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Ghali MS, Ali SM, Gibreal KJS, Singh R, Shehata MS, Al-Zoubi RM, Zarour A. Indications and clinical outcomes of percutaneous cholecystostomies in acute cholecystitis: a study from Qatar. BMC Surg 2025; 25:100. [PMID: 40089720 PMCID: PMC11909981 DOI: 10.1186/s12893-025-02765-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 01/08/2025] [Indexed: 03/17/2025] Open
Abstract
INTRODUCTION Acute cholecystitis (AC) is a prevalent condition in emergency departments (EDs). Standard care involves early laparoscopic cholecystectomy; however, in cases of delayed presentation, high surgical risk, or during situations like the COVID-19 pandemic, percutaneous cholecystostomy (PC) serves as an alternative management strategy. This study reports our center's experience with PC in managing AC, providing insights from a unique geographical context. METHODS We conducted a retrospective review of 97 patients undergoing PC operation from June 1, 2016, to January 1, 2021. The data collected included demographic details, indications for PC, clinical outcomes, ICU admissions, overall mortality, and long-term follow-up. RESULTS The cohort comprised 61.9% male patients with a mean age of 67.2 ± 15.5 years. The primary comorbidity was hypertension (83.5%), and 88.6% had an ASA (American Society of Anesthesiologists) score of ≥ III. The main cause of AC was calculous type, and 15.2% of cases were acalculous cholecystitis. Main Tokyo Guidelines 18 (TG 18) grade was grade II and was found in 56.4% of patients. The readmission rate was 33.1% and overall mortality rate was 34% during follow-up. The native population in Qatar were older and burdened with more co-morbidities. High risk of surgery was the main indication for PC, followed by delayed presentation of AC. Patients with delayed presentations were younger (p = 0.051), had higher albumin levels (p = 0.005), and had lower ICU admission rates (p = 0.002) and mortality (p = 0.014) than those with multiple comorbidities. The overall Mortality rates post-PC were 34%, predominantly attributed to underlying conditions rather than the PC procedure itself. Patients who proceeded to post-PC cholecystectomy were younger, had higher albumin levels, and experienced fewer readmissions (p < 0.05). CONCLUSION In high-risk patients or when surgical risk is prohibitive, PC is a viable and effective alternative for AC management. Post-PC cholecystectomy was associated with favorable outcomes, suggesting PC as a bridge to surgery in selected patients. This study highlights the role of PC in a high-risk population within our regional setting.
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Affiliation(s)
- Mohamed Said Ghali
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, 3050, Qatar
- Department of General Surgery, Ain Shams University, Cairo, Egypt
| | - Syed Muhammad Ali
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, 3050, Qatar
- Wiell Cornell medical college, Doha, Qatar
| | | | - Rajvir Singh
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, 3050, Qatar
| | - Mona S Shehata
- Department of Pharmacy, Woman's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Raed M Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
- Department of Biomedical Sciences, QU-Health, College of Health Sciences, Qatar University, Doha, 2713, Qatar.
- Department of Chemistry, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Ahmad Zarour
- Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, 3050, Qatar
- Wiell Cornell medical college, Doha, Qatar
- Department of Surgery, College of Medicine, Qatar University, Doha, 2713, Qatar
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Pan CW, Ramai D, Beran A, Wang Y, Huang Y, Morris J. Endoscopic transpapillary gallbladder stenting vs percutaneous cholecystostomy for managing acute cholecystitis: Nationwide propensity score study. Endosc Int Open 2025; 13:a25210084. [PMID: 40018071 PMCID: PMC11866036 DOI: 10.1055/a-2521-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 01/15/2025] [Indexed: 03/01/2025] Open
Abstract
Background and study aims Cholecystectomy is the standard treatment for acute cholecystitis, but it may not be suitable for all patients. For those who cannot undergo surgery, a percutaneous cholecystostomy tube (PCT) and ERCP-guided transpapillary gallbladder drainage are viable options. We aimed to perform a nationwide study to assess 30-day readmission rates, adverse events (AEs), and mortality rates in these two cohorts. Patients and methods We conducted a nationwide cohort study using data from the Nationwide Readmissions Database (NRD) from 2016 to 2019. We identified patients with acute cholecystitis during the index admission who underwent either PCT or ERCP-guided gallbladder drainage. Propensity score matching along with multivariable regression was used to compare cohorts. Results During the study period, 3,592 patients (average age 63.0 years) underwent endoscopic drainage, whereas 80,372 patients (average 70.8 years) underwent Interventional Radiology drainage. Utilizing multivariate Cox regression analysis, compared with ERCP, PCT had a higher risk for 30-day readmission (adjusted hazard ratio [aHR] 1.47; 95% confidence interval [CI] 1.27 to 1.71; P < 0.001). The PCT group had a significantly higher rate of readmission for acute cholecystitis compared with the ERCP group (2.72% vs 0.86%; P < 0.005). Cox proportional hazard ratio showed a 3.41-fold increased risk (95% CI 1.99 to 5.84) for readmission in the PCT group. ERCP was consistently associated with lower rates of post-procedural AEs compared with PCT including acute hypoxemic respiratory failure ( P < 0.001), acute renal failure ( P < 0.001), shock ( P < 0.001), and need for blood transfusions ( P < 0.001). Conclusions Our nationwide analysis revealed that ERCP-guided gallbladder drainage should be the preferred approach for managing acute cholecystitis when unfit for surgery.
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Affiliation(s)
- Chun-wei Pan
- Internal Medicine, Cook County Hospital, Chicago, United States
| | - Daryl Ramai
- Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, United States
| | - Azizullah Beran
- Gastroenterology and Hepatology, Indiana University, Bloomington, United States
| | - Yichen Wang
- Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, United States
| | - Yuting Huang
- Gastroenterology & Hepatology, Mayo Clinic in Florida, Jacksonville, United States
| | - John Morris
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States
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Lodato F, Landi S, Bassi M, Ghersi S, Cennamo V. Urgent Endoscopic Biliary Procedures: "Run Like the Wind"? J Clin Med 2025; 14:1017. [PMID: 39941686 PMCID: PMC11818415 DOI: 10.3390/jcm14031017] [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: 01/23/2025] [Revised: 02/01/2025] [Accepted: 02/04/2025] [Indexed: 02/16/2025] Open
Abstract
Emergency endoscopy is an activity that must be guaranteed 7 days a week and 24 h a day. The pathologies of endoscopic interest that require emergency intervention are mainly hemorrhages of the upper digestive tract, the removal of foreign bodies, and the ingestion of caustics. The emergency endoscopist must therefore be experienced in the management of these pathologies. Nowadays, however, we know that even some biliary tract pathologies must be managed within a variable period between 12 and 72 h, in particular acute cholangitis (Ach), acute biliary pancreatitis (ABP), biliary duct leaks (BDLs), and acute cholecystitis (AC). If, on one hand, there is little awareness among doctors about which pathologies of the biliary tract really deserve urgent treatment, on the other, the international guidelines, although not uniformly, have acquired the results of the studies and have clarified that only severe Ach should be treated within 12 h; in other cases, endoscopic treatment can be delayed up to 72 h according to the specific condition. This obviously has a significant organizational implication, as not all endoscopists have training in biliary tract endoscopy, and guaranteeing the availability of a biliary endoscopist 24/7 may be incompatible with respecting the working hours of individual professionals. This review aims to evaluate which pathologies of the biliary tract really require an endoscopic approach in emergency or urgency and the organizational consequences that this can determine. Based on the guidelines, we can conclude that a daytime availability for urgent biliary tract procedures 7 days a week should be provided for the management of severe ACh. Patients with ABP, AC unfit for surgery, and not responsive to medical therapy or BDLs can be treated over a longer period, allowing its scheduling on the first available day of the week.
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Affiliation(s)
- Francesca Lodato
- Department of Gastroenterology and Interventional Endoscopy, AUSL Bologna Bellaria, Maggiore Hospital, 40133 Bologna, Italy; (S.L.); (M.B.); (S.G.); (V.C.)
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Spota A, Shahabi A, Mizdrak E, Englesakis M, Mahbub F, Shlomovitz E, Al-Sukhni E. Postinsertion Management of Cholecystostomy Tubes for Acute Cholecystitis: A Systematic Review. Surg Laparosc Endosc Percutan Tech 2025; 35:e1336. [PMID: 39898671 DOI: 10.1097/sle.0000000000001336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 10/09/2024] [Indexed: 02/04/2025]
Abstract
BACKGROUND Percutaneous gallbladder drainage (PGD) is indicated to treat high-risk patients with acute cholecystitis. Trends suggest increasing use of PGD over time as the population ages and lives longer with multiple comorbidities. There is no consensus on the management of cholecystostomies tube once inserted. This review aims to synthesize and describe the most common protocols in terms of the need and timing of follow-up imaging, management of a destination tube, timing of tube removal, and optimal interval time from tube positioning to delayed cholecystectomy. METHODS The study protocol has been registered on the International Prospective Register of Systematic Reviews-PROSPERO. Studies on adult patients diagnosed with acute cholecystitis who underwent a PGD from 2000 to November 2023 were included. The databases searched were MEDLINE, Embase, and Cochrane. The quality assessment tools provided by the NHLBI (National Heart, Lung, and Blood Institute) were applied and descriptive statistics were performed. RESULTS We included 22,349 patients from 94 studies with overall fair quality (6 prospective and 88 retrospective). In 92.7% of papers, the authors checked by imaging all patients with a PGD (41 studies included). Depending on protocol time, 30% of studies performed imaging within the first 2 weeks and 35% before tube removal (40 studies included). In the case of a destination tube, 56% of studies reported removing the tube (25 studies included). In the case of tube removal, the mean time after insertion was more than 4 weeks in 24 of the 33 included studies (73%). Interval cholecystectomies are more frequently performed after 5 weeks from PGD (32/38 included studies, 84%). Limitations included high clinical heterogeneity and prevalent retrospective studies. CONCLUSIONS A standard management for percutaneous cholecystostomy after insertion is difficult to define based on existing evidence, and currently we can only rely on the most common existing protocols.
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Affiliation(s)
| | | | | | | | | | - Eran Shlomovitz
- General Surgery
- Vascular Interventional Radiology
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eisar Al-Sukhni
- Departments of Surgery
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Elkeleny MR, El-Haddad HMK, Kandel MM, El-Deen MIS. Early Laparoscopic Cholecystectomy Versus Percutaneous Cholecystostomy Followed by Delayed Laparoscopic Cholecystectomy in Patients with Grade II Acute Cholecystitis According to Tokyo Guidelines TG18. J Laparoendosc Adv Surg Tech A 2025. [PMID: 39876707 DOI: 10.1089/lap.2024.0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2025] Open
Abstract
Introduction: In the past, most patients with acute cholecystitis (AC) were treated conservatively. However, strong evidence from various studies has shown that laparoscopic cholecystectomy (LC) is safe and should be the primary treatment for AC. However, this may not be the case for all AC grades. This study aimed to compare two recommended approaches for grade II AC as outlined in the Tokyo guidelines TG18, focusing on early operative outcomes. Methods: We conducted a retrospective review of medical records for all patients diagnosed with grade II AC. The study compared patients who underwent early LC (group A, n = 130) with those who initially received percutaneous cholecystostomy (PC) followed by LC (group B, n = 90). Results: Both groups had similar Tokyo classification parameters. However, there were significant differences in baseline data, operative challenges, and postoperative complications. Cholecystostomy-related complications were observed in seven patients. The conversion rate for was 25% for group A and 5% for group B. The incidence of intraoperative biliary injury was 10% for group A and 2.2% for group B. In group A, 92% of patients with biliary injury and 80% of those who required conversion to open surgery had evidence of localized inflammation around the gallbladder. Conclusion: For selected patients with grade II AC and higher risks, PC placement can be beneficial in preventing life-threatening consequences. The study suggests a 2-month interval between PC and subsequent LC. Overall, performing LC after PC was found to be easier than early LC. Local inflammatory changes, including empyema, were associated with higher complication rates in the early LC group.
