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Coutureau J, Millet I, Taourel P. CT of acute abdomen in the elderly. Insights Imaging 2025; 16:95. [PMID: 40335795 PMCID: PMC12058634 DOI: 10.1186/s13244-025-01955-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 03/17/2025] [Indexed: 05/09/2025] Open
Abstract
Abdominal disorders represent 10 to 15% of all Emergency Department visits in elderly patients. This educational review focuses on acute abdomen pathologies specific to the elderly and on their imaging patterns and proposes a strategy for performing CT scans in this population. Bowel obstruction is the most common cause of emergency surgery in the elderly with a higher proportion of colonic obstructions, in particular obstructive colorectal cancer and sigmoid volvulus. Concerning abdominal inflammatory processes, such as cholecystitis, appendicitis, and diverticulitis, gangrenous cholecystitis and complicated appendicitis are relatively frequently encountered due to delayed diagnoses. Bowel ischemia, which includes acute mesenteric ischemia (AMI) and ischemic colitis (IC), is also much more common after the age of 80. Although ischemic colitis is mainly related to cardiovascular risk factors, it can also result from a persistent distension above a colonic cancer or from fecal impaction. Finally, extra-abdominal pathologies responsible for acute abdominal pain, such as inferior myocardial infarction, should not be overlooked. In clinical practice, when possible thanks to sufficient and appropriate radiological resources, we recommend a scan without injection of contrast and an injection depending on the results of the unenhanced scan, decided by the radiologist present at the CT scan room during the examination. CRITICAL RELEVANCE STATEMENT: CT is critical in the diagnosis and management of patients over 75 years old with an acute abdomen, given the difficulty of clinico-biological diagnosis, the frequency of complicated forms, and the morbidity induced by delayed diagnosis. KEY POINTS: The most common site and cause of bowel obstruction in the elderly is large bowel obstruction due to colon cancer. Discrepancy between a poor clinical examination and complicated forms on imaging, particularly for inflammation and infections, is responsible for late diagnosis and increased morbidity. Ischemia, including of the small bowel, colon, and gallbladder are common cause of acute abdomen in elderly. In patients with upper quadrant pain, consider extra-abdominal causes such as pneumonia or myocardial infarction.
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Affiliation(s)
- Juliette Coutureau
- Department of Medical Imaging, Lapeyronie University Hospital, Montpellier, France
| | - Ingrid Millet
- Department of Medical Imaging, Lapeyronie University Hospital, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), Univ Montpellier, INSERM, Montpellier, France
| | - Patrice Taourel
- Department of Medical Imaging, Lapeyronie University Hospital, Montpellier, France.
- Desbrest Institute of Epidemiology and Public Health (IDESP), Univ Montpellier, INSERM, Montpellier, France.
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Liang Y, Feng X, Liang S, Zhang J, Yu C. Association between platelet-to-high-density lipoprotein cholesterol ratio and gallstone prevalence in the American adult population: a cross-sectional study analysis. BMC Gastroenterol 2025; 25:297. [PMID: 40281441 PMCID: PMC12032805 DOI: 10.1186/s12876-025-03930-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 04/23/2025] [Indexed: 04/29/2025] Open
Abstract
OBJECTIVE The platelet-to-high-density lipoprotein cholesterol ratio(PHR), a novel marker of inflammatory response and metabolic dysregulation, has been linked to various chronic conditions.This study aimed to evaluate the association between PHR and the prevalence of gallstones. METHODS This cross-sectional study analyzed data collected from the United States National Health and Nutrition Examination Survey(NHANES)between 2017 and 2023. Multivariate logistic regression, generalized additive models, and subgroup analyses were employed to assess the relationship between PHR and gallstone prevalence. RESULTS A total of 13,163 participants were included, of whom 1,441(10.95%) self-reported a history of gallstones. After adjusting for potential confounders, a positive association was observed between the natural log-transformed PHR(LN[PHR])and gallstone prevalence(OR = 1.27, 95%CI: 1.09-1.49). This positive correlation became more pronounced with increasing PHR levels(P-trend = 0.01). Smooth curve fitting analysis indicated a linear relationship between PHR and gallstone prevalence. Subgroup analyses revealed that the association was strongest in participants aged 20-39 years, women, and individuals of other racial/ethnic groups. CONCLUSION Elevated PHR levels are significantly associated with a higher risk of gallstones. While our observational data suggest plausibility for PHR-gallstone, these findings should be interpreted as hypothesis-generating rather than definitive clinical evidence. Future mechanistic studies should elucidate whether this association reflects causal pathways or epiphenomenal relationships.
