-up of 644 days (range, 11-2206 days), CBD stones recurred in 12 patients after a mean of 884 days (range, 439-1799 days) after the procedure. Conclusion Percutaneous transcholecystic removal of common bile duct stones seems to be a safe and effective method. © RSNA, 2018 Online supplemental material is available for this article . See also the editorial by vanSonnenberg and Panchanathan in this issue.
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Affiliation(s)
- Gyoo-Sik Jung
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Yong Joo Kim
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Jong Hyuk Yun
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Jung Gu Park
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Byung Chul Yun
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Byung Hoon Han
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Sang Uk Lee
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Young Hwan Kim
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
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Stanek A, Dohan A, Barkun J, Barkun A, Reinhold C, Valenti D, Cassinotto C, Gallix B. Percutaneous cholecystostomy: A simple bridge to surgery or an alternative option for the management of acute cholecystitis? Am J Surg 2018; 216:595-603. [DOI: 10.1016/j.amjsurg.2018.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/26/2017] [Accepted: 01/13/2018] [Indexed: 02/01/2023]
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Management After Percutaneous Cholecystostomy: What Should We do With the Catheter? Surg Laparosc Endosc Percutan Tech 2018; 28:256-260. [DOI: 10.1097/sle.0000000000000559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Lee SO, Yim SK. [Management of Acute Cholecystitis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:264-268. [PMID: 29791985 DOI: 10.4166/kjg.2018.71.5.264] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Acute cholecystitis is a common serious complication of gallstones. The reported mortality of acute cholecystitis is approximately 3%, but the rate increases with age or comorbidity of the patient. If appropriate treatment is delayed, complications can develop as a consequence with a grave prognosis. The current standard of care in acute cholecystitis is an early laparoscopic cholecystectomy with the appropriate administration of fluid, electrolyte, and antibiotics. On the other hand, the severity of the disease and patient's operational risk must be considered. In those with high operational risks, gall bladder drainage can be performed as an alternative. Currently percutaneous and endoscopic drainage are available and show clinical success in most cases. After recovering from acute cholecystitis, the patients who have undergone drainage should be considered for cholecystectomy as a definitive treatment. However, in elderly patients or patients with significant comorbidity, operational risks may still be high, making cholecystectomy inappropriate. In these patients, gallstone removal using the percutaneous tract or endoscopy may be considered.
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Affiliation(s)
- Seung Ok Lee
- Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung Kyun Yim
- Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
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15
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Comment on "Percutaneous Stone Removal". Ann Surg 2018; 270:e12-e13. [PMID: 29771726 DOI: 10.1097/sla.0000000000002823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Srinivasa RN, Chick JFB, Cooper K, Srinivasa RN. Interventional Radiology-Operated Endoscopy as an Adjunct to Image-Guided Interventions. Curr Probl Diagn Radiol 2018; 48:184-188. [PMID: 29674012 DOI: 10.1067/j.cpradiol.2018.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/16/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Interventional radiology-operated endoscopy is an underused technique, which may have a significant impact on the ability to treat patients with a variety of conditions. The purpose of this article is to discuss the setup, equipment, and potential clinical uses of interventional radiology-operated endoscopy. METHODS A number of new and innovative interventions may be performed in the biliary, genitourinary, and gastrointestinal systems through percutaneous access that interventional radiologists already create. When used in combination, endoscopy adds an entirely new dimension to the fluoroscopic-guided procedures of which interventional radiologists are accustomed. RESULTS Interventional radiologists are in a unique position to implement endoscopy into routine practice given the manual dexterity and hand-eye coordination already required to perform other image-guided interventions. CONCLUSION Although other specialists traditionally have performed endoscopic interventions and local politics often dictate referral patterns, a collaborative relationship among these specialists and interventional radiology will allow for improved patient care. A concerted effort is needed by interventional radiologists to learn the techniques and equipment required to successfully incorporate endoscopy into practice.