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Affiliation(s)
- Mostafa R Elkeleny
- General Surgery Department, GIT and Liver Unite, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hany M K El-Haddad
- General Surgery Department, GIT and Liver Unite, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed M Kandel
- General Surgery Department, Faculty of Medicine Port Said University, Alexandria, Egypt
| | - Mostafa I Seif El-Deen
- General Surgery Department, GIT and Liver Unite, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Teke E, Ağca B, Güneş Y, Teke GN, Yaz AS, Aydın MT, Başak A, Yıldırım G. Percutaneous cholecystostomy in elderly patients with acute cholecystitis: Factors influencing mortality, morbidity, and length of hospital stay. ULUS TRAVMA ACIL CER 2025; 31:59-65. [PMID: 39775515 PMCID: PMC11843392 DOI: 10.14744/tjtes.2024.94489] [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: 06/11/2024] [Revised: 10/15/2024] [Accepted: 11/01/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND Acute cholecystitis (AC) is increasingly common and imposes a burden on healthcare systems, particularly in the elderly population. While laparoscopic cholecystectomy (LC) is the definitive treatment, percutaneous cholecystostomy (PC) is often preferred based on various factors. The treatment of elderly patients requires a multidisciplinary approach that carefully assesses surgical risks due to age-related changes and comorbidities. This retrospective study evaluates factors affecting mortality, morbidity, and hospital stay in elderly patients diagnosed with AC who presented to the emergency department and underwent PC. METHODS This retrospective study, conducted between January 2013 and January 2021, included patients aged 70 years and older with grade 2 and 3 AC, as classified by the Tokyo Guidelines, who underwent PC. Data on laboratory parameters, comorbidities, and outcomes were collected and analyzed. RESULTS Among the 76 included patients, complications occurred in 7.9% of cases, with catheter replacement being the most common complication. In-hospital mortality was 5.2%. Factors influencing hospital stay included intervention timing and serum albumin levels. Placement of percutaneous cholecystostomy within the first three days of hospitalization has been shown to shorten the length of hospital stay. CONCLUSION Personalized treatment strategies are essential for managing AC in elderly patients. Early placement of PC may reduce hospital stays and associated costs. Further research and updated guidelines are necessary to optimize outcomes in this demographic group.
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Affiliation(s)
- Emre Teke
- General Surgery Department, University of Health Sciences, Gaziantep City Hospital, Gaziantep-Türkiye
| | - Birol Ağca
- General Surgery Department, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul-Türkiye
| | - Yasin Güneş
- General Surgery Department, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul-Türkiye
| | - Gamze Nur Teke
- Anesthesiology and Reanimation Department, University of Health Sciences, Gaziantep City Hospital, Gaziantep-Türkiye
| | - Ahmet Said Yaz
- General Surgery Department, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul-Türkiye
| | - Mehmet Timuçin Aydın
- General Surgery Department, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul-Türkiye
| | - Ahmet Başak
- General Surgery Department, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum-Türkiye
| | - Gülşah Yıldırım
- Interventional Radiology Department, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul-Türkiye
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Wael M, Seif M, Mourad M, Altabbaa H, Ibrahim IM, Elkeleny MR. Early Versus Delayed Laparoscopic Cholecystectomy, after Percutaneous Gall Bladder Drainage, for Grade II Acute Cholecystitis TG18 in Patients with Concomitant Cardiopulmonary Disease. J Laparoendosc Adv Surg Tech A 2024; 34:1069-1078. [PMID: 39234751 DOI: 10.1089/lap.2024.0233] [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] [Indexed: 09/06/2024] Open
Abstract
Background: The advancement in medical care has led to an increase in patients with acute cholecystitis (AC) and cardiopulmonary comorbidities referred for surgery. Grade II AC, according to Tokyo Guidelines in 2018 (TG18), is characterized by severe local inflammation with no systemic affection. The optimal treatment for patients with high-risk grade II AC has not yet been clearly established, which is still a dilemma. For these patients, laparoscopic cholecystectomy (LC), despite being the only definitive treatment, is still a challenge. The introduction of percutaneous cholecystostomy as a temporary minimally invasive alternative technique allows an immediate gallbladder decompression with a rapid clinical improvement. However, the next step after percutaneous transhepatic gall bladder drainage (PTGBD) in these high-risk patients is still a debate, with no definitive consensus about the ideal treatment of choice as well as its optimal timing. In our study, we followed a treatment algorithm for high-risk patients that involved early gallbladder decompression by PTGBD, followed by LC at different intervals once the patient is considered fit for surgery. Method: A retrospective study of 58 patients with high-risk grade II AC with cardiopulmonary comorbidity from our medical records was included. They were managed initially with PTGBD, an LC was then performed either within 7 days after drain insertion (early group, 26 patients), while an LC was performed later for the remaining patients within 6-8 weeks after PTGBD (late group, 32 patients). The results of the two groups were analyzed. Result: Procalcitonin and C-reactive protein were significantly higher in the late group. No significant difference was found between both groups with regard to operative time, PTGBD-related complications, and major perioperative complications. Timing after PTGBD did not affect the incidence of operative complications. Total hospital stay was significantly shorter in the early group. Conclusion: PTGBD is a safe initial intervention for high-risk patients with AC with a low morbidity and high success rate. Urgent LC after PTGBD can be performed safely for well-selected high-risk patients with the timing of surgery is personalized according to each patient's clinical situation. Early LC (after PTGBD) has the advantage of shorter hospital stay, low cost, as well as avoiding the risk of biliary complications and mortality if waiting a delayed surgery with no significant difference in morbidity compared with late LC.
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Affiliation(s)
- Mohamed Wael
- Liver and GIT unit, Alexandria University Main Hospital, Alexandria, Egypt
- Alexandria University, Alexandria, Egypt
| | - Mostafa Seif
- Liver and GIT unit, Alexandria University Main Hospital, Alexandria, Egypt
- Alexandria University, Alexandria, Egypt
| | - Mohamed Mourad
- Liver and GIT unit, Alexandria University Main Hospital, Alexandria, Egypt
- Alexandria University, Alexandria, Egypt
| | | | - Ibrahim Mabrouk Ibrahim
- Liver and GIT unit, Alexandria University Main Hospital, Alexandria, Egypt
- Alexandria University, Alexandria, Egypt
| | - Mostafa Refaie Elkeleny
- Liver and GIT unit, Alexandria University Main Hospital, Alexandria, Egypt
- Alexandria University, Alexandria, Egypt
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Weiss T, Franko R, Lahav L, Lifshitz G, Avital S, Rudnicki Y. The impact of routine cholangiography for asymptomatic patients after cholecystostomy insertion for acute cholecystitis. Am J Surg 2024; 238:116000. [PMID: 39378543 DOI: 10.1016/j.amjsurg.2024.116000] [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: 07/10/2024] [Revised: 09/27/2024] [Accepted: 10/03/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND We aim to investigate the impact of routine cholangiography on asymptomatic patients with percutaneous cholecystostomy (PCC) for acute cholecystitis (AC). METHODS The study included all patients treated with PCC for AC from 2017 to 2020 at a single academic center. Patients who underwent routine cholangiography within 30 days post-discharge while asymptomatic were compared to patients who were only followed clinically. RESULTS The groups (cholangiography group, n = 44, and control group, n = 145) were similar in terms of age, comorbidities, and clinical presentation. The readmission rate for biliary disease in the cholangiography group was nearly half that of the control group (22.7 % vs. 40.7 %, p = 0.05) over an average follow-up of 10.4 months. The time to drain removal, cholecystectomy rate, and time to operation were comparable between the groups (42 vs. 40 days, p = 0.47, 52.3 % vs 53.1 %, p = NS and 69 vs. 82 days, p = 0.17, respectively). CONCLUSIONS Routine cholangiography can help reduce biliary disease readmissions among asymptomatic patients with PCC for AC without delaying further treatment.
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Affiliation(s)
- Tal Weiss
- Department of Surgery, Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Rotem Franko
- Department of Surgery, Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lauren Lahav
- Department of Surgery, Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lifshitz
- Department of Surgery, Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Avital
- Department of Surgery, Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Rudnicki
- Department of Surgery, Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Niiya F, Tamai N, Yamawaki M, Noda J, Azami T, Takano Y, Nishimoto F, Nagahama M. Benefits of endoscopic gallbladder stenting following percutaneous transhepatic gallbladder drainage. World J Gastrointest Surg 2024; 16:2902-2909. [PMID: 39351569 PMCID: PMC11438794 DOI: 10.4240/wjgs.v16.i9.2902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/10/2024] [Accepted: 08/05/2024] [Indexed: 09/18/2024] Open
Abstract
BACKGROUND Endoscopic transpapillary gallbladder drainage is challenging because of the complexity of the procedure and high incidence of adverse events (AEs). To overcome these problems, endoscopic gallbladder stenting (EGBS) after percutaneous transhepatic gallbladder drainage (PTGBD) can be effective, as it mitigates inflammation and adhesion. AIM To examine the benefits of EGBS after PTGBD to assess its efficacy and impact on AEs. METHODS We retrospectively analyzed data from 35 patients who underwent EGBS after PTGBD at a single center between January 2016 and December 2023. The primary outcomes were technical success and AEs, and the rate of recurrent cholecystitis was evaluated. In addition, the reasons for the failure of the procedure were identified. RESULTS Among the 35 patients, the technical success rate was 77.1% and the final contrast of the cystic duct was successful in 97.1% of patients. The incidence of early AEs was relatively low (11.4%), with no instances of cystic duct perforation. The rate of recurrent cholecystitis was 3.7%, and no other biliary events were observed. CONCLUSION EGBS after PTGBD may be significantly beneficial, with a substantial success rate and minimal AEs in both short- and long-term follow-ups.
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Affiliation(s)
- Fumitaka Niiya
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Naoki Tamai
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Masataka Yamawaki
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Jun Noda
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Tetsushi Azami
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Yuichi Takano
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Fumiya Nishimoto
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Masatsugu Nagahama
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
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Ullah N, Kannan V, Ahmed O, Geddada S, Ibrahiam AT, Al-Qassab ZM, Malasevskaia I. Effectiveness and Safety of Cholecystectomy Versus Percutaneous Cholecystostomy for Acute Cholecystitis in Older and High-Risk Surgical Patients: A Systematic Review. Cureus 2024; 16:e70537. [PMID: 39479123 PMCID: PMC11524642 DOI: 10.7759/cureus.70537] [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: 08/31/2024] [Accepted: 09/30/2024] [Indexed: 11/02/2024] Open
Abstract
Acute cholecystitis (AC) is a prevalent surgical emergency, particularly among elderly individuals who present with high perioperative risks. While early cholecystectomy (CCY) is the standard treatment, percutaneous cholecystostomy (PC) is proposed as an alternative for high-risk patients. This systematic review aims to evaluate the comparative safety and efficacy of CCY versus PC in managing AC among elderly and high-risk surgical patients. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted across multiple electronic databases, including PubMed/Medline, Cochrane Central Register of Controlled Trials (CENTRAL), ScienceDirect, Europe PMC, ClinicalTrials.gov, and EBSCO Open Dissertations, from July 1 to 15, 2024. Studies published from January 2019 to July 15, 2024, were included if they focused on patients aged 65 and older or those classified as high-risk surgical candidates. The review encompassed 72,366 participants across 22 studies, predominantly observational. Key outcomes assessed included postoperative complications, readmission rates, recurrence of cholecystitis, and mortality rates. This study highlights the need for individualized treatment strategies for managing AC in elderly populations. While CCY remains the preferred approach when feasible, PC offers a critical alternative for high-risk patients. Future research is necessary to optimize outcomes for this vulnerable population.
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Affiliation(s)
- Najeeb Ullah
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vaishnavi Kannan
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Osman Ahmed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sunitha Geddada
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Amir T Ibrahiam
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Zahraa M Al-Qassab
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Iana Malasevskaia
- Research and Development, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Hirakawa N, Yamamoto K, Sofuni A, Tsuchiya T, Ishii K, Tanaka R, Tonozuka R, Mukai S, Nagai K, Matsunami Y, Kojima H, Minami H, Nakatsubo R, Asano K, Itoi T. Factors predicting technical failure of endoscopic transpapillary gallbladder drainage for acute cholecystitis. DEN OPEN 2024; 4:e308. [PMID: 37915764 PMCID: PMC10616688 DOI: 10.1002/deo2.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
Objectives Endoscopic transpapillary gallbladder drainage (ETGBD) is a highly technical procedure, but few studies have evaluated factors that predict its technical success. Therefore, in this study, we sought to identify predictors of technically successful ETGBD. Methods One hundred and eighty-two patients who underwent ETGBD for acute cholecystitis at our hospital were retrospectively investigated. Factors associated with technical failure were identified by focusing on clinical characteristics, anatomical features (direction of the cystic duct branch and course of the cystic duct), and procedural factors (cystic duct and gallbladder with or without contrast and cystic duct injury). Results The technical success rate was 84.6% (154/182) and the clinical success rate was 96.1% (148/154). The adverse event rate was 11.0% (20/182; cystic duct injury in 13 patients, pancreatitis in six, and liver abscess in one. Univariate and multivariate analyses identified the right cranial direction and spiral-type course of the cystic duct to be significant anatomical features and cystic duct injury to be a significant procedural feature contributing to the technical failure of ETGBD. Conclusions ETGBD is a highly practical procedure for patients with acute cholecystitis. However, difficulty is encountered in some cases because of anatomical and procedural factors. Our results suggest that ETGBD may be difficult and thus should not be performed in cases with the right cranial direction or spiral-type course of the cystic duct or those with cystic duct injury.
