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Curry J, Chervu N, Cho NY, Hadaya J, Vadlakonda A, Kim S, Keeley J, Benharash P. Percutaneous cholecystostomy tube placement as a bridge to cholecystectomy for grade III acute cholecystitis: A national analysis. Surg Open Sci 2024; 18:6-10. [PMID: 38312302 PMCID: PMC10831282 DOI: 10.1016/j.sopen.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Percutaneous cholecystostomy (PCT) is an alternative to cholecystectomy (CCY) in high-risk surgical candidates with severe acute cholecystitis. A subset of these patients ultimately undergo delayed CCY. We therefore compared outcomes of delayed CCY in patients with grade III acute cholecystitis who received a PCT on index admission, to those who did not. Methods Non-elective adult hospitalizations for grade III acute cholecystitis that underwent delayed CCY were identified in the 2016-2020 Nationwide Readmission Database. Patients who received a PCT during their index admission comprised the PCT group (others: Non-PCT). Outcomes were assessed for the CCY hospitalization. Entropy balancing was used to generate sample weights to adjust for differences in baseline characteristics. Regression models were created to evaluate the association between PCT and the outcomes of interest. Results Of an estimated 13,782 patients, 13.3 % comprised PCT. Compared to Non-PCT, PCT were older (71.1 ± 13.1 vs 67.4 ± 15.3 years) and more commonly in the highest income quartile (22.5 vs 16.1 %, both p < 0.001). After risk adjustment, PCT was associated with reduced odds of respiratory (AOR 0.67, CI 0.54-0.83) and infectious (AOR 0.77, CI 0.62-0.96) complications after eventual CCY. Finally, PCT had comparable pLOS (β +0.31, CI [-0.14, 0.77]) and operative hospitalization costs (β $800, CI [-2300, +600]). Conclusion In the present study, PCT was associated with decreased odds of perioperative complications and comparable resource utilization upon readmission CCY. Our findings suggest that PCT may be helpful in bridging patients with grade III acute cholecystitis to eventual CCY.
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Affiliation(s)
- Joanna Curry
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, California, USA
| | - Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, California, USA
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
| | - Shineui Kim
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
| | - Jessica Keeley
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, California, USA
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Ali H, Shamoon S, Bolick NL, Manickam S, Sattar U, Poola S, Mudireddy P. Outcomes of endoscopic retrograde cholangiopancreatography-guided gallbladder drainage compared to percutaneous cholecystostomy in acute cholecystitis. Ann Hepatobiliary Pancreat Surg 2023; 27:56-62. [PMID: 36536503 PMCID: PMC9947363 DOI: 10.14701/ahbps.22-065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/08/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022] Open
Abstract
Backgrounds/Aims Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) is an alternative to percutaneous cholecystostomy (PTC) for hospitalized acute cholecystitis (AC) patients. Methods We retrospectively analyzed propensity score matched (PSM) AC hospitalizations using the National Inpatient Sample database between 2016 and 2019 to compare the outcomes of ERGD and PTC. Results After PSM, there were 3,360 AC hospitalizations, with 48.8% undergoing PTC and 51.2% undergoing ERGD. There was no difference in median length of stay between the PTC and ERGD cohorts (p = 0.110). There was a higher median hospitalization cost in the ERGD cohort, $62,562 (interquartile range [IQR] $40,707-97,978) compared to PTC, $40,413 (IQR $25,244-65,608; p < 0.001). The 30-day inpatient mortality was significantly lower in hospitalizations with ERGD compared to PTC (adjusted hazard ratio 0.16, 95% confidence interval [CI]: 0.1-0.41; p < 0.001). There was no difference in association with blood transfusions, acute renal failure, ileus, small bowel obstruction, and open cholecystectomy conversion (p > 0.05) between hospitalizations with ERGD and PTC. There was lower association of acute hypoxic respiratory failure (adjusted ratio [AOR] 0.46, 95% CI: 0.29-0.72; p = 0.001), hypovolemia (AOR 0.66, 95% CI: 0.49-0.82; p = 0.009) and higher association of lower gastrointestinal bleed (AOR 1.94, 95% CI: 1.48-2.54; p < 0.001) with ERGD compared to PTC. Conclusions ERGD is a safer alternative to PTC in patients with AC. The risk complications are lower in ERGD compared to PTC but no difference exists based on mortality or conversion to open cholecystectomy.
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Affiliation(s)
- Hassam Ali
- Department of Gastroenterology, East Carolina University/Vidant Medical Center, Greenville, NC, United States,Corresponding author: Hassam Ali, MD Department of Gastroenterology, East Carolina University/Vidant Medical Center, 600 Moye Blvd., VMC MA Room 350, Mailstop #734, Greenville, NC 27834, United States Tel: +1-708-971-4468, Fax: +1-252-422-1522, E-mail: ORCID: https://orcid.org/0000-0001-5546-9197
| | - Sheena Shamoon
- Department of Internal Medicine, Rawalpindi Medical University, Punjab, Pakistan
| | - Nicole Leigh Bolick
- Department of Dermatology, University of New Mexico, Albuquerque, NM, United States
| | - Swethaa Manickam
- Department of Gastroenterology, East Carolina University/Vidant Medical Center, Greenville, NC, United States
| | - Usama Sattar
- Department of Internal Medicine, Quaid-e-Azam Medical College, Punjab, Pakistan
| | - Shiva Poola
- Department of Gastroenterology, East Carolina University/Vidant Medical Center, Greenville, NC, United States
| | - Prashant Mudireddy
- Department of Gastroenterology, East Carolina University/Vidant Medical Center, Greenville, NC, United States
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Kaneta A, Sasada H, Matsumoto T, Sakai T, Sato S, Hara T. Efficacy of endoscopic gallbladder drainage in patients with acute cholecystitis. BMC Surg 2022; 22:224. [PMID: 35690750 PMCID: PMC9188174 DOI: 10.1186/s12893-022-01676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/31/2022] [Indexed: 12/07/2022] Open
Abstract
Background Early cholecystectomy is recommended for patients with acute cholecystitis. However, emergency surgery may not be indicated due to complications and disease severity. Patients requiring drainage are usually treated with percutaneous transhepatic gallbladder drainage (PTGBD), whereas patients with biliary duct stones undergo endoscopic stones removal followed by endoscopic gallbladder drainage (EGBD). Herein, we investigated the efficacy of EGBD in patients with acute cholecystitis. Methods Overall, 101 patients receiving laparoscopic cholecystectomy between September 2019 and September 2020 in our department were retrospectively analyzed. Results The patients (n = 101) were divided into three groups: control group that did not undergo drainage (n = 68), a group that underwent EGBD (n = 7), and a group that underwent PTGBD (n = 26). Median surgery time was 107, 166, and 143 min, respectively. Control group had a significantly shorter surgery time, whereas it did not significantly differ between EGBD and PTGBD groups. The median amount of bleeding was 5 g, 7 g, and 7.5 g, respectively, and control group had significantly less bleeding than the drainage group. We further divided patients into the following subgroups: patients requiring a 5 mm clip to ligate the cystic duct, patients requiring a 10 mm clip due to the thickness of the cystic duct, patients requiring an automatic suturing device, and patients undergoing subtotal cholecystectomy due to impossible cystic duct ligation. There was no significant difference between EGBD and PTGBD regarding the clip used or the need for an automatic suturing device and subtotal cholecystectomy. Conclusions There was no significant difference between EGBD and PTGBD groups regarding surgery time or bleeding amount when surgery was performed after gallbladder drainage for acute cholecystitis. Therefore, EGBD was considered a useful preoperative drainage method requiring no drainage bag.
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Affiliation(s)
- Anri Kaneta
- Department of Surgery, Kensei Hospital, 2 Ogimachi, Hirosaki, Aomori, 036-8511, Japan.