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Affiliation(s)
- Rajiv N Srinivasa
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, MI.
| | | | - Kyle Cooper
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Ravi N Srinivasa
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, MI
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Chan JHY, Teoh AYB. The development of peroral cholecystoscopy and advanced gallbladder interventions. Endosc Ultrasound 2018; 7:85-88. [PMID: 29667622 PMCID: PMC5914192 DOI: 10.4103/eus.eus_7_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Joey Ho Yi Chan
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Anthony Yuen Bun Teoh
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Hybrid Percutaneous-Endoscopic Treatment for Acute Calculous Cholecystitis in a High-Risk Surgical Patient. ACG Case Rep J 2017; 4:e89. [PMID: 28761892 PMCID: PMC5519400 DOI: 10.14309/crj.2017.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/12/2017] [Indexed: 11/24/2022] Open
Abstract
Acute cholecystitis (AC) has long been treated with percutaneous cholecystostomy (PC) in patients who are poor surgical candidates, but it is associated with high recurrence rate. We report our experience with a hybrid percutaneous-endoscopic technique in an elderly patient with AC who had received a PC. In this technique, a pediatric endoscope was introduced through the PC opening to the gallbladder, and the stones were visualized, fragmented, and extracted using a retrieval basket. The patient’s AC resolved, and within 2 weeks the PC tube was removed. The patient remained asymptomatic at the 6-month and 1-year follow-up visits. We believe that if this method is replicated in large scale, it could be an effective alternative to cholecystectomy in nonsurgical candidates.
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Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared With Traditional Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2017; 26:377-380. [PMID: 27579981 PMCID: PMC5054953 DOI: 10.1097/sle.0000000000000305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The study aimed to compare the application values of endoscopic-laparoscopic cholecystolithotomy (ELC) and laparoscopic cholecystectomy (LC) for patients with cholecystolithiasis. It did a retrospective analysis of 107 patients with cholecystolithiasis who underwent ELC and 144 patients with cholecystolithiasis who underwent LC. There is no significant difference in operating time and expenses when comparing ELC with LC (P>0.05). ELC showed significantly less blood loss during operation compared with LC (P<0.01). Shortened exhaust time (P<0.05) and hospital stay (P<0.01) were present in patients who underwent ELC. Moreover, ELC showed decreased occurrence rate of dyspepsia and diarrhea in comparison with LC (P<0.01). The stone recurrence rate of ELC was 16.67%. ELC decreased the recurrence of stone in common bile duct in comparison with LC. The contractile function of gallbladder was close to normal (P<0.05), and the thickness of gallbladder wall significantly decreased (P<0.001). Patients who underwent ELC showed less digestive symptom, good recovery, and low stone recurrence compared with those who underwent LC.
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Wang T, Luo H, Yan HT, Zhang GH, Liu WH, Tang LJ. Risk factors for gallbladder contractility after cholecystolithotomy in elderly high-risk surgical patients. Clin Interv Aging 2017; 12:129-136. [PMID: 28138229 PMCID: PMC5238807 DOI: 10.2147/cia.s125139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Cholecystolithiasis is a common disease in the elderly patient. The routine therapy is open or laparoscopic cholecystectomy. In the previous study, we designed a minimally invasive cholecystolithotomy based on percutaneous cholecystostomy combined with a choledochoscope (PCCLC) under local anesthesia. Methods To investigate the effect of PCCLC on the gallbladder contractility function, PCCLC and laparoscope combined with a choledochoscope were compared in this study. Results The preoperational age and American Society of Anesthesiologists (ASA) scores, as well as postoperational lithotrity rate and common biliary duct stone rate in the PCCLC group, were significantly higher than the choledochoscope group. However, the pre- and postoperational gallbladder ejection fraction was not significantly different. Univariable and multivariable logistic regression analyses indicated that the preoperational thickness of gallbladder wall (odds ratio [OR]: 0.540; 95% confidence interval [CI]: 0.317–0.920; P=0.023) and lithotrity (OR: 0.150; 95% CI: 0.023–0.965; P=0.046) were risk factors for postoperational gallbladder ejection fraction. The area under receiver operating characteristics curve was 0.714 (P=0.016; 95% CI: 0.553–0.854). Conclusion PCCLC strategy should be carried out cautiously. First, restricted by the diameter of the drainage tube, the PCCLC should be used only for small gallstones in high-risk surgical patients. Second, the usage of lithotrity should be strictly limited to avoid undermining the gallbladder contractility and increasing the risk of secondary common bile duct stones.