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Affiliation(s)
- Noriyuki Hirakawa
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Kenjiro Yamamoto
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Atsushi Sofuni
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Kentaro Ishii
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Reina Tanaka
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Ryosuke Tonozuka
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Shuntaro Mukai
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Kazumasa Nagai
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Yukitoshi Matsunami
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Hiroyuki Kojima
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Hirohito Minami
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Ryosuke Nakatsubo
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Kyoko Asano
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Takao Itoi
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
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12
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Villa E. EUS gallbladder drainage for acute cholecystitis: time to push the paradigm. Gastrointest Endosc 2024; 99:449-451. [PMID: 38368044 DOI: 10.1016/j.gie.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 11/19/2023] [Indexed: 02/19/2024]
Affiliation(s)
- Edward Villa
- Division of Gastroenterology and Hepatology, NorthShore University Health Systems, Evanston, Illinois, USA
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13
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Tanaka K, Takano Y, Kigawa G, Shiozawa T, Takahashi Y, Nagahama M. Percutaneous transhepatic gallbladder drainage versus endoscopic gallbladder stenting for managing acute cholecystitis until laparoscopic cholecystectomy. Asian J Endosc Surg 2024; 17:e13253. [PMID: 37837367 DOI: 10.1111/ases.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Gallbladder drainage by methods such as percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic gallbladder stenting (EGBS) is important in the early management of moderate to severe acute cholecystitis. METHODS In patients undergoing laparoscopic cholecystectomy (LC) for acute cholecystitis after a month or more of gallbladder drainage, the clinical course was compared between patients initially treated with PTGBD or EGBS. RESULTS Among 331 patients undergoing LC for cholecystitis between 2018 and 2022, 43 first underwent 1 or more months of gallbladder drainage. The median interval between drainage initiation and LC was 89 days (range, 28-261) among 34 patients with PTGBD and 70 days (range, 62-188) among nine with EGBS (p = 0.644). During this waiting period, PTGBD was clamped in six patients and removed in five. Cholecystitis relapsed in three PTGBD patients (9%) and four EGBS patients (44%; p = 0.026). Relapses were managed with medications. Cholecystectomy duration (p = 0.022), intraoperative blood loss (p = 0.026), frequency of abdominal drain insertion (p = 0.023), and resort to bailout surgery such as fundus-first approaches (p = 0.030) were significantly greater in patients with EGBS. Postoperative complications were somewhat likelier (p = 0.095) and postoperative hospital stays were longer (p = 0.007) in the EGBS group. CONCLUSION Among patients whose LC was performed 1 or more months after initiation of drainage, daily living during the waiting period associated with drainage was well supported by EGBS, but LC and the postoperative course were more complicated than in PTGBD patients.
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Affiliation(s)
- Kuniya Tanaka
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yuichi Takano
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Gaku Kigawa
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Toshimitsu Shiozawa
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yuki Takahashi
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Masatsugu Nagahama
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
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14
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Bozic D, Ardalic Z, Mestrovic A, Bilandzic Ivisic J, Alicic D, Zaja I, Ivanovic T, Bozic I, Puljiz Z, Bratanic A. Assessment of Gallbladder Drainage Methods in the Treatment of Acute Cholecystitis: A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:5. [PMID: 38276039 PMCID: PMC10817550 DOI: 10.3390/medicina60010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Gallbladder drainage is a treatment option in high-risk surgical patients with moderate or severe acute cholecystitis. It may be applied as a bridge to cholecystectomy or a definitive treatment option. Apart from the simple and widely accessible percutaneous cholecystostomy, new attractive techniques have emerged in the previous decade, including endoscopic transpapillary gallbladder drainage and endoscopic ultrasound-guided gallbladder drainage. The aim of this paper is to present currently available drainage techniques in the treatment of AC; evaluate their technical and clinical effectiveness, advantages, possible adverse events, and patient outcomes; and illuminate the decision-making path when choosing among various treatment modalities for each patient, depending on their clinical characteristics and the accessibility of methods.
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Affiliation(s)
- Dorotea Bozic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Zarko Ardalic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Antonio Mestrovic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Josipa Bilandzic Ivisic
- Department of Gastroenterology, General Hospital of Sibenik-Knin County, Stjepana Radica 83, 22000 Sibenik, Croatia;
| | - Damir Alicic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Ivan Zaja
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
- University Department of Health Studies, University of Split, Rudjera Boskovica 35, 21000 Split, Croatia
| | - Tomislav Ivanovic
- Department of Abdominal Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia;
| | - Ivona Bozic
- Department of Rheumatology and Immunology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia;
| | - Zeljko Puljiz
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Andre Bratanic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
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15
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Lau J, Sinha S. Outcome Predictors of Percutaneous Cholecystostomy As Definitive Versus Bridging Treatment for Acute Cholecystitis. Cureus 2023; 15:e49962. [PMID: 38179380 PMCID: PMC10765770 DOI: 10.7759/cureus.49962] [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: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Percutaneous cholecystostomy (PC) is a treatment option for patients with acute cholecystitis (AC) who are too unwell, or too morbid for laparoscopic cholecystectomy (LC). Some patients have PC as a definitive treatment, whereas others have PC as a bridging treatment prior to LC. The aim of this study is to investigate patient characteristics and mortality among those who received PC as definitive treatment versus bridging treatment. Methods Our study retrospectively reviewed all patients treated with PC for AC from February 2019 to November 2022 at the Torbay and South Devon NHS Foundation Trust, Torquay, England. Fifty patients underwent PC for AC, with 48 patients having follow-up data available for analysis. Of these, 26 patients (54%) only received PC (definitive PC), and 22 patients (46%) later underwent LC (bridging LC). Results In this study, 68.8% of the patients were male, with a mean age of 76 ± 9 years. The overall mean Charlson Comorbidity Index (CCI) score was 4.96 ± 1.12, and the mean American Society of Anesthesiologists (ASA) score was 2.83 ± 0.36. The median PC drain duration was 42 days. Six patients (12.5%) had a recurrence of AC with a mean of 57 days onset after PC insertion. Twelve patients (25%) experienced PC complications: 11 (23%) were minor, involving pain or a dislodged tube, and one (2%) was major, resulting in a subhepatic abscess. The median duration from PC insertion to LC surgery was 50.5 days. The bridging LC cohort had a 30-day and one-year mortality of 0%, while the definitive PC cohort had a 30-day mortality of 30.8% (eight patients) and a one-year mortality of 46.1% (12 patients). The bridging LC cohort compared to the definitive PC cohort had a significantly lower CCI (4.39 vs 5.57, p<0.05), and a significantly lower ASA (2.61 vs 3.04, p<0.05). The one-year survival cohort compared to the 30-day mortality cohort had significantly lower ASA (2.71 vs 3.25 p<0.05), and a non-significantly lower CCI (4.66 vs 5.86 p=0.094). The presence of negative predictive factors of respiratory dysfunction and hyperbilirubinemia had higher 30-day and 90-day mortality rates of 31.3% and 37.5%, compared to their absence of 9.4% and 21.4% respectively. Conclusion Our results demonstrate that PC is a safe procedure with a high success rate and low complications. We showed that PC is an effective treatment option for bridging a select cohort of patients to receive a delayed LC. Furthermore, the data suggests ASA and CCI scoring can be used as clinical adjuncts to assess whether bridging patients from PC to LC is appropriate. Finally, ASA, respiratory dysfunction, and hyperbilirubinemia can be used as significant negative predictors of post-PC mortality.
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Affiliation(s)
- Joshua Lau
- Upper GI Surgery, Torbay & South Devon NHS Foundation Trust, Torquay, GBR
| | - Surajit Sinha
- Upper GI Surgery, Torbay & South Devon NHS Foundation Trust, Torquay, GBR
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16
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Rimbaş M, Tripodi G, Rizzatti G, Larghi A. Endoscopic ultrasound in the management of acute cholecystitis: Practical review. Dig Endosc 2023; 35:809-818. [PMID: 37253177 DOI: 10.1111/den.14605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/29/2023] [Indexed: 06/01/2023]
Abstract
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged over the last years as an alternative procedure to percutaneous drainage (PT)-GBD in patients with acute cholecystitis (AC) at high surgical risk. This process has been driven by the advent of lumen-apposing metal stents (LAMS) with electrocautery-enhanced capability, which has rendered the drainage procedure easier to accomplish and safer. Studies and meta-analyses have proven the superiority of EUS-GBD over PT-GBD in high-surgical-risk patients with AC. Little evidence exists in the same setting that EUS-GBD compares equally with laparoscopic cholecystectomy (LC). Moreover, EUS-GBD might theoretically have a possible role in patients at high surgical risk with an indication to undergo cholecystectomy or with a high probability of conversion from LC to open cholecystectomy. Properly designed studies are needed to better clarify the role of EUS-GBD in these patient populations.
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Affiliation(s)
- Mihai Rimbaş
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
- Clinic of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Giulia Tripodi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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17
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Yirgin H, Topal Ü, Tatlıdil Y, Sibic O, Yirgin İK, Bozkurt MA. What is the effect of percutaneous cholesistostomy in patients with acute cholecystitis? when is the right time for the procedure? ULUS TRAVMA ACIL CER 2023; 29:1269-1279. [PMID: 37889032 PMCID: PMC10771249 DOI: 10.14744/tjtes.2023.40090] [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] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Acute cholecystitis (AC) is one of the most common emergency diseases in surgical practice. Although the gold standard treatment is laparoscopic cholecystectomy, percutaneous cholecystostomy (PC) is performed in some patients due to age, comorbidity, and delays in admission. We aimed to investigate the effect of timing on the clinical process of patients undergoing PC. METHODS Patients who underwent PC between February 2017 and December 2021 were included in the study. Those who un-derwent PC in the first 72 h were determined as the early PC group, and those who underwent PC after 72 h were determined as the late PC group. Demographic information of the patients, clinical information before drainage, biochemical values of the first 3 days, length of hospital stay, morbidity and mortality in the early and late period after drainage, and elective cholecystectomy information were recorded. These data were compared between the two groups. RESULTS One hundred and twenty-two patients were included in the study. Early PC was performed in 98 patients (80.3%) and late PC was performed in 24 patients (19.7%). The median follow-up period was 26.6 months (min: 0.25-max: 67) in the early PC group and 26.4 months (min: 0.6-max: 66) in the late PC group (P=0.408). There was no statistically significant difference in mean age, distribu-tion of males and women, concomitant disease, Charlson Comorbidity Index, hepatopancreatobiliary pathology (HPBP), endoscopic retrograde cholangiopancreatography in history and grade (TG18) compared to Tokyo classification (P>0.05). There was no difference between the biochemical parameters (P>0.05). In our study, the median length of hospital stay was 6 (min: 2-max: 36) days in the early PC group, and the median was 9 days (min: 5-max: 20) in the late PC group (P<0.001). A total of 25 patients developed HPBP after PC, 16 of which were AC. There was no statistically significant difference between the early and late PC groups in terms of HPBP develop-ment after PC (P=0.576). There was no statistically significant difference between the early and late PC group in terms of the rate of surgery and type of operation (emergency/elective, open/laparoscopic/conversion, total/subtotal, duration) (P>0.05). CONCLUSION Discussions about the right timing are ongoing. In our study, we found that patients who underwent early PC had shorter hospital stays. There was no difference between the early and late groups in terms of patient characteristics and severity of AC. PC procedure in AC should be based on algorithms determined by objective data instead of patient-based indications with ran-domized controlled trials.