| | - Hirotaka Sasada
- Department of Surgery, Kensei Hospital, 2 Ogimachi, Hirosaki, Aomori, 036-8511, Japan
| | - Takuma Matsumoto
- Department of Surgery, Kensei Hospital, 2 Ogimachi, Hirosaki, Aomori, 036-8511, Japan
| | - Tsuyoshi Sakai
- Department of Surgery, Kensei Hospital, 2 Ogimachi, Hirosaki, Aomori, 036-8511, Japan
| | - Shuichi Sato
- Department of Surgery, Kensei Hospital, 2 Ogimachi, Hirosaki, Aomori, 036-8511, Japan
| | - Takashi Hara
- Department of Surgery, Kensei Hospital, 2 Ogimachi, Hirosaki, Aomori, 036-8511, Japan
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McCarty TR, Thompson CC. Lumen Apposition: A Changing Landscape in Therapeutic Endoscopy. Dig Dis Sci 2022; 67:1660-1673. [PMID: 35430698 DOI: 10.1007/s10620-022-07426-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 12/09/2022]
Abstract
The concept of endoscopic lumen apposition has seen a dramatic shift in the last several decades. Early natural orifice trans-luminal endoscopic surgery (NOTES) concepts have transformed into specialized lumen-apposing metal stents (LAMSs) and delivery devices, which provide endoscopists a minimally invasive alternative to surgical intervention. These LAMSs have become the bedrock of therapeutic endoscopy and provide treatment for a wide spectrum of gastrointestinal disorders. In this review, we summarize the changing landscape of therapeutic endoscopy by highlighting the use of LAMS and future directions as well as alternative devices to achieve lumen apposition.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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Abstract
The concept of endoscopic lumen apposition has seen a dramatic shift in the last several decades. Early natural orifice trans-luminal endoscopic surgery (NOTES) concepts have transformed into specialized lumen-apposing metal stents (LAMSs) and delivery devices, which provide endoscopists a minimally invasive alternative to surgical intervention. These LAMSs have become the bedrock of therapeutic endoscopy and provide treatment for a wide spectrum of gastrointestinal disorders. In this review, we summarize the changing landscape of therapeutic endoscopy by highlighting the use of LAMS and future directions as well as alternative devices to achieve lumen apposition.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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Minimally Invasive Management of Acute Cholecystitis and Frailty Assessment in Geriatric Patients. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:119-123. [PMID: 34882615 DOI: 10.1097/sle.0000000000001021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022]
Abstract
The aim was to compare laparoscopic cholecystectomy (LC) with the percutaneous cholecystostomy (PC) for the management of acute lithiasic cholecystitis in geriatric patients and investigate the decision-making using frailty assessment. A retrospective analysis was performed in all patients aged over 65 years who were treated for acute cholecystitis at our hospital in a period of 5 years. Patients were divided in LC and PC groups. In total, 111 (54.1%) patients were subjected to LC and 94 (45.9%) to PC. The American Society of Anesthesiologists (ASA) and the Clinical Frailty Score were lower for the LC group. However, for patients over 85 years of age, frailty scores between groups were not statistically different. Morbidity and mortality between groups were not statistically different. Both LC and PC are safe and efficient in geriatric patients. Frailty score may better drive the selection of patients to be managed laparoscopically.
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Percutaneous cholecystostomy results of 136 acute cholecystitis patients: A retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.980122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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McCarty TR, Hathorn KE, Bazarbashi AN, Jajoo K, Ryou M, Thompson CC. Endoscopic gallbladder drainage for symptomatic gallbladder disease: a cumulative systematic review meta-analysis. Surg Endosc 2021; 35:4964-4985. [PMID: 34231061 DOI: 10.1007/s00464-020-07758-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/23/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided transmural or endoscopic retrograde cholangiography (ERC)-based transpapillary drainage may provide alternative treatment strategies for high-risk surgical candidates with symptomatic gallbladder (GB) disease. The primary aim of this study was to perform a systematic review and meta-analysis to investigate the efficacy and safety of endoscopic GB drainage for patients with symptomatic GB disease. METHODS Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed in accordance with PRISMA and MOOSE guidelines. Pooled proportions were calculated for measured outcomes including technical success, clinical success, adverse event rate, recurrence rate, and rate of reintervention. Subgroup analyses were performed for transmural versus transpapillary, transmural lumen apposing stent (LAMS), and comparison to percutaneous transhepatic drainage. Heterogeneity was assessed with I2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing. RESULTS Thirty-six studies (n = 1538) were included. Overall, endoscopic GB drainage achieved a technical and clinical success of 87.33% [(95% CI 84.42-89.77); I2 = 39.55] and 84.16% [(95% CI 80.30-87.38); I2 = 52.61], with an adverse event rate of 11.00% [(95% CI 9.25-13.03); I2 = 7.08]. On subgroup analyses, EUS-guided transmural compared to ERC-assisted transpapillary drainage resulted in higher technical and clinical success rates [OR 3.91 (95% CI 1.52-10.09); P = 0.005 and OR 4.59 (95% CI 1.84-11.46); P = 0.001] and lower recurrence rate [OR 0.17 (95% CI 0.06-0.52); P = 0.002]. Among EUS-guided LAMS studies, technical success was 94.65% [(95% CI 91.54-96.67); I2 = 0.00], clinical success was 92.06% [(95% CI 88.65-94.51); I2 = 0.00], and adverse event rate was 11.71% [(95% CI 8.92-15.23); I2 = 0.00]. Compared to percutaneous drainage, EUS-guided drainage possessed a similar efficacy and safety with significantly lower rate of reintervention [OR 0.05 (95% CI 0.02-0.13); P < 0.001]. DISCUSSION Endoscopic GB drainage is a safe and effective treatment for high-risk surgical candidates with symptomatic GB disease. EUS-guided transmural drainage is superior to transpapillary drainage and associated with a lower rate of reintervention compared to percutaneous transhepatic drainage.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Kelly E Hathorn
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Kunal Jajoo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, 02115, USA.
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Image-guided percutaneous cholecystostomy: a comprehensive review. Ir J Med Sci 2021; 191:727-738. [PMID: 34021480 DOI: 10.1007/s11845-021-02655-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
Acute cholecystitis (AC) is a common emergency condition with severity ranging from mild to severe. Gallstones and critical illnesses are the common predisposing factors. Mild AC is primarily managed with medical therapy and early cholecystectomy. Moderate and severe AC require individualized treatment with a preference for early cholecystectomy. However, cholecystectomy may not always be feasible due to co-morbidities. Hence, this group of patients needs minimally invasive methods to drain the gallbladder (GB). Percutaneous cholecystostomy (PC) is the image-guided drainage of GB in the setting of moderate to severe AC. There are different approaches to PC. The technical aspects, success, and complications of PC as well as management of cholecystostomy catheter after the patient recovers from the acute episode should be thoroughly understood by the interventional radiologist. We present an extensive up-to-date review of the essential aspects of PC including indications, contraindications, techniques, and outcomes, including complications and success rates.
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Outcomes of Patients Treated With Upfront Cholecystostomy for Severe Acute Cholecystitis. Surg Laparosc Endosc Percutan Tech 2020; 30:79-84. [PMID: 31876887 DOI: 10.1097/sle.0000000000000747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Percutaneous cholecystostomy tube (PCT) placement is a treatment method for acute cholecystitis, both in adult patients unsuitable for surgery and those failing to improve with conservative management. The purpose of this study was to assess the outcomes of patients undergoing cholecystostomy. MATERIALS AND METHODS A review of consecutive patients who underwent PCT insertion over a 10-year period was performed. Outcomes assessed included cholecystostomy dwell time, tubogram requirement, cholecystostomy reinsertion, cholecystectomy, bile leaks, and mortality. RESULTS One hundred eight patients (77 male individuals, 31 female individuals) were included. The mean age was 70 years (range: 29 to 93 y). A total of 89 transhepatic and 19 transperitoneal PCTs were inserted. Fifty-nine patients (55%) had a subsequent tubogram to assess cystic duct patency or catheter position. Mean catheter dwell time was 17 days (range: 1 to 154 d). Eleven (10%) required PCT reinsertion. Time to reinsertion ranged from 2 to 163 days (mean=38 d). Fifty-three patients (50%) had no further biliary intervention after removal of the cholecystostomy catheter. One patient required subsequent drainage of a hepatic abscess, and another developed a biloma. Thirty-two patients (30%) underwent cholecystectomy (66% laparoscopic, 34% open). Thirty-day mortality after PCT insertion was 8.3%. Twenty patients (19%) died of non-cholecystostomy-related illness during the 10-year follow-up period. CONCLUSIONS Cholecystostomy is an important treatment method of acute cholecystitis as a bridge to cholecystectomy or as an alternative definitive treatment option in those unsuitable for surgery. A tubogram is not always necessary before tube removal. Cholecystostomy tubes can be removed safely with little risk of bile leak if patients are clinically well, and clean-appearing bile is draining.
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Garcés-Albir M, Martín-Gorgojo V, Perdomo R, Molina-Rodríguez JL, Muñoz-Forner E, Dorcaratto D, Ortega J, Sabater L. Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy? J Gastrointest Surg 2020; 24:2579-2586. [PMID: 31792903 DOI: 10.1007/s11605-019-04424-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/25/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate whether percutaneous cholecystostomy (PC) for the treatment of acute calculous cholecystitis (ACC) has better results than emergency cholecystectomy (EC) in elderly and high-risk surgical patients. METHODS Patients ≥ 70 years and/or ≥ ASA-PS 3 with ACC treated with PC or EC between 2005 and 2016 were retrospectively reviewed. Both techniques were compared regarding morbi-mortality, hospital stay, complications and readmissions. A subgroup analysis in higher risk patients (≥ 70 years plus ≥ ASA-PS 3) was also performed. A binary logistic regression analysis for outcome variables to calculate the OR was carried out. RESULTS A total of 461 patients were included in the study. The results of PC were worse compared to EC: 30-day mortality (8.6 vs. 1.7%, OR 18.4), 90-day mortality (10.4 vs. 2.1%, OR 10.3), length of stay (days) (13.21 ± 8.2 vs. 7.48 ± 7.67, OR 8.7) and readmission rate (35.1 vs. 12.6%, OR 4.7). Complications were lower for PC (14 vs. 22.6%, OR 0.41), but there were no significant differences in the number of severe complications (Clavien-Dindo ≥ III). Higher-risk subgroup analysis (n = 193; PC = 128, EC = 65) showed similar results to the whole series. Patients with ACC for more than 3 days had more risk of severe complications in both groups (OR 2.26; OR 2.76). CONCLUSION PC was associated with an increased risk of mortality at 30 and 90 days, more readmissions and longer hospital stay. Although PC presents a lower risk of complications, the percentage of severe complications (Clavien-Dindo ≥ III) does not show significant differences.