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Affiliation(s)
- Yongkang Liang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui province, China
| | - Xueyi Feng
- Department of General Surgery, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, 237005, Anhui province, China
| | - Song Liang
- Department of General Surgery, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, 237005, Anhui province, China
| | - Juhe Zhang
- Department of General Surgery, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, 237005, Anhui province, China
| | - Changjun Yu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui province, China.
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Yu J, Park S, Jeong S, Park SJ, Song J, Kim HJ, Lee J, Ko A, Oh SN, Park SM. Association between cholecystectomy and chronic kidney disease risk: a nationally retrospective cohort study. Transl Gastroenterol Hepatol 2025; 10:27. [PMID: 40337758 PMCID: PMC12056102 DOI: 10.21037/tgh-24-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 12/18/2024] [Indexed: 05/09/2025] Open
Abstract
Background Cholecystectomy, a common surgery, has been associated to various health issues. Some evidence suggests associations between gallbladder removal and elevated risks of metabolic and cardiovascular diseases. However, the potential association between cholecystectomy and chronic kidney disease (CKD) remains understudied. This study aims to investigate the potential relationship between cholecystectomy and CKD risk using a large, population-based cohort. Methods A retrospective cohort study was conducted using data from the National Health Insurance Service (NHIS) of Korea [2011-2019]. A total of 2,885 participants who underwent cholecystectomy were matched with 8,653 controls. We matched 2,885 cholecystectomy patients with 8,653 controls (1:3 ratio) by sex and propensity score. The incidence of CKD was followed from the surgery date until death or 2019. Results During a mean follow-up time of 6.04 years, 239 CKD cases were identified. The risk of CKD was significantly increased in the cholecystectomy group compared with the non-cholecystectomy group after adjustment for covariates [adjusted hazard ratio (aHR) 1.89; 95% confidence interval (CI): 1.55-2.31]. This association was observed more than 3 years after cholecystectomy (aHR 1.68; 95% CI: 1.38-2.05) and were consistent across strata of sex, age group, household income, physical activity, and smoking status. Conclusions Post-cholecystectomy patients might have a higher risk of CKD, and this increased risk could persist over time. Further long-term and in-depth studies are needed to explore the association between cholecystectomy and CKD.
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Affiliation(s)
- Jiwon Yu
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
- Department of Artificial Intelligence Convergence, Hallym University Graduate School, Chuncheon, South Korea
| | - Sangwoo Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, Korea University College of Medicine, Seoul, South Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Jihun Song
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Hye Jun Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Jaewon Lee
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Ahryoung Ko
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Si Nae Oh
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Lv G, Wang D, Huang Y, Shi R, Qin C, Chen X, Zeng X, Luo H, Yang P, Chen S, Wang J. High serum uric acid levels are associated with increased prevalence of gallstones in adult women: a cross-sectional study based on NHANES. Front Med (Lausanne) 2025; 12:1487974. [PMID: 39897593 PMCID: PMC11782260 DOI: 10.3389/fmed.2025.1487974] [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: 08/29/2024] [Accepted: 01/02/2025] [Indexed: 02/04/2025] Open
Abstract
Objective We investigated the association between serum uric acid (SUA) levels and gallstone (GS) prevalence in adult women. Methods Participants' information were taken from the United States National Health and Nutrition Examination Survey (2017-2020). Logistic regression analysis and dose-response curve were used to assess the association between SUA levels and the prevalence of GS in adult women. Subgroup analyses were performed to investigate associations between SUA levels and age, ethnicity, body mass index, hypertension, and diabetes. Results A total of 600 participants self-reported a history of GS. After adjusting for confounding, the prevalence of GS in adult women increased by 14% for every 1 mg/dL increase in SUA (odds ratio [OR]: 1.14, 95% confidence interval [CI]: 1.06, 1.22). Testing SUA as a categorical variable for sensitivity analyses indicated a 1.6-fold increase in the prevalence of GS in tertile 3 (OR=1.60, 95% CI: 1.25, 2.04) compared to tertile 1. Dose-response curves showed a nonlinear correlation between SUA levels and the prevalence of GS. Subgroup analyses indicated that SUA level was associated with an increased prevalence of GS in most subgroups, although subtle differences existed. Conclusion SUA was positively and non-linearly associated with the prevalence of GS in adult females. Despite the inability to clarify the causal relationship between them, our results remain interesting.