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Affiliation(s)
- Hakan Yirgin
- Department of Gastroenterology Surgery, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul-Türkiye
| | - Ümmihan Topal
- Department of Radiology, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul-Türkiye
| | - Yunusemre Tatlıdil
- Department of General Surgery, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul-Türkiye
| | - Osman Sibic
- Department of General Surgery, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul-Türkiye
| | - İnci Kizildağ Yirgin
- Department of Radiology, Oncology Institute, Istanbul University, İstanbul-Türkiye
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18
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Bhatia M, Thomas B, Azir E, Al-Maliki D, Ballal K, Tantrige P, Yusuf GT, El-Hasanii S. Percutaneous Cholecystostomy to Manage a Hot Gallbladder: A Single Center Experience. Cureus 2023; 15:e45348. [PMID: 37724097 PMCID: PMC10505269 DOI: 10.7759/cureus.45348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 09/20/2023] Open
Abstract
Objective A percutaneous cholecystostomy (PC) is a suitable option for treating acutely inflamed gallbladders. Its use has been postulated before for treating acute cholecystitis (AC), especially in elderly populations. The primary aim of our study is to analyze and present the positive results of PC as a bridge to laparoscopic cholecystectomy. Methods All patients who underwent PC at our hospital, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR, from October 2020 were reviewed using a retrospective approach. Results Our study comprises 123 patients, with 72 females (58.5%) and 51 males (41.4%). In our study, many patients had significant comorbidities, and some of them were categorized as high-risk due to their frailty and medical conditions. The majority of the patients were in American Society of Anaesthesiologists' (ASA) groups II and III (45, 61), respectively. Though hospital stays can depend on variable factors, in our experience, the mean hospital length of stay was 12.7 days. In our study, 119 patients (96.8%) had the procedure through the interventional radiological approach, while only four patients had it through the laparoscopic approach. The transhepatic route for drainage was more commonly practiced at our center and was used in 108 patients. At the time of writing this article, 54 patients have already had a laparoscopic cholecystectomy (LC) done as an interval procedure after surpassing the acute attack of cholecystitis, while 42 patients are still awaiting their surgical procedure. Conclusion Our results show that PC is a viable option, especially in cases of AC that are not responding to conservative treatments. Our study has shown low complications and conversion rates after PC. We believe PC is a safe and effective tool for managing severe and refractory cases of AC.
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Affiliation(s)
- Mohit Bhatia
- Surgery, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR
| | - Bindhiya Thomas
- Surgery, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR
| | - Elia Azir
- Surgery, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR
| | - Doaa Al-Maliki
- Surgery, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR
| | - Khalid Ballal
- Intervention Radiology, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR
| | - Priyan Tantrige
- Intervention Radiology, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR
| | - Gibran Timothy Yusuf
- Intervention Radiology, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR
| | - Shamsi El-Hasanii
- Upper Gastrointestinal Surgery, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR
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19
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Arkoudis NA, Moschovaki-Zeiger O, Grigoriadis S, Palialexis K, Reppas L, Filippiadis D, Alexopoulou E, Brountzos E, Kelekis N, Spiliopoulos S. US-guided trocar versus Seldinger technique for percutaneous cholecystostomy (TROSELC II trial). Abdom Radiol (NY) 2023; 48:2425-2433. [PMID: 37081229 DOI: 10.1007/s00261-023-03916-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES The purpose of this study is to investigate the safety and effectiveness of the US-guided bedside trocar vs. the Seldinger technique for percutaneous cholecystostomy (PC) procedures. METHODS This is a prospective single-center, randomized, controlled trial (RCT) comparing the trocar (group T; 50 patients [27 men]; mean [± SD] age, 74.16 ± 15.59 years) with the Seldinger technique for PC (group S; 50 patients [23 men]; mean [± SD] age, 80.78 ± 14.09 years) in consecutive patients undergoing the procedure in a bedside setting with the sole employment of US as a guidance modality. Primary outcomes consisted of technical success and complications associated with the procedure. Secondary outcome measures involved procedure duration, intra-/post-procedure pain evaluation, and clinical success. RESULTS PC was technically successful for all 100 patients. Clinical success rates were similar between group T and S (94% vs. 92%, respectively; p = 0.34). Equal total procedure-related complications were noted in both groups (4% vs. 4%; p = 0.5). A minor bleeding event (bile mixed with blood) occurred in one patient (2%) in group T and one patient (2%) in group S; accidental catheter dislodgement in one patient (2%) from group T, and a small biloma in one patient (2%) from group S. No procedure-related deaths or major bleeding events were noted. PC was significantly faster in group T (1.41 ± 1.13 vs. 4.41 ± 2.68 min; p < 0.001). Mean pain score during PC was significantly lower in group T compared with group S at 12 h of follow-up (1.43 ± 1.45 vs. 3.36 ± 2.05; p < 0.01). CONCLUSION US-guided bedside trocar technique for PC was equally effective and safe as the Seldinger technique, but it was faster and simpler to perform and led to reduced pain following the procedure.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece.
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Grigoriadis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
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20
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Tuncer K, Kilinc Tuncer G, Çalık B. Factors affecting the recurrence of acute cholecystitis after treatment with percutaneous cholecystostomy. BMC Surg 2023; 23:143. [PMID: 37231394 DOI: 10.1186/s12893-023-02042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The aim of this study was to determine the recurrence rate of patients who did not have interval cholecystectomy after treatment with percutaneous cholecystostomy and to investigate the factors that may affect the recurrence. METHODS Patients who did not undergo interval cholecystectomy after percutaneous cholecystostomy treatment between 2015 and 2021 were retrospectively screened for recurrence. RESULTS 36.3% of the patients had recurrence. Recurrence was found more frequently in patients with fever symptoms at the time of admission to the emergency department (p = 0.003). Recurrence was found to be more frequent in those who had a previous cholecystitis attack (p = 0.016). It was determined that patients with high lipase and procalcitonin levels had statistically more frequent attacks (p = 0.043, p = 0.003). It was observed that the duration of catheter insertion was longer in patients who had relapses (p = 0.019). The cut-off value for lipase was calculated as 15.5, and the cut-off value for procalcitonin as 0.955, in order to identify patients at high risk for recurrence. In the multivariate analysis for the development of recurrence, presence of fever, a history of previous cholecystitis attack, lipase value higher than 15.5 and procalcitonin value higher than 0.955 were found to be risk factors. CONCLUSIONS Percutaneous cholecystostomy is an effective treatment method in acute cholecystitis. Insertion of the catheter within the first 24 h may reduce the recurrence rate. Recurrence is more common in the first 3 months following removal of the cholecystostomy catheter. Having a previous history of cholecystitis attack, fever symptom at the time of admission, elevated lipase and procalcitonin are risk factors for recurrence.
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Affiliation(s)
- Korhan Tuncer
- Department of General Surgery, University of Bakırçay, Çiğli Training and Research Hospital, Izmir, Turkey.
| | - Gizem Kilinc Tuncer
- Department of General Surgery, University of Health Sciences Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Bülent Çalık
- Department of General Surgery, University of Health Sciences Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
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21
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Robles-Medranda C, Oleas R, Puga-Tejada M, Alcivar-Vasquez J, Del Valle R, Olmos J, Arevalo-Mora M, Egas-Izquierdo M, Tabacelia D, Baquerizo-Burgos J, Pitanga-Lukashok H. Prophylactic EUS-guided gallbladder drainage prevents acute cholecystitis in patients with malignant biliary obstruction and cystic duct orifice involvement: a randomized trial (with video). Gastrointest Endosc 2023; 97:445-453. [PMID: 36328209 DOI: 10.1016/j.gie.2022.10.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Patients with distal malignant biliary obstruction (MBO) and cystic duct orifice tumoral involvement have an increased risk for the development of acute cholecystitis after self-expandable metallic stent (SEMS) placement. We aimed to determine whether primary EUS-guided gallbladder drainage prevents acute cholecystitis in these patients. METHODS This was a single-center, randomized control trial in patients with distal MBO enrolled from July 2018 to July 2020. Patients were randomized into 2 groups: an interventional group treated with conventional ERCP biliary drainage with SEMS placement and subsequent primary EUS-guided gallbladder drainage (EUS-GBD) and a control group treated with conventional biliary drainage alone. The primary outcome of the study was the occurrence of post-treatment acute cholecystitis, assessed for ≤12 months or until death. The secondary outcomes were hospitalization length and median survival time. RESULTS Forty-four patients were included in the study: 22 in each group. Five patients in the control group (22.7%) and none in the intervention group experienced acute cholecystitis. The median hospitalization time was significantly lower in the interventional group than in the control group (2 days vs 1 day, P = .017). There was no difference in the observed median survival rates in the primary EUS-GBD group (2.9 months) and the control group (2.8 months) (P = .580). CONCLUSION In this single-center study of patients with unresectable MBO and occlusion of the cystic duct orifice, prophylactic EUS-GBD demonstrated a reduced incidence of acute cholecystitis.
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Affiliation(s)
| | - Roberto Oleas
- Instituto Ecuatoriano de Enfermedades Digestivas, Guyaquil, Ecuador
| | | | | | - Raquel Del Valle
- Instituto Ecuatoriano de Enfermedades Digestivas, Guyaquil, Ecuador
| | - Juan Olmos
- Instituto Ecuatoriano de Enfermedades Digestivas, Guyaquil, Ecuador
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22
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Jenkins PE, MacCormick A, Zhong J, Makris GC, Gafoor N, Chan D. Transhepatic or transperitoneal technique for cholecystostomy: results of the multicentre retrospective audit of cholecystostomy and further interventions (MACAFI). Br J Radiol 2023. [DOI: 10.1259/bjr.20220279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective: This analysis of the MACAFI (multicentre audit of cholecystostomy and further interventions) data aims to assess the procedural technique and technical specifications related to percutaneous cholecystostomy (PC) insertion in patients with acute calculous cholecystitis (ACC). PC can be performed either with transperitoneal (TP) or a transhepatic (TH) approach. There is no clear evidence for the superiority of either technique. Methods: The data set included patients who underwent PC for ACC between first January 2019 and first January 2021. Data included patient demographics, imaging diagnosis, insertion technique, tube size, and outcomes including 6 month follow-up. Results: 1186 patients from 36 sites were identified through the MACAFI study with 913 patients having access route recorded. A transhepatic route was used in 572 [62.6%] compared to 308 TP [33.7%]. There was an increased rate of bleeding when using the TH route (2.6% vs 0.3%, p = 0.01) although other post-procedural complications (such as bile leak) were similar between the two groups. No significant difference was demonstrated in 30- or 90-day mortality (TH vs TP, 8.7vs 9.3%, p = 0.86 and 13.8vs 15.4%, p = 0.58, respectively). The readmission rate with recurrent cholecystitis was significantly greater in those with TH compared to TP approach (22.0% vs 14.9%, p = 0.01, respectively). Conclusion: The TP PC approach may be safer than TH, with lower bleeding complication rate and fewer readmissions. Advances in knowledge: A transperitoneal approach for cholecystostomy was associated with lower bleeding complication rate and lower rate of readmissions with recurrent cholecystitis compared to the transhepatic approach.
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Affiliation(s)
- Paul Edward Jenkins
- Peninsula Radiology Academy, Plymouth PL6 5WR, England, United Kingdom
- Department of Interventional Radiology, University Hospital Plymouth NHS Trust, Plymouth, UK
| | - Andrew MacCormick
- Peninsula Radiology Academy, Plymouth PL6 5WR, England, United Kingdom
| | - Jim Zhong
- Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Gregory C Makris
- Department of Interventional Radiology, University Hospitals Plymouth NHS Trust, PL6 8DH, England, United Kingdom
| | - Nelofer Gafoor
- Department of Upper GI Surgery, University Hospitals Plymouth NHS Trust, PL6 8DH, England, United Kingdom
| | - David Chan
- Department of Interventional Radiology, St Thomas’ Hospital, Guys and St Thomas NHS Foundation Trust, Westminster Bridge Rd, London, United Kingdom
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23
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Cho SH, Oh D, Song TJ, Gwon DI, Ko GY, Ko HK, Park DH, Seo DW, Lee SK, Kim MH, Lee SS. Long-term outcomes of endoscopic ultrasound-guided gallbladder drainage versus in situ or ex situ percutaneous gallbladder drainage in real-world practice. Dig Endosc 2022. [PMID: 36424886 DOI: 10.1111/den.14485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Many studies showed better outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) when compared with percutaneous transhepatic gallbladder drainage (P-GBD) in which most tubes were left in situ. However, no studies have directly compared EUS-GBD with P-GBD after tube removal (ex situ). We compared the long-term outcomes of EUS-GBD and ex situ or in situ P-GBD in high surgical risk patients with acute cholecystitis. METHODS We reviewed the records of 182 patients (EUS-GBD, n = 75; P-GBD, n = 107) who underwent gallbladder drainage. The procedural outcomes, long-term outcomes, and adverse events were compared. RESULTS The EUS-GBD group and the P-GBD group had similar rates of technical and clinical success. Early adverse events were less common in the EUS-GBD group (5.5% vs. 18.9%, P = 0.010). The long-term outcomes were evaluated in 168 patients (EUS-GBD, n = 67; P-GBD ex situ, n = 84; P-GBD in situ, n = 17). The rate of cholecystitis recurrence in the EUS-GBD group (6.0%) was similar to that in the P-GBD ex situ group (9.6%, P = 0.422), but significantly lower than that in the P-GBD in situ group (23.5%, P = 0.049). P-GBD in situ was a significant predictor of recurrent cholecystitis (hazard ratio 14.6; 95% confidence interval 2.9-72.8). CONCLUSION The long-term recurrence rate of acute cholecystitis in patients who underwent EUS-GBD was comparable to that in patients whose P-GBD could be removed. However, patients in whom P-GBD could not be removed showed higher rates of recurrent cholecystitis than patients with EUS-GBD.