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Affiliation(s)
- Marina Garcés-Albir
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain.
| | - Víctor Martín-Gorgojo
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Raúl Perdomo
- Department of Surgery, Hospital Maciel, 11000, Montevideo, Uruguay
| | | | - Elena Muñoz-Forner
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Dimitri Dorcaratto
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Joaquín Ortega
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Luis Sabater
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia. Biomedical Research Institute INCLIVA, Avd. Blasco Ibañez 17, 46010, Valencia, Spain
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Abstract
Geriatric patients tend to have subtle presentations of biliary disorders and, if untreated, can decompensate acutely. Each biliary disorder warrants formulation of an individualized treatment plan with a multidisciplinary approach. Acute cholecystitis, a common complication of gallstones, is initially managed by conservative measures and subsequently, among patients with optimal surgical risk, through laparoscopic or open cholecystectomy. High-risk patients undergo temporization, percutaneous or endoscopic, followed by definitive intervention. Acute cholecystitis with complications (ie, perforation, gangrene, or small bowel obstruction) warrants emergent cholecystectomy. Gallstone migration into the biliary system can cause choledocholithiasis, often complicated by biliary pancreatitis or cholangitis if not intervened. Therapy for choledocholithiasis is based on biliary clearance through endoscopic and, infrequently, surgical approaches.
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13
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Sharma P, McCarty TR, Chhoda A, Costantino A, Loeser C, Muniraj T, Ryou M, Thompson CC. Alternative uses of lumen apposing metal stents. World J Gastroenterol 2020; 26:2715-2728. [PMID: 32550749 PMCID: PMC7284179 DOI: 10.3748/wjg.v26.i21.2715] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/27/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
The advent of lumen apposing metal stents (LAMS) has revolutionized the management of many complex gastroenterological conditions that previously required surgical or radiological interventions. These procedures have garnered popularity due to their minimally invasive nature, higher technical and clinical success rate and lower rate of adverse events. By virtue of their unique design, LAMS provide more efficient drainage, serve as conduit for endoscopic access, are associated with lower rates of leakage and are easy to be removed. Initially used for drainage of pancreatic fluid collections, the use of LAMS has been extended to gallbladder and biliary drainage, treatment of luminal strictures, creation of gastrointestinal fistulae, pancreaticobiliary drainage, improved access for surgically altered anatomy, and drainage of intra-abdominal and pelvic abscesses as well as post-surgical fluid collections. As new indications of endosonographic techniques and LAMS continue to evolve, this review summarizes the current role of LAMS in the management of these various complex conditions and also highlights clinical pearls to guide successful placement of LAMS.
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Affiliation(s)
- Prabin Sharma
- Department of Gastroenterology and Hepatology, Yale-New Haven Health-Bridgeport Hospital, Bridgeport, CT 06610, United States
| | - Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Ankit Chhoda
- Department of Internal Medicine, Yale-New Haven Health-Bridgeport Hospital, Bridgeport, CT 06708, United States
| | - Antonio Costantino
- Department of Gastroenterology and Hepatology, Yale-New Haven Health-Bridgeport Hospital, Bridgeport, CT 06610, United States
| | - Caroline Loeser
- Department of Gastroenterology and Hepatology, Yale-New Haven Health-Bridgeport Hospital, Bridgeport, CT 06610, United States
| | - Thiruvengadam Muniraj
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
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Yan J, Patel N, Li G, Wu D, Cleary K, Iordachita I. Body-Mounted MRI-Conditional Parallel Robot for Percutaneous Interventions Structural Improvement, Calibration, and Accuracy Analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1990-1993. [PMID: 31946290 DOI: 10.1109/embc.2019.8857667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To assist in percutaneous interventions in the lower back under magnetic resonance imaging guidance, a 4 degree-of-freedom body-mounted parallel robot is developed. The robot structure is improved comparatively to a previously developed robot, to increase the stability, enhance accuracy, and streamline the assembly and calibration process. The optimized assembly and calibration workflows are carried out, and the system accuracy is evaluated. The results demonstrate that the system positioning and angular accuracy are 2.28±1.1 mm and 1.94±1.01 degrees respectively. The results show that the new system has a promising and consistent behavior.
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15
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Higa JT, Sahar N, Kozarek RA, La Selva D, Larsen MC, Gan SI, Ross AS, Irani SS. EUS-guided gallbladder drainage with a lumen-apposing metal stent versus endoscopic transpapillary gallbladder drainage for the treatment of acute cholecystitis (with videos). Gastrointest Endosc 2019; 90:483-492. [PMID: 31054909 DOI: 10.1016/j.gie.2019.04.238] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 04/21/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS There is an evolving role for EUS-guided transmural gallbladder (GB) drainage. Endoscopic transpapillary GB drainage is a well-established, nonoperative treatment for acute cholecystitis. We compared the outcomes of 78 cases of EUS-guided versus transpapillary GB drainage at a single, U.S.-based, high-volume endoscopy center. METHODS This was a retrospective analysis performed from May 2013 to January 2018, identified from a database of nonoperative patients with acute cholecystitis. Both electrocautery-enhanced and nonelectrocautery-enhanced lumen-apposing metal stents were used. For transpapillary drainage, guidewire access was obtained and then a transpapillary 7F × 15-cm double-pigtail plastic stent was placed. RESULTS In patients who had successful transpapillary or transmural drainage, demographics data were similar. Technical success was observed in 39 of 40 patients (97.5%) who underwent first attempt at EUS-guided drainage versus 32 of 38 patients (84.2%) for first-attempt transpapillary drainage (adjusted odds ratio, 9.83; 95% confidence interval, .93-103.86). Clinical success was significantly higher with EUS drainage in 38 of 40 patients (95.0%) versus transpapillary drainage in 29 of 38 patients (76.3%) (adjusted odds ratio, 7.14; 95% confidence interval, 1.32-38.52). Recurrent cholecystitis was lower in the EUS-guided drainage group (2.6% vs 18.8%, respectively; P = .023) on univariate analysis but only trended to significance in a multiple regression model. Duration of follow-up, reintervention rates, hospital length of stay, and overall adverse event rates were similar between groups. CONCLUSIONS EUS-guided GB drainage results in a higher clinical success rate compared with transpapillary drainage and may be associated with a lower recurrence rate of cholecystitis. However, transpapillary drainage should be considered as the first-line treatment for patients who are surgical candidates but require temporizing measures or require an ERCP for alternative reasons.
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Affiliation(s)
- Jennifer T Higa
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Nadav Sahar
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Richard A Kozarek
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Danielle La Selva
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael C Larsen
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Seng-Ian Gan
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Andrew S Ross
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Shayan S Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
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16
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Pisano M, Ceresoli M, Cimbanassi S, Gurusamy K, Coccolini F, Borzellino G, Costa G, Allievi N, Amato B, Boerma D, Calcagno P, Campanati L, Campanile FC, Casati A, Chiara O, Crucitti A, di Saverio S, Filauro M, Gabrielli F, Guttadauro A, Kluger Y, Magnone S, Merli C, Poiasina E, Puzziello A, Sartelli M, Catena F, Ansaloni L. 2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population. World J Emerg Surg 2019; 14:10. [PMID: 30867674 PMCID: PMC6399945 DOI: 10.1186/s13017-019-0224-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/28/2019] [Indexed: 12/18/2022] Open
Abstract
Background Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide. Aim The present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population. Material and methods The 2016 WSES guidelines on ACC were used as baseline; six questions have been used to investigate the particularities in elderly population; the answers have been developed in terms of differences compared to the general population and to statements of the 2016 WSES Guidelines. The Consensus Conference discusses, voted, and modified the statements. International experts contributed in the elaboration of final statements and evaluation of the level of scientific evidences. Results The quality of the studies available decreases when we approach ACC in elderly. Same admission laparoscopic cholecystectomy should be suggested for elderly people with ACC; frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist. The role of cholecystostomy is uncertain. Discussion and conclusions The evaluation of pro and cons for surgery or for alternative treatments in elderly suffering of ACC is more complex than in young people; also, the oldest old age is not a contraindication for surgery; however, a larger use of frailty and surgical risk scores could contribute to reach the best clinical judgment by the surgeon. The present guidelines offer the opportunity to share with the scientific community a baseline for future researches and discussion.
