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Inoue T, Kitano R, Ibusuki M, Kobayashi Y, Ito K, Yoneda M. Endoscopic gallbladder inside-stenting combined with aspirated lavage for calculous cholecystitis in poor surgical candidates: a prospective pilot study. Sci Rep 2023; 13:21156. [PMID: 38036684 PMCID: PMC10689747 DOI: 10.1038/s41598-023-48543-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023] Open
Abstract
Although long-term stent placement via endoscopic gallbladder stenting (EGBS) reportedly reduces cholecystitis recurrence in patients unfit to undergo cholecystectomy, it can increase the frequency of other late adverse events (AEs) such as cholangitis. This study aimed to examine the feasibility of endoscopic gallbladder inside-stenting (EGB-IS) with lavage and aspiration. This prospective, single-center, pilot study enrolled 83 patients with acute calculous cholecystitis who were poor candidates for surgery. A dedicated catheter with eight side holes was used for lavage and aspiration, and a dedicated single-pigtail stent equipped with a thread was used for EGB-IS. Outcomes such as technical success, clinical success, early AEs, recurrence of cholecystitis, and other symptomatic late AEs associated with EGB-IS with lavage and aspiration were evaluated. The technical and clinical success rates were 80.7% (67/83) and 98.5% (66/67), respectively. The rate of early AEs was 3.6% (3/83). The rate of recurrent cholecystitis was 4.5% (3/66) and that of symptomatic late AEs (besides cholecystitis) was 6.1% (4/66). Consequently, the rate of overall late AEs (cholecystitis plus other events) was 10.6% (7/66). The 1-, 2-, and 3-year cumulative incidence rates of all late AEs were 3.2%, 11.2%, and 18.9%, respectively. EGB-IS with lavage and aspiration for calculous cholecystitis showed promising results in poor surgical candidates. EGB-IS may be useful when EGBS with long-term stent placement is planned, since prevention of cholecystitis recurrence, without a rise in the incidence of other AEs, is anticipated.
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Affiliation(s)
- Tadahisa Inoue
- Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Rena Kitano
- Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Mayu Ibusuki
- Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yuji Kobayashi
- Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kiyoaki Ito
- Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Masashi Yoneda
- Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Arkoudis NA, Moschovaki-Zeiger O, Reppas L, Grigoriadis S, Alexopoulou E, Brountzos E, Kelekis N, Spiliopoulos S. Percutaneous cholecystostomy: techniques and applications. Abdom Radiol (NY) 2023; 48:3229-3242. [PMID: 37338588 DOI: 10.1007/s00261-023-03982-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
Acute cholecystitis (AC) is a critical condition requiring immediate medical attention and treatment and is one of the most frequently encountered acute abdomen emergencies in surgical practice, requiring hospitalization. Laparoscopic cholecystectomy is considered the favored treatment for patients with AC who are fit for surgery. However, in high-risk patients considered poor surgical candidates, percutaneous cholecystostomy (PC) has been suggested and employed as a safe and reliable alternative option. PC is a minimally invasive, nonsurgical, image-guided intervention that drains and decompresses the gallbladder, thereby preventing its perforation and sepsis. It can act as a bridge to surgery, but it may also serve as a definitive treatment for some patients. The goal of this review is to familiarize physicians with PC and, more importantly, its applications and techniques, pre- and post-procedural considerations, and adverse events.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece.