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Affiliation(s)
- Sung Hyun Cho
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dongwook Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Jun Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong Il Gwon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Gi-Young Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Heung-Kyu Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do Hyun Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Koo Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myung-Hwan Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang Soo Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Sgantzou IK, Samara AA, Adamou A, Floros T, Diamantis A, Fytsilis F, Papaefthymiou A, Karagiorgas G, Ioannidis I, Kapsoritakis A, Zacharoulis D, Vlychou M, Rountas C. Computed tomography-guided percutaneous cholecystostomy: a single institution's 6-year experience. Ann Gastroenterol 2022; 35:668-672. [PMID: 36406966 PMCID: PMC9648522 DOI: 10.20524/aog.2022.0755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/03/2022] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Acute cholecystitis (AC) is an emergency commonly managed by a surgical department. The interventional part of the standard treatment algorithm includes laparoscopic or open cholecystectomy. Percutaneous cholecystostomy (PC) under imaging guidance is recommended as the first-line approach in the subset of high-risk patients for perioperative complications, as a bridging therapy to elective surgery or as a definitive solution. The aim of the present study was to evaluate the mortality and morbidity of PC performed under computed tomographic (CT) guidance in patients at high surgical risk. METHODS Medical and imaging records from all consecutive patients who underwent a CTPC between 2015 and 2020 were reviewed. Adult patients with a definite indication for CTPC were recruited and mortality 7 and 30 days post-procedure was recorded. Variables potentially affecting those outcomes were retrieved and included in our analysis. RESULTS Eighty-six consecutive patients at high risk for surgical management were identified and included in the present study. Most patients (58.1%) were diagnosed with AC, while 14 (16.3%) had concurrent AC and cholangitis, 13 (15.2%) gallbladder empyema, and 9 (10.4%) hydrops. The 7- and 30-day mortality rates were 16.3% (14/86) and 22.1% (19/86), respectively, and were significantly associated with patients' hospitalization in the intensive care unit (P<0.05). Other parameters investigated, such as age, sex, diagnosis, catheter diameter, and duration of hospital stay were not significantly associated with our primary outcome. CONCLUSION PC is a safe alternative to surgery in patients with high perioperative risk, thus providing acceptable mortality rates.
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Affiliation(s)
- Ioanna Konstantina Sgantzou
- Department of Radiology (Ioanna Konstantina Sgantzou, Antonis Adamou, Georgios Karagiorgas, Ioannis Ioannidis, Marianna Vlychou, Christos Rountas)
| | - Athina A. Samara
- Department of Surgery (Athina A. Samara, Theodoros Floros, Alexandros Diamantis, Dimitrios Zacharoulis)
| | - Antonis Adamou
- Department of Radiology (Ioanna Konstantina Sgantzou, Antonis Adamou, Georgios Karagiorgas, Ioannis Ioannidis, Marianna Vlychou, Christos Rountas)
| | - Theodoros Floros
- Department of Surgery (Athina A. Samara, Theodoros Floros, Alexandros Diamantis, Dimitrios Zacharoulis)
| | - Alexandros Diamantis
- Department of Surgery (Athina A. Samara, Theodoros Floros, Alexandros Diamantis, Dimitrios Zacharoulis)
| | - Fotios Fytsilis
- Department of Gastroenterology (Fotios Fytsilis, Apostolis Papaefthymiou, Andreas Kapsoritakis), University General Hospital of Larissa, Greece
| | - Apostolis Papaefthymiou
- Department of Gastroenterology (Fotios Fytsilis, Apostolis Papaefthymiou, Andreas Kapsoritakis), University General Hospital of Larissa, Greece
| | - Georgios Karagiorgas
- Department of Radiology (Ioanna Konstantina Sgantzou, Antonis Adamou, Georgios Karagiorgas, Ioannis Ioannidis, Marianna Vlychou, Christos Rountas)
| | - Ioannis Ioannidis
- Department of Radiology (Ioanna Konstantina Sgantzou, Antonis Adamou, Georgios Karagiorgas, Ioannis Ioannidis, Marianna Vlychou, Christos Rountas)
| | - Andreas Kapsoritakis
- Department of Gastroenterology (Fotios Fytsilis, Apostolis Papaefthymiou, Andreas Kapsoritakis), University General Hospital of Larissa, Greece
| | - Dimitrios Zacharoulis
- Department of Surgery (Athina A. Samara, Theodoros Floros, Alexandros Diamantis, Dimitrios Zacharoulis)
| | - Marianna Vlychou
- Department of Radiology (Ioanna Konstantina Sgantzou, Antonis Adamou, Georgios Karagiorgas, Ioannis Ioannidis, Marianna Vlychou, Christos Rountas)
| | - Christos Rountas
- Department of Radiology (Ioanna Konstantina Sgantzou, Antonis Adamou, Georgios Karagiorgas, Ioannis Ioannidis, Marianna Vlychou, Christos Rountas)
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25
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Gawande A, Mukewar S, Daswani R, Bhaware B, Mukewar S. Recent Endoscopic Ultrasound-Related Publications With Potential to Influence Clinical Practice. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0041-1741107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AbstractThe field of endoscopic ultrasound (EUS) has evolved significantly over the last two decades from being a tool of only diagnostic purpose to tissue acquisition and now therapeutic potential. There have been several important publications in the field of EUS in the last few years, which had a major impact in the clinical management of various gastrointestinal disorders. In this review, we discuss four such articles that in our opinion will significantly impact the role of EUS in treating various conditions. The first article is a randomized controlled trial comparing EUS-guided gall bladder drainage with percutaneous gall bladder drainage for high-risk acute cholecystitis. The second article is a randomized controlled trial comparing EUS versus minimally invasive surgery for necrotizing pancreatitis. The third article is a novel human study of EUS-guided portal pressure measurement in patients with portal hypertension. The last article is also a randomized controlled trial evaluating the role of rapid on-site evaluation for EUS-guided fine needle biopsy in solid pancreatic lesions.
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Affiliation(s)
- Atul Gawande
- Department of Gastroenterology, Midas Multispeciality Hospital, Nagpur, Maharashtra, India
| | - Shrikant Mukewar
- Department of Gastroenterology, Midas Multispeciality Hospital, Nagpur, Maharashtra, India
| | - Ravi Daswani
- Department of Gastroenterology, Midas Multispeciality Hospital, Nagpur, Maharashtra, India
| | - Bhushan Bhaware
- Department of Gastroenterology, Midas Multispeciality Hospital, Nagpur, Maharashtra, India
| | - Saurabh Mukewar
- Department of Gastroenterology, Midas Multispeciality Hospital, Nagpur, Maharashtra, India
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26
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Shin MH, Choi NK. Feasibility of surgeon-performed percutaneous transhepatic gallbladder drainages in patients with acute cholecystitis. Ann Surg Treat Res 2022; 102:257-262. [PMID: 35611088 PMCID: PMC9111964 DOI: 10.4174/astr.2022.102.5.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/25/2022] [Accepted: 03/10/2022] [Indexed: 12/07/2022] Open
Abstract
Purpose This study aimed to evaluate the feasibility of surgeon-performed percutaneous transhepatic gallbladder drainage (PTGBD). Methods Patients treated with PTGBD for acute cholecystitis (AC), performed by surgeons at Chosun University Hospital for 12 months between March 2017 and February 2018, were enrolled retrospectively, into the S-PTGBD group (n = 134). Patients with PTGBD performed by interventional radiologists for 12 months, 6 months before March 2017, and after February 2018, were included in the X-PTGBD group (n = 107). In addition to the basic characteristics of the patients, severity of AC, comorbidities, intervals from hospital admission to the PTGBDs, procedural times, technical success rates, intention-to-treat rates, and complication rates were evaluated and compared. Results Except for the patient’s age (older in S-PTGBD), there were no differences in the patient’s basic profiles, including the severity of the AC and comorbidities. Although the procedural times were significantly shorter in the X-PTGBD group (18.13 minutes vs. 11.39 minutes), effectiveness indicators such as the technical success rates and intention-to-treat rates and safety, such as the major complication rates in the S-PTGBD group, were comparable with those in the X-PTGBD group. The intervals between hospital admissions and PTGBDs were shorter in the S-PTGBD group, although this difference disappeared in the high-risk group. Effectiveness and safety in the high-risk group were also comparable between the groups. Conclusion The PTGBDs performed by surgeons are as effective and safe as those performed by interventional radiologists with faster implementation of PTGBD.
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Affiliation(s)
- Min-Ho Shin
- Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Nam-Kyu Choi
- Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Chosun University Hospital, Gwangju, Korea
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Elective Laparoscopic Cholecystectomy Is Better than Conservative Treatment in Elderly Patients with Acute Cholecystitis After Percutaneous Transhepatic Gallbladder Drainage. J Gastrointest Surg 2021; 25:3170-3177. [PMID: 34173163 DOI: 10.1007/s11605-021-05067-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is unclear whether cholecystectomy is beneficial after percutaneous transhepatic gallbladder drainage (PTGBD) in elderly patients with acute cholecystitis (AC). METHODS This single-center, retrospective study included 202 patients aged >80 years with AC without common bile duct (CBD) stones who underwent PTGBD between January 2010 and December 2019. RESULTS One hundred and forty-two patients underwent elective laparoscopic cholecystectomy (ELC), and 60 underwent conservative treatment, specifically PTGBD removal (PTGBD-R) in 36 patients and PTGBD maintained (PTGBD-M) in 24 patients. The postoperative major complication (POMC) rate in the ELC group was 8.5%. The cumulative incidence for recurrence of biliary events (BE) in the PTGBD-R group was 22.2%. The cumulative incidence for PTGBD-related complication in the PTGBD-M group was 70.8%. Mortality after initial treatment was not significantly different between the three groups (2.8% vs. 2.8% vs. 8.3%, p=0.381). In multivariate analysis, a Charlson age comorbidity index ≥6 and body mass index ≤19 were significant risk factors for POMC after ELC, and a closed cystic duct was a significant risk factor for recurrent BE after PTGBD-R. CONCLUSION ELC is recommended in AC after PTGBD for selected patients aged >80 years without CBD stones due to the high recurrence rate of BE after PTGBD-R and the difficulty associated with PTGBD-M.
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Yao P, Chang Z, Liu Z. Factors influencing failure to undergo interval cholecystectomy after percutaneous cholecystostomy among patients with acute cholecystitis: a retrospective study. BMC Gastroenterol 2021; 21:410. [PMID: 34711183 PMCID: PMC8555182 DOI: 10.1186/s12876-021-01989-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/20/2021] [Indexed: 02/07/2023] Open
Abstract
Background Percutaneous cholecystostomy (PC) with interval cholecystectomy is an effective treatment modality in high-risk patients with acute cholecystitis. However, some patients still fail to undergo interval cholecystectomy after PC, with the reasons rarely reported. Hence, this study aimed to explore the factors that prevent a patient from undergoing interval cholecystectomy. Methods Data from patients with acute cholecystitis who had undergone PC from January 1, 2017 to December 31, 2019 in our hospital were retrospectively collected. The follow-up endpoint was the patient undergoing cholecystectomy. Patients who failed to undergo cholecystectomy were followed up every three months until death. Univariate and multivariate analyses were performed to analyze the factors influencing failure to undergo interval cholecystectomy. A nomogram was used to predict the numerical probability of non-interval cholecystectomy. Results Overall, 205 participants were identified, and 67 (32.7%) did not undergo cholecystectomy during the follow-up period. Multivariate analysis revealed that having a Tokyo Guidelines 2018 (TG18) grade III status (odds ratio [OR]: 3.83; 95% confidence interval [CI]: 1.27–11.49; p = 0.017), acalculous cholecystitis (OR: 4.55; 95% CI: 1.59–12.50; p = 0.005), an albumin level < 28 g/L (OR: 4.15; 95% CI: 1.09–15.81; p = 0.037), and a history of malignancy (OR: 4.65; 95% CI: 1.62–13.37; p = 0.004) were independent risk factors for a patient’s failure to undergo interval cholecystectomy. Among them, the presence of a history of malignancy exhibited the highest influence in the nomogram for predicting non-interval cholecystectomy. Conclusions Having a TG18 grade III status, acalculous cholecystitis, severe hypoproteinemia, and a history of malignancy influence the failure to undergo cholecystectomy after PC in patients with acute cholecystitis.