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Affiliation(s)
- Michele Pisano
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Marco Ceresoli
- 2General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | | | - Kurinchi Gurusamy
- 4Division of Surgery and Interventional Science, University College London, London, UK
| | - Federico Coccolini
- 5General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | | | - Gianluca Costa
- 7Surgical and Medical Department of Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Niccolò Allievi
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Bruno Amato
- 8Department of Clinical Medicine and Surgery, University of Naples Federico II, Medical School, Naples, Italy
| | - Djamila Boerma
- 9Department of Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Pietro Calcagno
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Luca Campanati
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | | | | | - Osvaldo Chiara
- 3Milano Trauma Network, ASST Niguarda Hospital, Milan, Italy
| | - Antonio Crucitti
- 12General and Minimally Invasive Surgery Unit, Cristo Re Hospital, Sacro Cuore Catholic University, Rome, Italy
| | - Salomone di Saverio
- 13Cambridge Colorectal Unit, Box 201,Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Marco Filauro
- 14E.O.Ospedale Galliera di Genova, SC Chirurgia generale ed epatobiliopancreatica, Genova, Italy
| | - Francesco Gabrielli
- 2General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | - Angelo Guttadauro
- 2General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | - Yoram Kluger
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Stefano Magnone
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Cecilia Merli
- 16Unit of Emergency Medicine Bufalini Hospital, Cesena, Italy
| | - Elia Poiasina
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Alessandro Puzziello
- 17General and Day Surgery Unit, San Giovanni di Dio Hospital, University of Salerno, Fisciano, Italy
| | | | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Luca Ansaloni
- 6Department of Surgery, University Hospital of Verona, Verona, Italy
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17
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Yousef Z, Alotaibi A, Nafea O, Deeb A. Is cholecystostomy tube insertion a real bridge for cholecystectomy in acute cholecystitis? A retrospective cohort study. SAUDI JOURNAL FOR HEALTH SCIENCES 2019. [DOI: 10.4103/sjhs.sjhs_74_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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18
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Percutaneous cholecystostomy as a nonsurgical option for treatment of acute cholecystitis in elderly patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Elsharif M, Forouzanfar A, Oaikhinan K, Khetan N. Percutaneous cholecystostomy… why, when, what next? A systematic review of past decade. Ann R Coll Surg Engl 2018; 100:1-14. [PMID: 30286647 PMCID: PMC6204498 DOI: 10.1308/rcsann.2018.0150] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Percutaneous cholecystostomy tube drainage has played a vital role in management of cholecystitis in patients where surgery is not appropriate. However, management differs from unit to unit and even between different consultants in the same unit. We conducted this systematic review to understand which of these resulted in the best patient outcomes. METHODS We conducted a systematic review using the PubMed database for publication between January 2006 to December 2016. Keyword variants of 'cholecystostomy' and 'cholecystitis' were combined to identify potential relevant papers for inclusion. FINDINGS We identified 46 studies comprising a total of 312,085 patients from 20 different countries. These papers were reviewed, critically appraised and summarised in table format. Percutaneous cholecystostomy tube drainage is an important treatment modality with an excellent safety profile. It has been used successfully both as a definitive procedure and as a bridge to surgery. There continues to be great variation, however, when it comes to the indications, timing and management of these drains. As far as we are aware, this is the only systematic review to cover the past 10 years. It provides a much-needed update, considering all the technological development and new treatment options in laparoscopic surgery and interventional radiology.
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Affiliation(s)
- M Elsharif
- Department of General Surgery, Doncaster Royal Infirmary, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - A Forouzanfar
- Department of General Surgery, Northern General Hospital, Sheffield, UK
| | - K Oaikhinan
- Department of General Surgery, Doncaster Royal Infirmary, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Niraj Khetan
- Department of General Surgery, Doncaster Royal Infirmary, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
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Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with a lumen-apposing metal stent: a systematic review of case series. Eur J Gastroenterol Hepatol 2018; 30:695-698. [PMID: 29578866 DOI: 10.1097/meg.0000000000001112] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Management of patients with acute cholecystitis unfit for surgery is challenging. Recently, endoscopic ultrasound (EUS)-guided gallbladder drainage with a lumen-apposing metal stent (LAMS) has been introduced for these patients. We performed a systematic review and pooled-data analysis in this field. A comprehensive review of case series on gallbladder drainage with EUS-guided LAMS placement was performed. Only case series with at least five patients were considered. The rates of technical success, clinical success, and adverse events were computed. Overall, nine case series with a total of 226 patients were identified. The stent was positioned successfully in 215 cases [95.1%, 95% confidence interval (CI)=92.3-98]. Clinical success was achieved in 207 patients, corresponding to a 91.6% (95% CI=88-95.2) rate at intention-to-treat analysis and 96.3% (95% CI=93.7-99) at per-protocol analysis. A total of 24 (10.6%) adverse events occurred, including 11 (4.9%) cases during the procedure, and 13 (5.7%) observed at follow-up (median=6 months; range: 2-12 months). A surgical approach was required in only 25% of patients with a major adverse event. No case of procedure-related death was reported. EUS-guided LAMS placement for gallbladder drainage in patients with acute cholecystitis not suitable for surgery is highly successful and acceptably safe.
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21
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Donn E, Atkinson I, McCague A. Hemorrhagic Cholecystitis after Warfarin Use for Deep Vein Thrombosis. Surg J (N Y) 2018; 4:e102-e104. [PMID: 29922722 PMCID: PMC6005769 DOI: 10.1055/s-0038-1660450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/30/2018] [Indexed: 11/03/2022] Open
Abstract
Hemorrhagic cholecystitis is an uncommon form of acute cholecystitis which can be rapidly fatal. It may be hard to detect as it frequently presents with symptoms found in other, more common diagnoses. We report the case of a 63 year old man recently started on anticoagulation for deep vein thrombosis who was found to have hemorrhagic cholecystitis.
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Affiliation(s)
- Eric Donn
- Natividad Medical Center, Salinas, California
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22
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Manta R, Zulli C, Zullo A, Forti E, Tringali A, Dioscoridi L, Zito F, Bertani H, Conigliaro R, Mutignani M. Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with a silicone-covered nitinol short bilaterally flared stent: a case series. Endosc Int Open 2017; 5:E1111-E1115. [PMID: 29124119 PMCID: PMC5677460 DOI: 10.1055/s-0043-118659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/24/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND STUDY AIM Gallbladder drainage in patients with cholecystitis who are unsuitable for surgery may be performed by endoscopic ultrasound (EUS)-guided placement of specifically designed fully covered metal stents. We describe the first case series of patients treated with a silicone-covered nitinol stent with bilateral anchor flanges. PATIENTS AND METHODS Data from consecutive patients with acute cholecystitis who were deemed unsuitable candidates for surgery were collected. The stent placement procedure was performed in two tertiary endoscopy centers by four experienced endoscopists. Technical and clinical success rates, as well as adverse events and clinical outcome at follow-up, were assessed. RESULTS EUS-guided drainage for cholecystitis was performed in 16 patients (mean age 84 years; nine males). Technical and clinical success rates were 100 % (16/16) and 94 % (15/16), respectively; an early failure due to stone impaction occurred in the remaining case and required placement of a new stent. Symptom relief occurred in 11/15 cases (73 %) within 1 day, and within 2 days in the remaining 4 patients. Bleeding occurred in two patients (13 %): in one patient intraprocedural bleeding was successfully stopped during endoscopy; and delayed bleeding occurred in one patient requiring arterial embolization for catastrophic bleeding (patient died 10 days later). No cases of cholecystitis recurrence or biliary obstruction were observed during a median follow-up of 112 days (range 49 - 180 days). CONCLUSIONS Our data showed that EUS-guided gallbladder drainage with a specially designed stent is feasible and successful in patients with acute cholecystitis who are unfit for surgery.
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Affiliation(s)
- Raffaele Manta
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy,Corresponding author Raffaele Manta, MD Gastroenterology UnitNuovo Ospedale Civile Sant’ Agostino-EstenseViale Giardini AuslBaggiovaraModenaItaly+39-059-659235
| | - Claudio Zulli
- Endoscopy Unit, AOUI San Giovanni di Dio e Ruggi d’Aragona, G. Fucito Center, Mercato San Severino (SA), Italy
| | - Angelo Zullo
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Edoardo Forti
- Surgical Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | | | | | - Francesco Zito
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy
| | - Helga Bertani
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy
| | - Rita Conigliaro
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy
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23
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Kim HW, Lee JC, Lee J, Kim J, Hwang JH. A successful rendezvous endoscopic ultrasonography-guided gallbladder drainage in malignant cystic duct obstruction. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2017. [DOI: 10.18528/gii160023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hyoung Woo Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong-Chan Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jongchan Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jaihwan Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin-Hyeok Hwang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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24
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Percutaneous cholecystostomy for acute cholecystitis in elderly patients with comorbidities: Long-term outcomes after successful treatment and the risk factors for recurrence. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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25
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Cholecystostomy Treatment in an ICU Population: Complications and Risks. Surg Laparosc Endosc Percutan Tech 2017; 26:410-416. [PMID: 27661202 DOI: 10.1097/sle.0000000000000319] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Percutaneous cholecystostomy tube placement has widely been used as an alternative treatment to cholecystectomy, especially in advanced disease or critically ill patients. Reported postprocedural complication rates have varied significantly over the last decade. The goal of this study is to evaluate the safety of percutaneous cholecystostomy tube treatment in critically ill patients. STUDY DESIGN We performed a retrospective chart analysis of 96 critically ill patients who underwent cholecystostomy tube placement during an intensive care unit (ICU) stay between 2005 and 2010 in a tertiary care center in central Massachusetts. Complications within 72 hours of cholecystostomy tube placement and any morbidity or mortality relating to presence of cholecystostomy tube were considered. RESULTS A total of 65 male and 31 female patients with a mean age of 67.4 years underwent percutaneous cholecystostomy tube placement during an ICU stay. Sixty-six patients experienced a total of 121 complications, resulting in an overall complication rate of 69%. Fifty-four of these complications resulted from the actual procedure or the presence of the cholecystostomy tube; the other 67 complications occurred within 72 hours of the cholecystostomy procedure. Ten patients died. Tube dislodgment was the most common complication with a total of 34 episodes. CONCLUSIONS Cholecystostomy tube placement is associated with frequent complications, the most common of which is tube dislodgment. Severe complications may contribute to serious morbidity and death in an ICU population. Complication rates may be underreported in the medical literature. The potential impact of cholecystostomy tube placement in critically ill patients should not be underestimated.