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Affiliation(s)
- Tao Wang
- General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan, People's Republic of China
| | - Hao Luo
- General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan, People's Republic of China
| | - Hong-Tao Yan
- General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan, People's Republic of China
| | - Guo-Hu Zhang
- General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan, People's Republic of China
| | - Wei-Hui Liu
- General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan, People's Republic of China
| | - Li-Jun Tang
- General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan, People's Republic of China
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Wang T, Chen T, Zou S, Lin N, Liang HY, Yan HT, Li NL, Liu LY, Luo H, Chen Q, Liu WH, Tang LJ. Ultrasound-guided double-tract percutaneous cholecystostomy combined with a choledochoscope for performing cholecystolithotomies in high-risk surgical patients. Surg Endosc 2014; 28:2236-42. [PMID: 24570012 DOI: 10.1007/s00464-014-3451-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 01/16/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cholecystolithiasis is the most common disease treated by general surgery, with an incidence of about 0.15-0.22%. The most common therapies are open cholecystectomy (OC) or laparoscopic cholecystectomy (LC). However, with a greater understanding of the function of the cholecyst, more and more patients and surgeons are aware that preserving the functional cholecyst is important for young patients, as well as patients who would not tolerate anesthesia associated with either OC or LC. Based on these considerations, we have introduced a notable, minimally invasive treatment for cholecystolithotomy. METHODS We performed a retrospective review of patients with cholecystolithiasis who were unable to tolerate surgery or who insisted on preserving the functional cholecyst. Our particular approach can be simply described as ultrasound-guided percutaneous cholecystostomy combined with a choledochoscope for performing a cholecystolithotomy under local anesthesia. RESULTS Ten patients with cholecystolithiasis were treated via this approach. All except one patient had their gallbladder stones totally removed under local anesthesia, without the aggressive procedures associated with OC or LC. The maximum number of gallbladder stones removed was 16, and the maximum diameter was 13 mm without lithotripsy. After the minimally invasive surgery, the cholecyst contractile functions of all patients were normal, confirmed via ultrasound after a high-fat diet. Complications such as bile duct injury, biliary fistula, and bleeding occurred significantly less often than with OC and LC. The recurrence rates for each of 2 post-operative years were about 11.11% (1/9, excluding a failure case) with uncertainty surrounding recurrence or residue, and 22.22% (2/9, including one non-recurrence patient with follow-up time of 22 months), respectively. CONCLUSIONS Ultrasound-guided percutaneous cholecystostomy combined with choledochoscope is a safe, efficient, and minimally invasive cholecystolithotomy method. We recommend this technique for the management of small stones (less than 15 mm) in high-risk surgical patients.