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Affiliation(s)
- Peng Yao
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Zhihui Chang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China.
| | - Zhaoyu Liu
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
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Madhusudhan KS, Jineesh V, Keshava SN. Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures. Indian J Radiol Imaging 2021; 31:421-440. [PMID: 34556927 PMCID: PMC8448229 DOI: 10.1055/s-0041-1734222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Percutaneous biliary interventions are among the commonly performed nonvascular radiological interventions. Most common of these interventions is the percutaneous transhepatic biliary drainage for malignant biliary obstruction. Other biliary procedures performed include percutaneous cholecystostomy, biliary stenting, drainage for bile leaks, and various procedures like balloon dilatation, stenting, and large-bore catheter drainage for bilioenteric or post-transplant anastomotic strictures. Although these procedures are being performed for ages, no standard guidelines have been formulated. This article attempts at preparing guidelines for performing various percutaneous image-guided biliary procedures along with discussion on the published evidence in this field.
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Affiliation(s)
| | - Valakkada Jineesh
- Department of Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (Thiruvananthapuram), Kerala, India
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Jandura DM, Puli SR. Efficacy and safety of endoscopic transpapillary gallbladder drainage in acute cholecystitis: An updated meta-analysis. World J Gastrointest Endosc 2021; 13:345-355. [PMID: 34512882 PMCID: PMC8394187 DOI: 10.4253/wjge.v13.i8.345] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous transhepatic gallbladder drainage has been the most frequently performed treatment for acute cholecystitis for patients who are not candidates for surgery. Endoscopic transpapillary gallbladder drainage (ETGBD) has evolved into an alternative treatment. There have been numerous retrospective and prospective studies evaluating ETGBD for acute cholecystitis, though results have been variable.
AIM To evaluate the efficacy and safety of ETGBD in the treatment of inoperable patients with acute cholecystitis.
METHODS We performed a systematic review of major literature databases including PubMed, OVID, Science Direct, Google Scholar (from inception to March 2021) to identify studies reporting technical and clinical success, and post procedure adverse events in ETGBD. Weighted pooled rates were then calculated using fixed effects models for technical and clinical success, and post procedure adverse events, including recurrent cholecystitis.
RESULTS We found 21 relevant articles that were then included in the study. In all 1307 patients were identified. The pooled technical success rate was 82.62% [95% confidence interval (CI): 80.63-84.52]. The pooled clinical success rate was found to be 94.87% (95%CI: 93.54-96.05). The pooled overall complication rate was 8.83% (95%CI: 7.42-10.34). Pooled rates of post procedure adverse events were bleeding 1.03% (95%CI: 0.58-1.62), perforation 0.78% (95%CI: 0.39-1.29), peritonitis/bile leak 0.45% (95%CI: 0.17-0.87), and pancreatitis 1.98% (95%CI: 1.33-2.76). The pooled rates of stent occlusion and migration were 0.39% (95%CI: 0.13-0.78) and 1.3% (95%CI: 0.75-1.99) respectively. The pooled rate of cholecystitis recurrence following ETGBD was 1.48% (95%CI: 0.92-2.16).
CONCLUSION Our meta-analysis suggests that ETGBD is a feasible and efficacious treatment for inoperable patients with acute cholecystitis.
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Affiliation(s)
- David M Jandura
- Department of Gastroenterology, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
| | - Srinivas R Puli
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
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31
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Takahashi N, Umemura A, Suto T, Fujiwara H, Ariyoshi Y, Nitta H, Takahara T, Hasegawa Y, Sasaki A. Aggressive Laparoscopic Cholecystectomy in Accordance with the Tokyo Guideline 2018. JSLS 2021; 25:JSLS.2020.00116. [PMID: 33879993 PMCID: PMC8035821 DOI: 10.4293/jsls.2020.00116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Objectives: The Tokyo Guidelines 2018 have been widely adopted since their publication. However, the few reports on clinical outcomes following laparoscopic cholecystectomy have not taken into account the severity of the acute cholecystitis and the patient’s general condition, as estimated by the Charlson comorbidity index. This study aimed to assess the relationships between severity, Charlson comorbidity index, and clinical outcomes subsequent to laparoscopic cholecystectomy. Methods: We extracted the retrospective data for 370 Japanese patients who underwent emergency or scheduled early laparoscopic cholecystectomy within 72 hours from onset between February 2015 and August 2018. We compared postoperative factors in relationship to severity (grade I versus grade II/III). Then, we made a similar comparison between those with low (< 4) and high Charlson comorbidity index (≥ 4). Results: According to the Tokyo guideline 2018 levels of severity, there were 282 (76.2%), 61 (16.5%), and 27 (7.3%) patients in grades I, II, and III, respectively. With regards to surgical outcomes, the mean operating time was 62.3 minutes and the mean blood loss was 24.4 mL. The mean hospital stay was 3.6 days, with no mortalities. Blood loss was the only factor affected by severity (20.9 mL versus 60.1 mL, P = 0.0164), and operating time was the only factor affected by high Charlson comorbidity index (53.4 versus 67.8 minutes, P = 0.0153). Conclusion: Our aggressive strategy is acceptable, and severity and Charlson comorbidity index are not critical factors suggesting the disqualification of early laparoscopic cholecystectomy in patients with any grade acute cholecystitis.
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Affiliation(s)
- Naoto Takahashi
- Department of Surgery, Morioka Municipal Hospital, Morioka, Iwate, Japan
| | - Akira Umemura
- Department of Surgery, Iwate Medical University, Iwate Prefecture, Japan
| | - Takayuki Suto
- Department of Surgery, Morioka Municipal Hospital, Morioka, Iwate, Japan
| | - Hisataka Fujiwara
- Department of Surgery, Morioka Municipal Hospital, Morioka, Iwate, Japan
| | - Yu Ariyoshi
- Department of Surgery, Morioka Municipal Hospital, Morioka, Iwate, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Iwate Prefecture, Japan
| | - Takeshi Takahara
- Department of Surgery, Iwate Medical University, Iwate Prefecture, Japan
| | - Yasushi Hasegawa
- Department of Surgery, Iwate Medical University, Iwate Prefecture, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Iwate Prefecture, Japan
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32
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Hung YL, Chen HW, Tsai CY, Chen TC, Wang SY, Sung CM, Hsu JT, Yeh TS, Yeh CN, Jan YY. The optimal timing of interval laparoscopic cholecystectomy following percutaneous cholecystostomy based on pathological findings and the incidence of biliary events. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:751-759. [PMID: 34129718 DOI: 10.1002/jhbp.1012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of biliary events (BE) following percutaneous cholecystostomy (PC) in acute cholecystitis (AC) patients is high. Therefore, definitive laparoscopic cholecystectomy (LC) is recommended. We aimed to investigate the optimal timing of LC following PC with regard to the clinical course and pathological findings. METHODS All 744 AC patients with PC were included. The incidence and median number of BE were investigated with the concept of competing risks. The 344 patients with interval LC were divided into two groups based on the pathological findings of resected gallbladders: the acute/acute-and-chronic group (AANC group) (n = 221) and the chronic group (n = 123). A comparative analysis of the demographic data and perioperative outcomes was performed. RESULTS Among the 744 AC patients with PC, 142 patients experienced recurrent BE. The cumulative incidence of BE was 26.6%, and the median time to recurrence was 67.5 days. The PC-to-LC days of the chronic group were longer than those of the AANC group (73.51 vs 63.00, P < .001). The multivariate analysis indicated that the operation time was longer in the AANC group than in the chronic group (P = .040). CONCLUSION In terms of the clinical course and sequential pathological changes in the gallbladder, a 9- to 10-week interval after PC is the optimal timing for LC.
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Affiliation(s)
- Yu-Liang Hung
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Huan-Wu Chen
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chun-Yi Tsai
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Tse-Ching Chen
- Department of Anatomic Pathology, College of Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Chang-Mu Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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33
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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: 0.8] [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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34
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Hung YL, Sung CM, Fu CY, Liao CH, Wang SY, Hsu JT, Yeh TS, Yeh CN, Jan YY. Management of Patients With Acute Cholecystitis After Percutaneous Cholecystostomy: From the Acute Stage to Definitive Surgical Treatment. Front Surg 2021; 8:616320. [PMID: 33937313 PMCID: PMC8083985 DOI: 10.3389/fsurg.2021.616320] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Percutaneous cholecystostomy (PC) has become an important procedure for the treatment of acute cholecystitis (AC). PC is currently applied for patients who cannot undergo immediate laparoscopic cholecystectomy. However, the management following PC has not been well-reviewed. The efficacy of PC tubes has already been indicated, and compared to complications of other invasive biliary procedures, complications related to PC are rare. Following the resolution of AC, patients who can tolerate anesthesia and the surgical risk should undergo interval cholecystectomy to reduce the recurrence of biliary events. For patients unfit for surgery, whether owing to comorbidities, anesthesia risks, or surgical risks, expectant management may be applied; however, a high incidence of recurrence has been noted. In addition, several interesting issues, such as the indications for cholangiography via the PC tube, removal or maintenance of the PC catheter before definitive treatment, and timing of elective surgery, are all discussed in this review, and a relevant decision-making flowchart is proposed. PC is an effective and safe intervention, whether as expectant treatment or bridge therapy to definitive surgery. High-level evidence of post-PC care is still necessary to modify current practices.
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Affiliation(s)
- Yu-Liang Hung
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Mu Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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35
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Rabie M, Boshnaq M, Eldesouky S, Elabbassy I. Surgical and financial impact of delayed cholecystectomy in mild and moderate acute cholecystitis. Eur Surg 2021. [DOI: 10.1007/s10353-021-00701-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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36
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Otowa Y, Sawa H, Oji K, Arai K, Murata K, Mii Y, Kakinoki K, Kuroda D. Early Laparoscopic Cholecystectomy Has an Advantage over Antecedent Drainage for Grade II/III Acute Cholecystitis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02305-9] [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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37
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Mu P, Lin Y, Zhang X, Lu Y, Yang M, Da Z, Gao L, Mi N, Li T, Liu Y, Wang H, Wang F, Leung JW, Yue P, Meng W, Zhou W, Li X. The evaluation of ENGBD versus PTGBD in high-risk acute cholecystitis: A single-center prospective randomized controlled trial. EClinicalMedicine 2021; 31:100668. [PMID: 33385126 PMCID: PMC7772541 DOI: 10.1016/j.eclinm.2020.100668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Gallbladder drainage plays a key role in the management of acute cholecystitis (AC) patients. Percutaneous transhepatic gallbladder drainage (PTGBD) is commonly used while endoscopic naso-gallbladder drainage (ENGBD) serves as an alternative. METHODS A single center, prospective randomized controlled trial was performed. Eligible AC patients were randomly assigned to ENGBD or PTGBD group. Randomization was a computer-generated list with 1:1 allocation. All patients received cholecystectomy 2-3 months after drainage. The primary endpoint was abdominal pain score, and the intention-to-treat population was analyzed. (ClinicalTrials.gov: NCT03701464). FINDINGS Between Oct 1, 2018 and Feb 29, 2020, 22 out of 61 consecutive AC patients were enrolled in the final analysis. The mean abdominal pain scores before drainage, and at 24, 48, and 72 h after drainage in ENGBD were 6.9 ± 1.1, 4.3 ± 1.2, 2.2 ± 0.8 and 1.5 ± 0.5, respectively, while those of PTGBD were 7.4 ± 1.2, 6.2 ± 1.2, 5.3 ± 1.0 and 3.7 ± 0.9; and the mean gallbladder area tenderness scores were 8.4 ± 1.2, 5.7 ± 0.9, 3.5 ± 0.7, 2.5 ± 0.5 for ENGBD and 8.6 ± 0.9, 7.3 ± 1.0, 7.4 ± 0.5, 4.8 ± 0.9 for PTGBD. The mean abdominal pain and gallbladder area tenderness scores of the ENGBD significantly decreased than the PTGBD (group × time interaction P<0.001, respectively). ENGBD group presented lower post-operative hemorrhage and abdominal drainage tube placement rates (median (IQR) 15[5-20] vs 40[20-70]ml, 3vs9, P = 0.03), and pathological grade and lymphocyte count were observed (P = 0.004) between groups. No adverse events were observed in 3 months follow-up. INTERPRETATION Compared to PTGBD, ENGBD group presented less pain, better gallbladder pathological grades and less surgical difficulties during cholecystectomy procedures. FUNDING National Natural Science Foundation of China (82060551).