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Nitzan O, Brodsky Y, Edelstein H, Hershko D, Saliba W, Keness Y, Peretz A, Chazan B. Microbiologic Data in Acute Cholecystitis: Ten Years' Experience from Bile Cultures Obtained during Percutaneous Cholecystostomy. Surg Infect (Larchmt) 2017; 18:345-349. [DOI: 10.1089/sur.2016.232] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Affiliation(s)
- Orna Nitzan
- Infectious Disease Unit, Emek Medical Center, Afula, Israel
- Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel
- Faculty of Medicine in the Galilee, Bar Ilan University, Israel
| | - Yuri Brodsky
- Department of Surgery A, Emek Medical Center, Afula, Israel
| | - Hana Edelstein
- Infectious Disease Unit, Emek Medical Center, Afula, Israel
| | - Dan Hershko
- Department of Surgery A, Emek Medical Center, Afula, Israel
- Technion–Rappaport Faculty of Medicine, Haifa, Israel
| | - Walid Saliba
- Technion–Rappaport Faculty of Medicine, Haifa, Israel
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Yoram Keness
- Clinical Microbiology Laboratory, Emek Medical Center, Afula, Israel
| | - Avi Peretz
- Faculty of Medicine in the Galilee, Bar Ilan University, Israel
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Israel
| | - Bibiana Chazan
- Infectious Disease Unit, Emek Medical Center, Afula, Israel
- Technion–Rappaport Faculty of Medicine, Haifa, Israel
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27
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Sartelli M, Chichom-Mefire A, Labricciosa FM, Hardcastle T, Abu-Zidan FM, Adesunkanmi AK, Ansaloni L, Bala M, Balogh ZJ, Beltrán MA, Ben-Ishay O, Biffl WL, Birindelli A, Cainzos MA, Catalini G, Ceresoli M, Che Jusoh A, Chiara O, Coccolini F, Coimbra R, Cortese F, Demetrashvili Z, Di Saverio S, Diaz JJ, Egiev VN, Ferrada P, Fraga GP, Ghnnam WM, Lee JG, Gomes CA, Hecker A, Herzog T, Kim JI, Inaba K, Isik A, Karamarkovic A, Kashuk J, Khokha V, Kirkpatrick AW, Kluger Y, Koike K, Kong VY, Leppaniemi A, Machain GM, Maier RV, Marwah S, McFarlane ME, Montori G, Moore EE, Negoi I, Olaoye I, Omari AH, Ordonez CA, Pereira BM, Pereira Júnior GA, Pupelis G, Reis T, Sakakhushev B, Sato N, Segovia Lohse HA, Shelat VG, Søreide K, Uhl W, Ulrych J, Van Goor H, Velmahos GC, Yuan KC, Wani I, Weber DG, Zachariah SK, Catena F. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg 2017; 12:29. [PMID: 28702076 PMCID: PMC5504840 DOI: 10.1186/s13017-017-0141-6] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/20/2017] [Indexed: 02/06/2023] Open
Abstract
Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.
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Affiliation(s)
| | - Alain Chichom-Mefire
- Department of Surgery and Obstetrics/Gynaecology, Regional Hospital, Limbe, Cameroon
| | - Francesco M. Labricciosa
- 0000 0001 1017 3210grid.7010.6Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Timothy Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R Mandela School of Clinical Medicine, Durban, South Africa
| | - Fikri M. Abu-Zidan
- 0000 0001 2193 6666grid.43519.3aDepartment of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Abdulrashid K. Adesunkanmi
- 0000 0001 2183 9444grid.10824.3fDepartment of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Luca Ansaloni
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Miklosh Bala
- 0000 0001 2221 2926grid.17788.31Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Zsolt J. Balogh
- 0000 0004 0577 6676grid.414724.0Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales Australia
| | - Marcelo A. Beltrán
- Department of General Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile
| | - Offir Ben-Ishay
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Walter L. Biffl
- 0000 0001 1482 1895grid.162346.4Acute Care Surgery at The Queen’s Medical Center, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, USA
| | - Arianna Birindelli
- 0000 0004 1759 7093grid.416290.8Department of Surgery, Maggiore Hospital, Bologna, Italy
| | - Miguel A. Cainzos
- 0000 0000 8816 6945grid.411048.8Department of Surgery, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | | | - Marco Ceresoli
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Asri Che Jusoh
- Department of General Surgery, Kuala Krai Hospital, Kuala Krai, Kelantan Malaysia
| | - Osvaldo Chiara
- grid.416200.1Emergency Department, Niguarda Ca’ Granda Hospital, Milan, Italy
| | - Federico Coccolini
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Raul Coimbra
- 0000 0001 2107 4242grid.266100.3Department of Surgery, UC San Diego Medical Center, San Diego, USA
| | | | - Zaza Demetrashvili
- 0000 0004 0428 8304grid.412274.6Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, T’bilisi, Georgia
| | - Salomone Di Saverio
- 0000 0004 1759 7093grid.416290.8Department of Surgery, Maggiore Hospital, Bologna, Italy
| | - Jose J. Diaz
- 0000 0001 2175 4264grid.411024.2Shock Trauma Center, University of Maryland School of Medicine, Baltimore, USA
| | - Valery N. Egiev
- 0000 0000 9559 0613grid.78028.35Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Paula Ferrada
- 0000 0004 0458 8737grid.224260.0Department of Surgery, Virginia Commonwealth University, Richmond, VA USA
| | - Gustavo P. Fraga
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Wagih M. Ghnnam
- 0000000103426662grid.10251.37Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Jae Gil Lee
- 0000 0004 0470 5454grid.15444.30Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Carlos A. Gomes
- Department of Surgery, Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, Brazil
| | - Andreas Hecker
- 0000 0000 8584 9230grid.411067.5Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany
| | - Torsten Herzog
- 0000 0004 0490 981Xgrid.5570.7Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jae Il Kim
- 0000 0004 0470 5112grid.411612.1Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Kenji Inaba
- 0000 0001 2156 6853grid.42505.36Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, CA USA
| | - Arda Isik
- 0000 0001 1498 7262grid.412176.7Department of General Surgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Aleksandar Karamarkovic
- 0000 0001 2166 9385grid.7149.bClinic for Emergency Surgery, Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Jeffry Kashuk
- 0000 0004 1937 0546grid.12136.37Department of Surgery, Assia Medical Group, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Vladimir Khokha
- Department of Emergency Surgery, Mozyr City Hospital, Mozyr, Belarus
| | - Andrew W. Kirkpatrick
- 0000 0004 0469 2139grid.414959.4Departments of Surgery, Critical Care Medicine, and the Regional Trauma Service, Foothills Medical Centre, Calgary, Alberta Canada
| | - Yoram Kluger
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Kaoru Koike
- 0000 0004 0372 2033grid.258799.8Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Victor Y. Kong
- 0000 0004 0576 7753grid.414386.cDepartment of Surgery, Edendale Hospital, Pietermaritzburg, Republic of South Africa
| | - Ari Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Gustavo M. Machain
- 0000 0001 2289 5077grid.412213.7II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | - Ronald V. Maier
- 0000000122986657grid.34477.33Department of Surgery, University of Washington, Seattle, WA USA
| | - Sanjay Marwah
- 0000 0004 1771 1642grid.412572.7Department of Surgery, Pt BDS Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Michael E. McFarlane
- 0000 0004 0500 5353grid.412963.bDepartment of Surgery, Radiology, University Hospital of the West Indies, Kingston, Jamaica
| | - Giulia Montori
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Ernest E. Moore
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Iyiade Olaoye
- 0000 0000 8878 5287grid.412975.cDepartment of Surgery, University of Ilorin, Teaching Hospital, Ilorin, Nigeria
| | - Abdelkarim H. Omari
- 0000 0004 0411 3985grid.460946.9Department of Surgery, King Abdullah University Hospital, Irbid, Jordan
| | - Carlos A. Ordonez
- 0000 0001 2295 7397grid.8271.cDepartment of Surgery and Critical Care, Universidad del Valle, Fundación Valle del Lili, Cali, Colombia
| | - Bruno M. Pereira
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | | | - Guntars Pupelis
- Department of General and Emergency Surgery, Riga East University Hospital ‘Gailezers’, Riga, Latvia
| | - Tarcisio Reis
- Emergency Post-operative Department, Otavio de Freitas Hospital and Hosvaldo Cruz Hospital, Recife, Brazil
| | - Boris Sakakhushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Norio Sato
- 0000 0001 1011 3808grid.255464.4Department of Aeromedical Services for Emergency and Trauma Care, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Helmut A. Segovia Lohse
- 0000 0001 2289 5077grid.412213.7II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | - Vishal G. Shelat
- grid.240988.fDepartment of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Kjetil Søreide
- 0000 0004 0627 2891grid.412835.9Department of Gastrointestinal Surgery, Stavanger University Hospital, Stravenger, Norway
- 0000 0004 1936 7443grid.7914.bDepartment of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Waldemar Uhl
- 0000 0004 0490 981Xgrid.5570.7Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Ulrych
- 0000 0000 9100 9940grid.411798.2First Department of Surgery - Department of Abdominal, Thoracic Surgery and Traumatology, General University Hospital, Prague, Czech Republic
| | - Harry Van Goor
- 0000 0004 0444 9382grid.10417.33Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - George C. Velmahos
- 0000 0004 0386 9924grid.32224.35Trauma, Emergency Surgery, and Surgical Critical Care Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | - Kuo-Ching Yuan
- 0000 0004 1756 1461grid.454210.6Trauma and Emergency Surgery Department, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Imtiaz Wani
- 0000 0001 0174 2901grid.414739.cDepartment of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Dieter G. Weber
- 0000 0004 0453 3875grid.416195.eDepartment of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Sanoop K. Zachariah
- 0000 0004 1766 361Xgrid.464618.9Department of Surgery, Mosc Medical College, Kolenchery, Cochin, India
| | - Fausto Catena
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
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Affiliation(s)
- Satyarth Chaudhary
- Department of Gastroenterology and Hepatology, Kidney Hospital and Lifeline Medical Institutions, Jalandhar, Punjab, India
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Widmer J, Alvarez P, Sharaiha RZ, Gossain S, Kedia P, Sarkaria S, Sethi A, Turner BG, Millman J, Lieberman M, Nandakumar G, Umrania H, Gaidhane M, Kahaleh M. Endoscopic Gallbladder Drainage for Acute Cholecystitis. Clin Endosc 2015; 48:411-20. [PMID: 26473125 PMCID: PMC4604280 DOI: 10.5946/ce.2015.48.5.411] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 11/12/2014] [Accepted: 02/12/2015] [Indexed: 12/11/2022] Open
Abstract
Background/Aims Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. Methods Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. Results During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). Conclusions Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities.