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Affiliation(s)
- Tao Wang
- General Surgery Center, Chengdu Military General Hospital, Chengdu, 610083, Sichuan, China
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Gallbladder-preserving cholelithotomy in laparoscopic and flexible choledochoscopic era: a report of 316 cases. Surg Laparosc Endosc Percutan Tech 2013; 23:167-70. [PMID: 23579512 DOI: 10.1097/sle.0b013e31828a0b5f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The gallbladder is an organ with accurate functions of concentrating and storing bile and regulating the bile flow. Cholecystectomy is associated with some severe complications in some patients. This study was to investigate the safety and effectiveness of gallbladder-preserving cholelithotomy (GPC) for patients with gallstones in laparoscopic and flexible choledochoscopic era. METHODS From January 2006 to January 2007, a total of 316 patients with gallstone were assigned to GPC according to our inclusion criteria at Yunna Lithiasis Hospital. The procedures were performed by 1 surgical team under laparoscopic and flexible choledochoscopic guidance. The short-term clinical outcome and long-term gallstone recurrence rate were evaluated. RESULTS The success rate of GPC was 95.25%. No severe postoperative complications such as bile leakage and hemorrhage occurred. Conversion to cholecystectomy was required in 15 patients. During 25 to 72 months of follow-up, the gallstone recurrence rate at 12, 36, and 60 months were 0%, 3.32%, and 5.64%, respectively. CONCLUSION GPC using laparoscopy and flexible choledochoscopy is safe and effective in selected patients, the stone recurrence rate is acceptable.
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Sanjay P, Mittapalli D, Marioud A, White RD, Ram R, Alijani A. Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB (Oxford) 2013; 15:511-6. [PMID: 23750493 PMCID: PMC3692020 DOI: 10.1111/j.1477-2574.2012.00610.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/27/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to review a series of consecutive percutaneous cholecystostomies (PC) to analyse the clinical outcomes. METHODS All patients who underwent a PC between 2000 and 2010 were reviewed retrospectively for indications, complications, and short- and long-term outcomes. RESULTS Fifty-three patients underwent a PC with a median age was 74 years (range 14-93). 92.4% (n = 49) of patients were American Society of Anesthesiologists (ASA) III and IV. 82% (43/53) had ultrasound-guided drainage whereas 18% (10/53) had computed tomography (CT)-guided drainage. 71.6% (n = 38) of PC's employed a transhepatic route and 28.4% (n = 15) transabdominal route. 13% (7/53) of patients developed complications including bile leaks (n = 5), haemorrhage (n = 1) and a duodenal fistula (n = 1). All bile leaks were noted with transabdominal access (5 versus 0, P = 0.001). 18/53 of patients underwent a cholecystectomy of 4/18 was done on the index admission. 6/18 cholecystectomies (33%) underwent a laparoscopic cholecystectomy and the remaining required conversion to an open cholecystectomy (67%). 13/53 (22%) patients were readmitted with recurrent cholecystitis during follow-up of which 7 (54%) had a repeated PC. 12/53 patients died on the index admission. The overall 1-year mortality was 37.7% (20/53). CONCLUSIONS Only a small fraction of patients undergoing a PC proceed to a cholecystectomy with a high risk of conversion to an open procedure. A quarter of patients presented with recurrent cholecystitis during follow-up. The mortality rate is high during the index admission from sepsis and within the 1 year of follow-up from other causes.
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Affiliation(s)
| | | | - Aseel Marioud
- HPB Unit, Auckland City HospitalAuckland, New Zealand
| | - Richard D White
- Department of Radiology, Ninewells Hospital and Medical SchoolDundee, UK
| | - Rishi Ram
- HPB Unit, Auckland City HospitalAuckland, New Zealand
| | - Afshin Alijani
- Upper GI & HPB Unit, Ninewells Hospital and Medical SchoolDundee, UK
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Lorenz JM. Evaluating the controversial role of cholecystostomy in current clinical practice. Semin Intervent Radiol 2012. [PMID: 23204643 DOI: 10.1055/s-0031-1296087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Bonin EA, Lopes TL, Baron TH. Percutaneous cholecystoscopy and internal rendezvous for removal of gallstones and common bile duct stones (with video). Gastrointest Endosc 2012; 76:459-61. [PMID: 22115606 DOI: 10.1016/j.gie.2011.07.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 07/29/2011] [Indexed: 02/08/2023]
Affiliation(s)
- Eduardo A Bonin
- Department of Medicine, Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA
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