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Affiliation(s)
- Peilei Mu
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yanyan Lin
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xianzhuo Zhang
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yawen Lu
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Man Yang
- Department of Gastroenterology, Songgang People's Hospital, Shenzhen, Guangdong, China
| | - Zijian Da
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Long Gao
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Ningning Mi
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Tianya Li
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Ying Liu
- Foreign Languages Department of Lanzhou University, Lanzhou, China
| | - Haiping Wang
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, Gansu, China
| | - Fang Wang
- Department of Pathology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Joseph W. Leung
- Division of Gastroenterology and Hepatology, University of California, Davis Medical Center and Sacramento Veterans Affairs Medical Center, Sacramento, CA, United States
| | - Ping Yue
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Corresponding authors at: The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
| | - Wenbo Meng
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, Gansu, China
- Corresponding authors at: The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
| | - Wence Zhou
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, Gansu, China
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xun Li
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, Gansu, China
- The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
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38
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Bekki T, Abe T, Amano H, Hanada K, Kobayashi T, Noriyuki T, Ohdan H, Nakahara M. Validation of the Tokyo guideline 2018 treatment proposal for acute cholecystitis from a single-center retrospective analysis. Asian J Endosc Surg 2021; 14:14-20. [PMID: 32285589 DOI: 10.1111/ases.12801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The revised Tokyo guideline 2018 (TG18) recommends early laparoscopic cholecystectomy (LC) in patients with acute cholecystitis (AC) who satisfy the Charlson Comorbidity Index criteria and the ASA Physical Status Classification (ASA-PS). Our study aims to determine the efficacy of the TG18 treatment strategy. METHODS We enrolled 324 patients who had been diagnosed with AC according to the TG18 and who underwent cholecystectomy between 2010 and 2018. Perioperative variables and surgical outcomes were analyzed according to the TG18 treatment strategy and severity grading. RESULTS The Charlson Comorbidity Index and ASA-PS scores were significantly higher in patients with Grade II and Grade III AC than in those with Grade I AC. In patients with a higher severity grading, LC failed, necessitating blood transfusion and bailout surgery. Among patients treated by the TG18 strategy were a higher proportion with Grade I or II AC; their ASA-PS scores were significantly lower than patients with Grade III AC. Compared to patients not treated by the TG18 strategy, this group demonstrated significant differences in the achievement of LC, bailout surgery, postoperative hospital stays, and 90-day mortality rates. Intraoperative blood loss and blood transfusion were significantly higher in those not treated by the TG18 strategy. CONCLUSIONS Our study shows that the TG18 treatment strategy is well-designed and efficacious. Given the high rate of blood transfusion and conversion surgery in treatment strategies other that TG18, special attention should be paid when selecting the optimal treatment strategy.
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Affiliation(s)
- Tomoaki Bekki
- Department of Surgery, Onomichi General Hospital, Hiroshima, Japan
| | - Tomoyuki Abe
- Department of Surgery, Onomichi General Hospital, Hiroshima, Japan
| | - Hironobu Amano
- Department of Surgery, Onomichi General Hospital, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keiji Hanada
- Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshio Noriyuki
- Department of Surgery, Onomichi General Hospital, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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39
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Kamarajah SK, Karri S, Bundred JR, Evans RPT, Lin A, Kew T, Ekeozor C, Powell SL, Singh P, Griffiths EA. Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta-analysis. Surg Endosc 2020; 34:4727-4740. [PMID: 32661706 PMCID: PMC7572343 DOI: 10.1007/s00464-020-07805-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is increasingly performed in an ever ageing population; however, the risks are poorly quantified. The study aims to review the current evidence to quantify further the postoperative risk of cholecystectomy in the elderly population compared to younger patients. METHOD A systematic literature search of PubMed, EMBASE and the Cochrane Library databases were conducted including studies reporting laparoscopic cholecystectomy in the elderly population. A meta-analysis was reported in accordance with the recommendations of the Cochrane Library and PRISMA guidelines. Primary outcome was overall complications and secondary outcomes were conversion to open surgery, bile leaks, postoperative mortality and length of stay. RESULTS This review identified 99 studies incorporating 326,517 patients. Increasing age was significantly associated with increased rates of overall complications (OR 2.37, CI95% 2.00-2.78), major complication (OR 1.79, CI95% 1.45-2.20), risk of conversion to open cholecystectomy (OR 2.17, CI95% 1.84-2.55), risk of bile leaks (OR 1.50, CI95% 1.07-2.10), risk of postoperative mortality (OR 7.20, CI95% 4.41-11.73) and was significantly associated with increased length of stay (MD 2.21 days, CI95% 1.24-3.18). CONCLUSION Postoperative outcomes such as overall and major complications appear to be significantly higher in all age cut-offs in this meta-analysis. This study demonstrated there is a sevenfold increase in perioperative mortality which increases by tenfold in patients > 80 years old. This study appears to confirm preconceived suspicions of higher risks in elderly patients undergoing cholecystectomy and may aid treatment planning and informed consent.
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Affiliation(s)
- Sivesh K Kamarajah
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Foundation Trust Hospitals, Newcastle Upon Tyne, UK
- Institute of Cellular Medicine, University of Newcastle, Newcastle Upon Tyne, UK
| | - Santhosh Karri
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - James R Bundred
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Richard P T Evans
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Area 6, 7th Floor, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Aaron Lin
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tania Kew
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Chinenye Ekeozor
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Susan L Powell
- Department of Geriatric Medicine, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Pritam Singh
- Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK
- Regional Oesophago-Gastric Unit, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, GU2 7XX, UK
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Area 6, 7th Floor, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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40
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Marziali I, Cicconi S, Marilungo F, Benedetti M, Ciano P, Pagano P, D'Emidio F, Guercioni G, Catarci M. Role of percutaneous cholecystostomy in all-comers with acute cholecystitis according to current guidelines in a general surgical unit. Updates Surg 2020; 73:473-480. [PMID: 33058055 DOI: 10.1007/s13304-020-00897-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022]
Abstract
Acute calculous cholecystitis (ACC) is a very common complication of gallstone-related disease. Its currently recommended management changes according to severity of disease and fitness for surgery. The aim of this observational study is to assess the short- and long-term outcomes in all-comers admitted with diagnosis of ACC, treated according to 2013 Tokyo Guidelines (TG13). A retrospective analysis was conducted on a prospectively maintained database of 125 patients with diagnosis of ACC consecutively admitted between January 2017 and September 2019, subdivided in three groups according to TG13: percutaneous cholecystostomy (PC group), cholecystectomy (CH group), and conservative medical treatment (MT group). The primary end point was a composite of morbidity and/or mortality rates; the secondary end points were ACC recurrence, readmission, need for cholecystectomy rates and overall length of hospital stay (LOS). After a median follow-up of 639 days, overall morbidity rate was 20.8% and mortality rate was 6.4%. Death was directly related to AC during the index admission in two out of eight cases. There were no significant differences in primary end point according to the treatment group. Concerning secondary end points, ACC recurrence rate was not significantly different after PC (10.0%) or MT (9.1%); the readmission rates were significantly higher (p < 0.0001) in the MT group (48.5%) and in the PC group (25.0%) than in the CH group (5.8%); need for cholecystectomy rates was significantly higher (p < 0.0001) in the MT group (42.4%) than in the PC group (20.0%); median overall LOS was significantly higher in the PC (16 days) than in the MT (9 days) and than in the CH group (5 days). PC is an effective and safe rescue procedure in high-risk patients with ACC, representing a definitive treatment in 80% of cases of this specific subgroup.
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Affiliation(s)
- Irene Marziali
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Simone Cicconi
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Fabio Marilungo
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Michele Benedetti
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Paolo Ciano
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Paolo Pagano
- Interventional Radiology Units, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Fabio D'Emidio
- Interventional Radiology Units, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Gianluca Guercioni
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Marco Catarci
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy.
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Kim TH, Park DE, Chon HK. Endoscopic transpapillary gallbladder drainage for the management of acute calculus cholecystitis patients unfit for urgent cholecystectomy. PLoS One 2020; 15:e0240219. [PMID: 33035230 PMCID: PMC7546490 DOI: 10.1371/journal.pone.0240219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives Endoscopic transpapillary gallbladder drainage (ETGBD) has been proposed as an alternative to surgery or percutaneous cholecystostomy in patients with acute calculus cholecystitis (ACC). We aimed to evaluate the safety and efficacy of ETGBD via endoscopic transpapillary gallbladder stenting (ETGBS) or endoscopic naso-gallbladder drainage (ENGBD) as either a bridging or a definitive treatment option for patients with ACC when a cholecystectomy is delayed or cannot be performed. Methods From July 2014 to December 2018, 171 patients with ACC in whom ETGBD were attempted were retrospectively reviewed. The technical and clinical success rates and adverse events were evaluated. Moreover, the predictive factors for technical success and the stent patency in the ETGBS group with high surgical risk were examined. Results The technical and clinical success rates by intention-to-treat analysis for ETGBD were 90.6% (155/171) and 90.1% (154/171), respectively. Visible cystic duct on cholangiography were significant technical success predictor (adjusted odds ratio: 7.099, 95% confidence interval: 1.983–25.407, P = 0.003) as per logistic regression analysis. Adverse events occurred in 12.2% of patients (21/171: mild pancreatitis, n = 9; acute cholangitis, n = 6; post-endoscopic sphincterotomy bleeding, n = 4; and stent migration, n = 1; ACC recurrence, n = 1), but all patients were treated with conservative management and endoscopic treatment. Among the ETGBS group, the median stent patency in 70 patients with high surgical risk was 503 days (interquartile range: 404.25–775 days). Conclusions ETGBD, using either ETGBS or ENGBD, may be a suitable bridging option for ACC patients unfit for urgent cholecystectomy. In high surgical risk patients, ETGBS may be a promising and useful treatment modality with low ACC recurrence.
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Affiliation(s)
- Tae Hyeon Kim
- Department of Internal Medicine, Wonkwang University College of Medicine and Hospital, Iksan, Republic of Korea
| | - Dong Eun Park
- Department of Surgery, Wonkwang University College of Medicine and Hospital, Iksan, Republic of Korea
| | - Hyung Ku Chon
- Department of Internal Medicine, Wonkwang University College of Medicine and Hospital, Iksan, Republic of Korea
- * E-mail:
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Percutaneous Cholecystostomy Placement in Cases of Non-operative Cholecystitis: A Retrospective Cohort Analysis. World J Surg 2020; 44:4077-4085. [PMID: 32860139 DOI: 10.1007/s00268-020-05752-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acute (calculous) cholecystitis (AC) is an extremely common surgical presentation, managed by cholecystectomy. Percutaneous cholecystostomy (PC) is an alternative; however, its safety and efficacy, along with subsequent cholecystectomy, are underreported in South Africa, where patients often present late and access to emergency operating theatre is constrained. The aim of the study was to demonstrate the outcomes of PC in patients with AC not responding to antimicrobials. MATERIALS AND METHODS A retrospective cohort review of patient records, who underwent PC in Groote Schuur Hospital, Cape Town, between May 2013 and July 2016, was performed. Patients with PC for malignancy or acalculous cholecystitis were excluded. Technical success, clinical response, procedure-related morbidity and mortality were recorded. Interval LC parameters were investigated. RESULTS Technical success and clinical improvement was seen in 29 of 37 patients (78.38%) who had PC. Malposition (8.11%) was the most common complication. Two patients required emergency surgery (5.4%), while one tube was dislodged. Median tube placement duration was 25 days (range 1-211). Post-procedure, 16 patients (43.24%) went on to have LC, of which 50% (eight patients) required conversion to open surgery and 25% (four) had subtotal cholecystectomy. Median surgical time was 130 min. There were no procedure-related mortalities but eight patients (21.62%) died in the 90-day period following tube insertion. CONCLUSION In patients with AC, PC is safe, with high technical success and low complication rate. Subsequent cholecystectomy should be performed, but is usually challenging. The requirement for PC may predict a more complex disease process.