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Affiliation(s)
- Jessica Widmer
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Paloma Alvarez
- Division of Gastroenterology and Hepatology, Central University Hospital of Asturias, Asturias, Spain
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Sonia Gossain
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Prashant Kedia
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Savreet Sarkaria
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Amrita Sethi
- Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
| | - Brian G Turner
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Jennifer Millman
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Michael Lieberman
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Govind Nandakumar
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Hiren Umrania
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Monica Gaidhane
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA
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Timing of percutaneous cholecystostomy affects conversion rate of delayed laparoscopic cholecystectomy for severe acute cholecystitis. Surg Endosc 2015; 30:1028-33. [PMID: 26139479 DOI: 10.1007/s00464-015-4290-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Percutaneous cholecystostomy is reserved for very high-operative-risk patients suffering from severe acute cholecystitis, who do not respond to conservative treatment. It is associated with high conversion rate to open surgery, when cholecystectomy is held later on. Our objective was to assess whether early timing of percutaneous cholecystostomy decreases conversion rate of delayed laparoscopic cholecystectomy to open surgery. METHODS The study population included 59 patients who underwent percutaneous cholecystostomy for severe cholecystitis and then proceeded to delayed interval laparoscopic cholecystectomy. The study consisted of a retrospective survey of medical files, based on a prospective enrollment of the data. We assessed conversion rate between two groups based on the time period from onset of symptoms and from admission to hospital until performance of cholecystostomy. RESULTS Regarding the time from onset of pain to drainage, early cholecystostomy (within 2 days, group I) was associated with 8.3% conversion rate, in contrast to 33.3% in group II (3-6 days from onset of symptoms). Regarding the day of admission to hospital, early drainage revealed 16% conversion rate in contrast to 40.7% in later drainage (p = 0.047, Chi-square test). We found correlation between time interval of symptoms and admission to conversion rate, according to Spearman's correlation coefficient. CONCLUSIONS Early percutaneous cholecystostomy does decrease conversion rate of delayed laparoscopic cholecystectomy, possibly by halting the propagation of the inflammatory process and its consequences. When decision regarding the necessity to perform drainage of the severely inflamed gallbladder is established, it is suggested to be done as soon as possible.
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Kirkegård J, Horn T, Christensen SD, Larsen LP, Knudsen AR, Mortensen FV. Percutaneous cholecystostomy is an effective definitive treatment option for acute acalculous cholecystitis. Scand J Surg 2015; 104:238-43. [PMID: 25567854 DOI: 10.1177/1457496914564107] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/06/2014] [Indexed: 12/15/2022]
Abstract
AIMS Acute acalculous cholecystitis can be treated with percutaneous cholecystostomy in critically ill patients unfit for surgery. However, the evidence on the outcome is sparse. We conducted a retrospective analysis of acute acalculous cholecystitis patients treated with percutaneous cholecystostomy during a 10-year study period. METHODS An observational study of 56 consecutive patients treated with percutaneous cholecystostomy for acute acalculous cholecystitis was conducted in the period from 1 June 2002 to 31 May 2012. All data were obtained by review of medical records. RESULTS A total of 56 consecutive patients were treated with percutaneous cholecystostomy for acute acalculous cholecystitis. Six patients (10.7%) died within 30 days after the procedure. Percutaneous cholecystostomy could serve as a definitive treatment option in 45 patients (80.4%), whereas 1 patient (1.8%) required cholecystectomy due to recurrence of cholecystitis. Four patients (7.1%) were treated with percutaneous cholecystostomy as a bridging procedure to subsequent elective laparoscopic cholecystectomy within a median of 8.8 months (range: 7.7-33.4 months). There was no significant difference in the risk of cholecystitis recurrence between patients with (6/37) and without (2/3) contrast passage to the duodenum on cholangiography (p = 0.096). CONCLUSION Percutaneous cholecystostomy is successful as a definitive treatment option in the majority of patients with acute acalculous cholecystitis. It is associated with a low rate of mortality and subsequent cholecystectomy.
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Affiliation(s)
- J Kirkegård
- Department of Surgical Gastroenterology L, Aarhus University Hospital, Aarhus C, Denmark
| | - T Horn
- Department of Surgical Gastroenterology L, Aarhus University Hospital, Aarhus C, Denmark
| | - S D Christensen
- Department of Surgical Gastroenterology L, Aarhus University Hospital, Aarhus C, Denmark
| | - L P Larsen
- Department of Radiology, Aarhus University Hospital, Aarhus C, Denmark
| | - A R Knudsen
- Department of Surgical Gastroenterology L, Aarhus University Hospital, Aarhus C, Denmark
| | - F V Mortensen
- Department of Surgical Gastroenterology L, Aarhus University Hospital, Aarhus C, Denmark
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Abdulaal AF, Sharouda SK, Mahdy HA. Percutaneous cholecystostomy treatment for acute cholecystitis in high risk patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Widmer J, Singhal S, Gaidhane M, Kahaleh M. Endoscopic ultrasound-guided endoluminal drainage of the gallbladder. Dig Endosc 2014; 26:525-31. [PMID: 24422762 DOI: 10.1111/den.12221] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/20/2013] [Indexed: 12/13/2022]
Abstract
For patients with acute cholecystitis who are not suitable for surgery, endoscopic ultrasound-guided endoluminal drainage of the gallbladder (EUS-GBD) has been developed to overcome the limitations of percutaneous transhepatic gallbladder drainage when endoscopic transpapillary gallbladder drainage is not feasible. In the present review we have summarized the studies describing EUS-GBD. Indications, techniques, accessories, endoprostheses, limitations and complications reported in the different studies are discussed. There were 90 documented cases in the literature. The overall reported technical success rate was 87/90 (96.7%). All patients with technical success were clinically successful. A total of 11/90 (12.2%) patients had complications including pneumoperitoneum, bile peritonitis and stent migration. The advantage of EUS-GBD is its ability to provide gallbladder drainage especially in situations where percutaneous or transpapillary drainage is not feasible or is technically challenging. It also provides the option of internal drainage and the ability to carry out therapeutic maneuvers via cholecystoscopy.
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Affiliation(s)
- Jessica Widmer
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, USA
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34
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Widmer J, Alvarez P, Gaidhane M, Paddu N, Umrania H, Sharaiha R, Kahaleh M. Endoscopic ultrasonography-guided cholecystogastrostomy in patients with unresectable pancreatic cancer using anti-migratory metal stents: a new approach. Dig Endosc 2014; 26:599-602. [PMID: 24102709 DOI: 10.1111/den.12163] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 07/31/2013] [Indexed: 02/06/2023]
Abstract
Cholecystectomy is contraindicated in patients with comorbidities or unresectable cancer. Percutaneous transhepatic gallbladder drainage (PTGBD) is typically offered with response rates ranging from 56% to 100%, but has several risks such as bleeding, pneumothorax, pneumoperitoneum, bile leak, and/or catheter migration. Endoscopic transpapillary gallbladder drainage (ETGD) and endoscopic ultrasound-guided transmural gallbladder drainage (EUS-GBD) are alternative endoscopic modalities that have a technical feasibility, efficacy and safety profile comparable with PTGBD. In this report, we present the first case series of transgastric EUS-GBD with placement of a fully covered self-expandable metal stent with anti-migratory fins. In three pancreatic cancer cases with acute cholecystitis when ETGD was unsuccessful, there were no bile leaks or procedurally related complications. There were no acute cholecystitis recurrences. In conclusion, EUS-GBD is a promising, minimally invasive treatment for acute cholecystitis. Additional comparative studies are needed to validate the benefit of this technique.