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
| | - Stavros Grigoriadis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
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Ramírez-Giraldo C, Isaza-Restrepo A, Rico-Rivera EX, Vallejo-Soto JC, Van-Londoño I. Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute calculous cholecystitis in patients over 90 years of age. Langenbecks Arch Surg 2023; 408:194. [PMID: 37178184 PMCID: PMC10182932 DOI: 10.1007/s00423-023-02903-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the standard of care for acute calculous cholecystitis; however, in patients at high risk for surgery, particularly in the elderly, insertion of a percutaneous catheter drainage (PCD) at gallbladder is recommended. Current evidence suggests that PCD may have less favorable outcomes than LC, but also that LC-associated complications increase in direct relation to patient age. There is no recommendation supported by robust evidence to decide between one or the other procedure in super elderly patients. METHODS A retrospective observational cohort study was designed to analyze the surgical outcomes of super elderly patients with cholecystitis who underwent LC versus PCD for treatment. The surgical outcomes of a subgroup of high-risk patients were also analyzed. RESULTS A total of 96 patients who met the inclusion criteria between 2014 and 2021 were included. The median age of patients were 92 years (IQR: 4.00) with a female predominance (58.33%). The overall morbidity rate in the series was 36.45% and mortality rate was 7.29%. There was no statistically significant difference when compared to the associated morbidity and mortality among patients who underwent LC versus those who underwent PCD, neither in the analysis of the complete series or in the subgroup of high-risk patients. CONCLUSIONS The morbidity and mortality associated with the two most frequently recommended therapeutic options for operating super elderly patients with acute cholecystitis are high. We found no evidence of superiority in outcomes for either of the two procedures in this age group.
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Affiliation(s)
- Camilo Ramírez-Giraldo
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia.
- Universidad del Rosario, Bogotá, Colombia.
| | - Andrés Isaza-Restrepo
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | - Enid Ximena Rico-Rivera
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
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Jones H, Murray D, Murray R, Elfedaly M. Use of Percutaneous Cholecystostomy for the Management of Complicated Cholecystitis Causing Gastric Outlet Obstruction in an Elderly Patient. Cureus 2023; 15:e39708. [PMID: 37398758 PMCID: PMC10309170 DOI: 10.7759/cureus.39708] [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] [Accepted: 05/28/2023] [Indexed: 07/04/2023] Open
Abstract
The management of complicated cholecystitis in an elderly patient can present a complex clinical decision for surgeons. There is literature supporting the use of immediate laparoscopic cholecystectomy for cases of uncomplicated cholecystitis in elderly patients and complicated cholecystitis in the general population. There are, however, no clear guidelines for treating the unique presentation of an elderly patient with complicated cholecystitis. This is likely due to the many clinical risk factors that must be considered when caring for these complex patients often with many medical comorbidities. In this report, we present the case of an 81-year-old male with complicated chronic cholecystitis leading to the exceedingly rare complication of gastric outlet obstruction. The patient was successfully treated with percutaneous cholecystostomy tube placement and interval subtotal laparoscopic cholecystectomy.
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Affiliation(s)
- Hannah Jones
- Department of Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Dylan Murray
- Department of Surgery, University College Dublin, Dublin, IRL
| | - Richard Murray
- Department of Radiology, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Mohamed Elfedaly
- Department of Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
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Ramírez-Giraldo C, Rosas-Morales C, Vásquez F, Isaza-Restrepo A, Ibáñez-Pinilla M, Vargas-Rubiano S, Vargas-Barato F. Laparoscopic cholecystectomy in super elderly (> 90 years of age): safety and outcomes. Surg Endosc 2023:10.1007/s00464-023-10048-3. [PMID: 37093280 PMCID: PMC10338395 DOI: 10.1007/s00464-023-10048-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 03/26/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Nonagenarian patients are an age group in progressive growth. In this age group, indications for surgical procedures, including cholecystectomy, will be increasingly frequent, as biliary pathology and its complications are frequent in this population group. The main objective of this study was to analyze the safety and outcomes of laparoscopic cholecystectomy in patients older than 90 years. METHODS A retrospective observational cohort study was designed. This study involved 600 patients that were classified in 4 age groups for analysis (under 50 years, 50-69 years, 70-89 years, and over 90 years). Demographic, clinical, paraclinics, surgical, and outcome variables were compared according to age group. A multivariate analysis, which included variables considered clinically relevant, was performed to identify factors associated with mortality and complications classified with the Clavien-Dindo scale. RESULTS The patients evaluated had a median age of 65.0 (IQR 34.0) years and there was a female predominance (61.8%). A higher complication rate, conversion rate, subtotal cholecystectomy rate, and prolonged hospital stay were found in nonagenarians. The overall mortality rate was 1.6%. Mortality in the age group over 90 years was 6.8%. Regression models showed that age over 90 years (RR 4.6 CI95% 1.07-20.13), presence of cholecystitis (RR 8.2 CI95% 1.29-51.81), and time from admission to cholecystectomy (RR 1.2 CI95% 1.10-1.40) were the variables that presented statistically significant differences as risk factors for mortality. CONCLUSION Cholecystectomy in nonagenarian patients has a higher rate of complications, conversion rate, subtotal cholecystectomy rate, and mortality. Therefore, an adequate perioperative assessment is necessary to optimize comorbidities and improve outcomes. Also, it is important to know the greatest risk for informed consent and choose the surgical equipment and schedule of the procedure.