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Sagami R, Hayasaka K, Ujihara T, Nakahara R, Murakami D, Iwaki T, Katsuyama Y, Harada H, Tsuji H, Sato T, Nishikiori H, Murakami K, Amano Y. Feasibility of endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis patients receiving antithrombotic therapy. Ann Gastroenterol 2020; 33:391-397. [PMID: 32624660 PMCID: PMC7315717 DOI: 10.20524/aog.2020.0496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) as a treatment for patients with acute cholecystitis has been shown to obtain high technical and clinical success rates and a low recurrence rate. However, the safety of EUS-GBD for patients receiving antithrombotic therapy (ATT) has not been proven. The aim was to evaluate the safety and efficacy of EUS-GBD in patients receiving ATT. Methods Twelve patients with acute cholecystitis associated with gallstones who were receiving antithrombotic therapy and underwent EUS-GBD were enrolled in this retrospective study. Patients with grade II or III cholecystitis who had failed endoscopic transpapillary GBD (ETGBD) or developed recurrence after multiple ETGBD procedures underwent urgent drainage by EUS-GBD. The primary outcome was the rate of bleeding complications after the procedure and the secondary outcomes were the technical and clinical success rates, complications, and recurrence. Results Eleven (91.6%) patients underwent EUS-GBD with continuation of ATT (at least 1 agent). Five of 12 patients (41.7%) were receiving more than 1 agent for ATT. The rate of bleeding complications was 0% and the technical success rate was 100%, even though some patients had high-grade (severe) cholecystitis and/or several underlying diseases. Early complications were found in 2 (16.7%) patients. The clinical success rate was 91.7% (11/12). There were no recurrences of cholecystitis during the follow-up period (mean 261 [range 5-650] days). Conclusions EUS-GBD yielded high technical and clinical success rates and a low recurrence rate. No patients receiving ATT developed bleeding complications. EUS-GBD might be a good option for patients on ATT.
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Affiliation(s)
- Ryota Sagami
- Department of Gastroenterology, Oita San-ai Medical Center, Oita (Ryota Sagami Hiroaki Tsuji, Takao Sato, Hidefumi Nishikiori)
| | - Kenji Hayasaka
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Tetsuro Ujihara
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Ryotaro Nakahara
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Daisuke Murakami
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Tomoyuki Iwaki
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Yasushi Katsuyama
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Chiba (Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Yasushi Katsuyama, Hideaki Harada)
| | - Hiroaki Tsuji
- Department of Gastroenterology, Oita San-ai Medical Center, Oita (Ryota Sagami Hiroaki Tsuji, Takao Sato, Hidefumi Nishikiori)
| | - Takao Sato
- Department of Gastroenterology, Oita San-ai Medical Center, Oita (Ryota Sagami Hiroaki Tsuji, Takao Sato, Hidefumi Nishikiori)
| | - Hidefumi Nishikiori
- Department of Gastroenterology, Oita San-ai Medical Center, Oita (Ryota Sagami Hiroaki Tsuji, Takao Sato, Hidefumi Nishikiori)
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University (Kazunari Murakami)
| | - Yuji Amano
- Department of Endoscopy, New Tokyo Hospital, Chiba (Yuji Amano), Japan
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Sanaiha Y, Juo YY, Rudasill SE, Jaman R, Sareh S, de Virgilio C, Benharash P. Percutaneous cholecystostomy for grade III acute cholecystitis is associated with worse outcomes. Am J Surg 2020; 220:197-202. [DOI: 10.1016/j.amjsurg.2019.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 12/07/2022]
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Kaura K, Bazerbachi F, Sawas T, Levy MJ, Martin JA, Storm AC, Wise KB, Reisenauer CJ, Abu Dayyeh BK, D Topazian M, Petersen BT, Schiller HJ, Chandrasekhara V. Surgical outcomes of ERCP-guided transpapillary gallbladder drainage versus percutaneous cholecystostomy as bridging therapies for acute cholecystitis followed by interval cholecystectomy. HPB (Oxford) 2020; 22:996-1003. [PMID: 31685380 DOI: 10.1016/j.hpb.2019.10.1530] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/02/2019] [Accepted: 10/13/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Select patients with acute cholecystitis (AC) are not candidates for index cholecystectomy. We compared the influence of ERCP-guided transpapillary gallbladder drainage (ERGD) versus percutaneous cholecystostomy (PC) on delayed cholecystectomy outcomes. METHODS Consecutive patients undergoing ERGD or PC for AC from January 2007 to October 2018 were included. Primary outcome was the rate of conversion to open cholecystectomy and perioperative complications in groups. RESULTS The study included 52 patients with ERGD and 140 with PC prior to cholecystectomy (median 68 days [IQR: 47-105.5]). Technical success was higher in the PC group (100% vs 91%; P = 0.0004). There was a nonsignificant trend to lower postoperative complications with ERGD (30.7% vs 43.5%; P = 0.07). No difference in conversion to open cholecystectomy OR: 1.5 (95% CI: 0.68-3.65; P = 0.28) or severity of complications (Clavien-Dindo grade >2) OR: 0.60, (95% CI: 0.19-1.87; P = 0.38) was noted between the ERGD and PC groups. PC was associated with higher rates of unplanned repeat intervention (16.4% vs 7.7%; P = 0.02). CONCLUSION ERGD is suitable for patients with AC who is candidates for delayed cholecystectomy and should be considered for gallbladder drainage in patients with concomitant choledocholithiasis or cholangitis who require ERCP.
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Affiliation(s)
- Karan Kaura
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Fateh Bazerbachi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Tarek Sawas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - John A Martin
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Kevin B Wise
- Division of Surgery, Mayo Clinic, Rochester, MN, 55905, United States
| | - Christopher J Reisenauer
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, 55902, United States
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Mark D Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Bret T Petersen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Henry J Schiller
- Division of Surgery, Mayo Clinic, Rochester, MN, 55905, United States
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, United States.
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Identification of risk factors for obstructive cholecystitis following placement of biliary stent in unresectable malignant biliary obstruction: a 5-year retrospective analysis in single center. Surg Endosc 2020; 35:2679-2689. [DOI: 10.1007/s00464-020-07694-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/09/2020] [Indexed: 12/21/2022]
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Safety of Percutaneous Cholecystostomy Early Removal: A Retrospective Cohort Study. Surg Laparosc Endosc Percutan Tech 2020; 30:410-415. [PMID: 32398449 DOI: 10.1097/sle.0000000000000799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION There are no strong recommendations regarding the management of percutaneous cholecystostomy (PC). The aim of this study was to assess the safety of early PC removal in terms of complications and recurrent disease. MATERIALS AND METHODS Retrospective observational study of consecutive patients who underwent PC for acute cholecystitis from January 2012 to December 2017. We first evaluated PC-related complications and recurrent disease in patients whose drainage was removed as inpatients (IPR) or as outpatients (OPR). Patients were then divided into 2 groups according to the timing of PC removal: G1 with the PC removed within the first 7 days after its collocation and G2 with the PC removed after 7 days. RESULTS We included 151 patients. Patients in the OPR group had their catheters removed after 52 days (26 to 67 d) while the IPR group after 8 days (6 to 11 d); P<0.001. No difference was seen regarding complications, recurrent disease rate, or readmissions.G1 was comprised of 56 patients (37.1%), whereas G2 had 95 (62.9%). When G1 was compared with G2, no differences were seen in terms of complications. However, G1 presented a shorter duration of antibiotic treatment with 11 days (8 to 14 d) versus 15 days (12 to 23 d) in G2; P<0.001, but had a higher rate of recurrent disease 32.1% versus 14.7% in G2; P=0.014 and a higher rate of readmission 30.3% versus 13.6% in G2; P=0.019. CONCLUSIONS Removal of the PC during the index admission was not associated with a higher risk of complications. However, the PC removal before 7 days could be related to an increase in recurrent disease and readmissions.
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Søreide JA, Fjetland A, Desserud KF, Greve OJ, Fjetland L. Percutaneous cholecystostomy - An option in selected patients with acute cholecystitis. Medicine (Baltimore) 2020; 99:e20101. [PMID: 32384483 PMCID: PMC7440289 DOI: 10.1097/md.0000000000020101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
While urgent percutaneous cholecystostomy (PC) was introduced as an alternative to acute surgical treatment for acute cholecystitis (AC), the current place of PC in the treatment algorithm for AC is challenged. We evaluate demographics and outcomes of PC in routine clinical practice in a population-based cohort.Retrospective evaluation of consecutive patients treated with PC for AC between 2000 and 2015. The severity of cholecystitis was graded according to the 2013 Tokyo Guidelines.One hundred forty-nine patients were included (82; 55% males) (median age of 72.5 years; range, 21-92). The Tokyo Guidelines criteria of 2013 (TG13) severity grade distribution was 4%, 61.7%, and 34.2% for grades I, II, and III, respectively. No difference was observed between males and females with regard to age, American Society of Anesthesiologists (ASA) score, comorbidities, or previous history of cholecystitis. PC was successfully performed in all but 1 patient, and complications were few and minor. Less than half (48.3%) of all patients subsequently received definitive surgical treatment, mostly (83.3%) laparoscopy. No or minor complications were encountered in 58 (80.6%) patients. Operated patients were significantly younger (P = <.001) and had lower ASA scores (P = .005), less comorbidities (P < .001), and had more seldomly a severe grade 3 cholecystitis (P < .001) than non-operated patients.PC is useful in selected patients with AC. However, since only a half of the patients eventually received definitive surgical treatment, a better routine decision-making based on proper criteria may enable an improved allocation of the individual patient for tailored treatment according to the disease severity, the patient's comorbidity burden, and also to the treatment options available at the institution to prevent overutilization of a non-definitive treatment approach. Comprehension of this responsibility should be acknowledged by hospitals with an emergency surgical service, although the clinical decision-making remains a challenge of the responsible surgeon on call.
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Affiliation(s)
- Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger
- Department of Clinical Medicine, University of Bergen, Bergen
| | - Anja Fjetland
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger
| | - Kari F. Desserud
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger
| | - Ole Jakob Greve
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Lars Fjetland
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
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Cystic Duct Embolization with Chemical Gallbladder Ablation for the Treatment of Acute Calculous Cholecystitis in High-Risk Patients: A Prospective Single-Center Study. J Vasc Interv Radiol 2020; 31:644-648. [DOI: 10.1016/j.jvir.2019.12.806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/12/2019] [Accepted: 12/30/2019] [Indexed: 01/17/2023] Open
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Hung YL, Chong SW, Cheng CT, Liao CH, Fu CY, Hsieh CH, Yeh TS, Yeh CN, Jan YY, Wang SY. Natural Course of Acute Cholecystitis in Patients Treated With Percutaneous Transhepatic Gallbladder Drainage Without Elective Cholecystectomy. J Gastrointest Surg 2020; 24:772-779. [PMID: 30945085 DOI: 10.1007/s11605-019-04213-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/18/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative treatment for acute cholecystitis (AC). We aimed to understand the natural course of AC in patients treated with PTGBD but without later definitive treatments, such as laparoscopic cholecystectomy. METHODS This was a retrospective study of the period from June 2010 to December 2016, during which time 2371 patients were diagnosed with AC and 625 received PTGBD treatment. Among the 625 patients, 237 received no definitive treatment. A biliary event after the initial AC episode was the outcome of interest. In addition, the competing risk of death unrelated to biliary causes was present in the cohort. Therefore, a competing risk model was applied for analysis. RESULTS The cumulative incidence of biliary events was 29.8% with a median of 4.27 months, while the competing event, i.e., death unrelated to a biliary event, was noted in 14.9% of patients with a median 23.54 months. The risk factors of biliary events were prolonged PTGBD indwelling and an abnormal PTGBD cholangiogram. The risk factors of death unrelated to a biliary event included a high Charlson comorbidity index and the initial AC severity. CONCLUSIONS Definitive cholecystectomy is still recommended for patients undergoing PTGBD treatment due to the high incidence of later biliary events. A thorough preoperative evaluation is necessary for those patients before elective cholecystectomy because of the inferior life expectancy and physical status.
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Affiliation(s)
- Yu-Liang Hung
- School of Traditional Chinese Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China
| | - Sio-Wai Chong
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Chi-Tung Cheng
- Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Chi-Hsun Hsieh
- Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China
| | - Shang-Yu Wang
- Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China.
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China.
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China.
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