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Affiliation(s)
- Jessica Widmer
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, USA
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35
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Cha BH, Song HH, Kim YN, Jeon WJ, Lee SJ, Kim JD, Lee HH, Lee BS, Lee SH. Percutaneous cholecystostomy is appropriate as definitive treatment for acute cholecystitis in critically ill patients: a single center, cross-sectional study. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 63:32-8. [PMID: 24463286 DOI: 10.4166/kjg.2014.63.1.32] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND/AIMS Percutaneous cholecystostomy (PC) is an effective treatment for cholecystitis in high-risk surgical patients. However, there is no definitive agreement on the need for additional cholecystectomy in these patients. METHODS All patients who were admitted to Cheju Halla General Hospital (Jeju, Korea) for acute cholecystitis and who underwent ultrasonography-guided PC between 2007 and 2012 were consecutively enrolled in this study. Among 82 total patients enrolled, 35 underwent laparoscopic cholecystectomy after recovery and 47 received the best supportive care (BSC) without additional surgery. RESULTS The technical and clinical success rates for PC were 100% and 97.5%, respectively. The overall mean survival was 12.8 months. In the BSC group, mean survival was 5.4 months, and in the cholecystectomy group, mean survival was 22.4 months (p<0.01). However, there was no significant difference between these groups in multivariate analysis (relative risk [RR]=1.92; 95% CI, 0.77-4.77; p=0.16). However, advanced age (RR=1.05; 95% CI, 1.02-1.08; p=0.001) and higher class in the American Society of Anesthesiologists' physical status (RR=3.06; 95% CI, 1.37-6.83, p=0.006) were significantly associated with survival in the multivariate analysis. Among the 47 patients in the BSC group, the cholecystostomy tube was removed in 31 patients per protocol. Recurrent cholecystitis was not observed in either group of patients during the follow-up period. CONCLUSIONS In high-risk surgical patients, PC without additional cholecystectomy might be the best definitive management. Furthermore, the cholecystostomy drainage catheter can be safely removed in certain patients.
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Affiliation(s)
- Byung Hyo Cha
- Digestive Disease Center, Department of Internal Medicine, Cheju Halla General Hospital, Doreongno 65, Jeju 690-766, Korea
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Jayakrishnan TT, Groeschl RT, George B, Thomas JP, Pappas S, Gamblin TC, Turaga KK. Management of acute cholecystitis in cancer patients: a comparative effectiveness approach. Surg Endosc 2014; 28:1505-14. [DOI: 10.1007/s00464-013-3344-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 11/04/2013] [Indexed: 01/12/2023]
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37
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Zerem E, Omerović S, Imširović B. Is surgical cholecystectomy better than percutaneous in treatment of acute cholecystitis in patients unfit for surgery? J Gastrointest Surg 2013; 17:1542-3. [PMID: 23605246 DOI: 10.1007/s11605-013-2205-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 04/10/2013] [Indexed: 01/31/2023]
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38
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Li M, Li N, Ji W, Quan Z, Wan X, Wu X, Li J. Percutaneous cholecystostomy is a definitive treatment for acute cholecystitis in elderly high-risk patients. Am Surg 2013; 79:524-7. [PMID: 23635589 DOI: 10.1177/000313481307900529] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Percutaneous cholecystostomy (PC) is an alternative treatment for acute cholecystitis (AC) in elderly patients with high surgical risk and has lower morbidity and mortality than emergency cholecystectomy. There is controversy about whether cholecystectomy should be performed after PC in elderly high-risk patients. Medical records of patients with AC admitted to the Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, China, between January 2004 and July 2009 were reviewed retrospectively. The elderly high-risk patients with AC who underwent PC were selected for further study. The safety, efficacy, and long-term outcome of PC without cholecystectomy were evaluated in these patients. The symptoms of AC resolved in 98.6 per cent of patients; drainage-related morbidity and mortality rates were 4.1 and 1.4 per cent, respectively. No patient underwent cholecystectomy after PC. The recurrence rate of cholecystitis was 4.1 per cent. The one-year survival rate was 82.2 per cent, and the three-year survival rate was 39.7 per cent. No death was related to cholecystitis, but one patient died of septic shock on the second day after PC. Considering limited survival and a low recurrence rate of cholecystitis in elderly high-risk patients with AC, we propose that PC is a definitive treatment and cholecystectomy is not necessary after resolution of AC symptoms.
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Affiliation(s)
- Min Li
- Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangshu Province, China
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39
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Abstract
Acute cholecystitis is a commonly encountered medical emergency that is managed surgically with excellent results. Recent experiences with endoscopic cystic duct stent placement and cholecystectomy using the NOTES (Natural Orifice Transluminal Endoscopic Surgery) approach have inspired endoscopists to identify other less invasive means for treating cholecystitis. The ability to access and drain obstructive bile ducts in real time using endoscopic ultrasound guidance has led to recent reports of successful gallbladder drainage using similar techniques. This article discusses the current state of the endoscopic management of acute and acalculous cholecystitis, and outlines a consensus approach to the management of these patients.
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40
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Complication rate of ultrasound-guided percutaneous cholecystostomy in patients with coagulopathy. AJR Am J Roentgenol 2013; 199:W753-60. [PMID: 23169749 DOI: 10.2214/ajr.11.8445] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to compare the complication rate for ultrasound-guided percutaneous cholecystostomy in patients with coagulopathy to the rate in patients with normal coagulation. MATERIALS AND METHODS We performed a database search for patients who underwent ultrasound-guided percutaneous cholecystostomy from January 2000 through December 2010. Patients were divided into those with normal coagulation and those with coagulopathy, as documented by abnormal laboratory values (international normalized ratio ≥ 1.5 and platelet count ≤ 50 × 10(9)/L) or history of anticoagulant medication in the preceding 5 days. Medical records were reviewed, and complication rates and subsequent treatment was recorded. Statistical analysis was performed using the Fisher exact and chi-square tests. RESULTS Two hundred forty-two patients underwent ultrasound-guided percutaneous cholecystostomy (132 men and 110 women; mean [± SD] age, 73.9 ± 15.9 years; range, 22-104 years). One hundred thirty-two patients were coagulopathic and 110 had normal coagulation. Major complications related to ultrasound-guided percutaneous cholecystostomy were rare (4/242 cases [1.7%]) and included hemorrhage requiring transfusion (n = 1), death directly related to the procedure (n = 1), sepsis related to the procedure (n = 1), and abscess or biloma formation (n = 1). All of these occurred in the group with normal coagulation. Fourteen additional deaths (5.8%) that occurred within 30 days of the procedure were related to comorbidities. Minor catheter-related complications (15/242 [6.2%]) were due to catheter dislodgement (n = 11 [4.5%]), failure of placement (n = 1 [0.4%]), and hemorrhage not requiring transfusion (n = 3 [1.2%]). Two of the minor hemorrhagic complications were seen in the coagulopathic group and one in the normal coagulation group (p = 0.599). CONCLUSION There is no difference in the complication rate for ultrasound-guided percutaneous cholecystostomy in patients who are coagulopathic compared with those who have normal coagulation.
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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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Duszak R, Behrman SW. National Trends in Percutaneous Cholecystostomy Between 1994 and 2009: Perspectives From Medicare Provider Claims. J Am Coll Radiol 2012; 9:474-9. [DOI: 10.1016/j.jacr.2012.02.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
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Acute cholecystitis in high surgical risk patients: percutaneous cholecystostomy or emergency cholecystectomy? Am J Surg 2012; 204:54-9. [DOI: 10.1016/j.amjsurg.2011.05.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/13/2011] [Accepted: 05/13/2011] [Indexed: 01/10/2023]
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McKay A, Abulfaraj M, Lipschitz J. Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Surg Endosc 2011; 26:1343-51. [PMID: 22089258 DOI: 10.1007/s00464-011-2035-0] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 09/10/2011] [Indexed: 01/05/2023]
Abstract
BACKGROUND Percutaneous cholecystostomy is a less invasive method to treat acute cholecystitis in patients who are critically ill or have serious medical comorbidities precluding the use of general anesthesia. It remains controversial whether interval cholecystectomy is warranted. The objectives of the study were to determine the success rate and complications of percutaneous cholecystostomy and the proportion of patients without recurrent attacks in whom interval cholecystectomy was not needed. METHODS This was a retrospective review to determine the outcomes after percutaneous cholecystostomy for acute calculous cholecystitis between 1995 and 2007. Administrative data were used to better capture recurrent symptoms requiring treatment. RESULTS Sixty-eight patients with a mean age of 74 years were identified. Sixty-seven (98.5%) underwent successful insertion of the cholecystostomy tubes. Eleven patients suffered tube-related complications, including tube dislodgment (9), tube blockage (1), and bleeding that was controlled with conservative management (1). The initial episode of cholecystitis was treated successfully in 58 patients (85%). The overall in-hospital and 30-day mortality were both 15% (10 patients). A total of 7 patients (10%) underwent cholecystectomy while still in hospital. There were 39 patients at risk for recurrent disease who survived the initial episode and did not receive an interval cholecystectomy. Of these 39 patients, 16 (41%) suffered recurrent gallbladder-related disease. CONCLUSIONS Percutaneous cholecystostomy is an alternative to cholecystectomy in patients with acute calculous cholecystitis who are at high risk for surgical mortality and morbidity. It appears to have a low complication rate and good clinical success. Because a significant number of patients suffer recurrent attacks, elective cholecystectomy should be considered routinely. Unfortunately, firm criteria for selecting percutaneous cholecystostomy over cholecystectomy are lacking, and the surgeon's clinical judgment is critically important.