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Affiliation(s)
- Camilo Ramírez-Giraldo
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia.
- Universidad del Rosario, Bogotá, Colombia.
| | | | | | - Andrés Isaza-Restrepo
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | | | - Saul Vargas-Rubiano
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | - Felipe Vargas-Barato
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
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Kurihara H, Bunino FM, Fugazza A, Marrano E, Mauri G, Ceolin M, Lanza E, Colombo M, Facciorusso A, Repici A, Anderloni A. Endosonography-Guided Versus Percutaneous Gallbladder Drainage Versus Cholecystectomy in Fragile Patients with Acute Cholecystitis-A High-Volume Center Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111647. [PMID: 36422184 PMCID: PMC9699066 DOI: 10.3390/medicina58111647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Acute cholecystitis is a frequent cause of admission to the emergency department, especially in old and frail patients. Percutaneous drainage (PT-GBD) and endosonographic guided drainage (EUS-GBD) could be an alternative option for relieving symptoms or act as a definitive treatment instead of a laparoscopic or open cholecystectomy (LC, OC). The aim of the present study was to compare different treatment groups. Materials and Methods: This is a five-year monocentric retrospective study including patients ≥65 years old who underwent an urgent operative procedure. A descriptive analysis was conducted comparing all treatment groups. A propensity score was estimated based on the ACS score, incorporated into a predictive model, and tested by recursive partitioning analysis. Results: 163 patients were included: 106 underwent a cholecystectomy (81 laparoscopic (LC) and 25 Open (OC)), 33 a PT-GBD and 21 EUS-GBD. The sample was categorized into three prognostic groups according to the adverse event occurrence rate. All patients treated with EUS-GBD or LC resulted in the low risk group, and the adverse event rate (AE) was 10/96 (10.4%). The AE was 4/28 (14.2%) and 21/36 (58.3%) in the middle- and high-risk groups respectively (p < 0.001). These groups included all the patients who underwent an OC or a PT-GBD. The PT-GBD group had a lower clinical success rate (55.5%) and higher RR (16,6%) when compared with other groups. Conclusions: Surgery still represents the gold standard for AC treatment. Nevertheless, EUS-GBD is a good alternative to PT-GBD in terms of clinical success, RR and AEs in all kinds of patients.
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Affiliation(s)
- Hayato Kurihara
- Emergency Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca M. Bunino
- Emergency Surgery and Trauma Section, Department of Surgery, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy
| | - Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Enrico Marrano
- General Surgery, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain
| | - Giulia Mauri
- Emergency Surgery and Trauma Section, Department of Surgery, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy
| | - Martina Ceolin
- Emergency Surgery and Trauma Section, Department of Surgery, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Ezio Lanza
- Department of Diagnostic and Interventional Radiology, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Foggia, 71122 Foggia, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Correspondence:
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