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Affiliation(s)
- Andrew McKay
- Department of Surgery, Health Sciences Centre, University of Manitoba, GF-431, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
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Choi SB, Han HJ, Kim CY, Kim WB, Song TJ, Suh SO, Kim YC, Choi SY. Early Laparoscopic Cholecystectomy Is the Appropriate Management for Acute Gangrenous Cholecystitis. Am Surg 2011. [DOI: 10.1177/000313481107700412] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Treatment of severe acute cholecystitis by laparoscopic cholecystectomy remains controversial because of technical difficulties and high rates of complications. We determined whether early laparoscopic cholecystectomy is appropriate for acute gangrenous cholecystitis. The medical records of 116 patients with acute gangrenous cholecystitis admitted to the Korea University Guro Hospital between January 2005 and December 2009 were reviewed. The early operation group, those patients who had cholecystectomies within 4 days of the diagnosis, was compared with the delayed operation group, who had cholecystectomies 4 days after the diagnosis. Of the 116 patients, 57 were in the early operation group and 59 were in the delayed operation group. There were no statistical differences between the groups with respect to gender, age, body mass index, operative methods, major complications, duration of symptoms, mean operative time (98 vs 107 minutes), or postoperative hospital stay. However, the total hospital stay was significantly longer in the delayed operation group. More patients underwent preoperative percutaneous cholecystostomy in the delayed operation group (3.5 vs 15.3%). Early laparoscopic cholecystectomy for acute gangrenous cholecystitis is safe and feasible. There is no advantage to postponing an urgent operation in patients with acute gangrenous cholecystitis.
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Affiliation(s)
- Sae Byeol Choi
- Department of Surgery, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hyung Joon Han
- Department of Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Gyeonggi-Do, Korea
| | - Chung Yun Kim
- Department of Surgery, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Wan Bae Kim
- Department of Surgery, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Tae-Jin Song
- Department of Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Gyeonggi-Do, Korea
| | - Sung Ock Suh
- Department of Surgery, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Young Chul Kim
- Department of Surgery, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Sang Yong Choi
- Department of Surgery, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
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Chok KSH, Chu FSK, Cheung TT, Lam VWT, Yuen WK, Ng KKC, Chan SC, Poon RTP, Yeung C, Lo CM, Fan ST. Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis. ANZ J Surg 2010; 80:280-3. [PMID: 20575957 DOI: 10.1111/j.1445-2197.2009.05105.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To assess the efficacy and safety of percutaneous transhepatic cholecystostomy (PTC) in treatment for acute cholecystitis in high surgical risk patients. PATIENTS AND METHODS A retrospective review was carried out from January 1999 to June 2007 on 23 patients, 11 males and 12 females, who underwent PTC for the management of acute cholecystitis at the Department of Surgery, Queen Mary Hospital, Hong Kong, China. The mean age of the patients was 83. They all had either clinical or radiological evidence of acute cholecystitis and had significant pre-morbid diseases. The median follow-up period on them was 35 months. RESULTS All the PTCs performed were technically successful. One patient died from procedure-related haemoperitoneum, while 87% (n = 20) of all the patients had clinical resolution of sepsis by 20 h after PTC. Eight patients underwent elective cholecystectomy afterwards (62.5% with the laparoscopic approach). Eight patients had dislodgement of the PTC catheter and one of them developed recurrent acute cholecystitis 3 months after PTC. That patient was treated conservatively. Four patients died from their pre-morbid conditions during the follow-up period. CONCLUSION PTC was a safe and effective alternative for treating acute cholecystitis in this group of patients. Thirteen of them without elective cholecystectomy performed did not have recurrent acute cholecystitis after a single session of PTC. It may be considered as a definitive treatment for this group of patients.
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Affiliation(s)
- Kenneth S H Chok
- Centre for the Study of Liver Disease and Department of Surgery, The University of Hong Kong, Hong Kong, China.
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Gumus B. Percutaneous Cholecystostomy as a First-Line Therapy in Chronic Hemodialysis Patients with Acute Cholecystitis with Midterm Follow-up. Cardiovasc Intervent Radiol 2010; 34:362-8. [DOI: 10.1007/s00270-010-0025-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 10/15/2010] [Indexed: 10/18/2022]
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Yun SS, Hwang DW, Kim SW, Park SH, Park SJ, Lee DS, Kim HJ. Better treatment strategies for patients with acute cholecystitis and American Society of Anesthesiologists classification 3 or greater. Yonsei Med J 2010; 51:540-5. [PMID: 20499419 PMCID: PMC2880266 DOI: 10.3349/ymj.2010.51.4.540] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Laparoscopic cholecystectomy is the best treatment choice for acute cholecystitis. However, it still carries high conversion and mortality rates. The purpose of this study was to find out better treatment strategies for high surgical risk patients with acute cholecystitis. MATERIALS AND METHODS Between January 2002 and June 2008, we performed percutaneous cholecystostomy instead of emergency cholecystectomy in 44 patients with acute cholecystitis and American Society of Anesthesiologists (ASA) classification 3 or greater. This was performed in 31 patients as a bridge procedure before elective cholecystectomy (bridge group) and as a palliative procedure in 11 patients (palliation group). RESULTS The mean age of patients was 71.6 years (range 52-86 years). The mean ASA classifications before and after percutaneous cholecystostomy were 3.3 +/- 0.5 and 2.5 +/- 0.6, respectively, in the bridge group, and 3.6 +/- 0.7 and 3.1 +/- 1.0, in the palliation group, respectively. Percutaneous cholecystostomy was technically successful in all patients. There were two deaths after percutaneous cholecystostomy in the palliation group due to underlying ischemic heart disease and multiple organ failure. Resumption of oral intake was possible 2.9 +/- 1.8 days in the bridge group and 3.9 +/- 3.5 days in the palliation group after percutaneous cholecystostomy. We attempted 17 laparoscopic cholecystectomies and experienced one failure due to bile duct injury (success rate: 94.1%). The postoperative course of all cholecystectomy patients was uneventful. CONCLUSION Percutaneous cholecystostomy is an effective bridge procedure before cholecystectomy in patients with acute cholecystitis and ASA classification 3 or greater.
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Affiliation(s)
- Sung Su Yun
- Department of Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Dae Wook Hwang
- Department of Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Se Won Kim
- Department of Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang Hwan Park
- Department of Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang Jin Park
- Department of Anesthesiology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Dong Shick Lee
- Department of Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Hong Jin Kim
- Department of Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
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Súbtil JC, Betes M, Muñoz-Navas M. Gallbladder drainage guided by endoscopic ultrasound. World J Gastrointest Endosc 2010; 2:203-9. [PMID: 21160934 PMCID: PMC2999130 DOI: 10.4253/wjge.v2.i6.203] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/25/2010] [Accepted: 06/01/2010] [Indexed: 02/05/2023] Open
Abstract
The gold-standard management of acute cholecystitis is cholecystectomy. Surgical intervention may be contraindicated due to permanent causes. To date, the classical approach is percutaneous cholecystostomy in patients unresponsive to medical therapy. However, with this treatment some patients may experience discomfort, complications and a decrease in their quality of life. In these cases, endoscopic ultrasound (EUS)-guided gallbladder drainage may represent an effective minimally invasive alternative. Our objective is to describe in detail this new and not well-known technique: EUS-guided cholecystenterostomy. We will describe how the patient should be prepared, what accessories are needed and how the technique is performed. We will also discuss the possible indications for this technique and will provide a brief review based on published reports and our own experience.
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Affiliation(s)
- José Carlos Súbtil
- José Carlos Súbtil, Maite Betes, Miguel Muñoz-Navas, Gastroenterology Department, University Clinic of Navarra, Pamplona 31008, Spain
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Saad WEA, Wallace MJ, Wojak JC, Kundu S, Cardella JF. Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 2010; 21:789-95. [PMID: 20307987 DOI: 10.1016/j.jvir.2010.01.012] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 01/03/2010] [Accepted: 01/13/2010] [Indexed: 02/06/2023] Open
Affiliation(s)
- Wael E A Saad
- Division of Vascular Interventional Radiology, Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, USA.
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