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Affiliation(s)
- Guozheng Lv
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Decai Wang
- Department of Urology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
- NHC Key Laboratory of Nuclear Technology Medical Transformation, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Yu Huang
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Ruizi Shi
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Chuan Qin
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Xi Chen
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Xintao Zeng
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Hua Luo
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Pei Yang
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Sirui Chen
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Jianjun Wang
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
- NHC Key Laboratory of Nuclear Technology Medical Transformation, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
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Procida G, Montori G, Fugazzola P, Ansaloni L, Bergamini C, Campanile FC, Agresta F. Gallbladder surgery at an advanced age. GERIATRIC SURGERY AND PERIOPERATIVE CARE 2025:245-254. [DOI: 10.1016/b978-0-443-21909-2.00006-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Dutta P, Danpanichkul P, Suparan K, Pang Y, Rakwong K, Fine MR, Wijarnpreecha K. Sex disparities in global burden of gallbladder and biliary tract cancer: analysis of Global Burden of Disease study from 2010 to 2019. J Gastroenterol Hepatol 2024; 39:2863-2871. [PMID: 39380148 DOI: 10.1111/jgh.16763] [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: 07/15/2024] [Accepted: 09/22/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND AND AIM The global burden of gallbladder and biliary tract cancer (GBTC) has been on the rise, making it a major public health concern. We aim to comprehensively analyze sex disparities in the temporal trends of GBTC incidence, mortality, and disability-adjusted life years (DALYs) regionally and globally from 2010 to 2019. METHODS Age-standardized rates of GBTC incidence, death, and DALYs were analyzed utilizing the Global Burden of Disease study 2019. RESULTS From 2010 to 2019, the estimated annual percent change (APC) of the age-standardized incidence rates (ASIRs) and age-standardized disability-adjusted life years (ASDALYs) due to GBTC globally decreased in both sexes (males, APC: -0.80%; APC: -1.00%) and (females, APC: -0.89%; APC: -0.96%). At the same time, age-standardized death rates (ASDRs) decreased only in males (APC: -0.82%) and remained stable in females. By regions, ASIRs and ASDR increased in both sexes only in Southeast Asia (SEA) but decreased in the other regions. All regions had decreased ASDALYs except for an increase in ASDALYs for females only in the SEA region (APC: 0.41%), and males have a stable trend. CONCLUSIONS Our study reveals substantial geographic variance in the burden of GBTC, specifically in the SEA region. Therefore, localized interventional methodologies must be undertaken to effectively address this global burden from GBTC.
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Affiliation(s)
- Priyata Dutta
- Department of Internal Medicine, Trinity Health Ann Arbor Hospital, Ypsilanti, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Pojsakorn Danpanichkul
- Department of Internal Medicine, Texas Tech University Health Sciences Centre, Lubbock, Texas, USA
| | - Kanokphong Suparan
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yanfang Pang
- Affiliated Hospital of Yuanjiang Medical University for Nationalities, Baise, Guangxi, China
- National Immunological Laboratory of Traditional Chinese Medicine, Nanning, Guangxi, China
- Key Laboratory of Research on Clinical Molecular Diagnosis for High Incidence Diseases in Western Guangxi, Baise, Guangxi, China
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Michael R Fine
- Huron Gastroenterology Associates, Ypsilanti, Michigan, USA
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
- Department of Medicine, BIO5 Institute, University of Arizona College of Medicine, Phoenix, Arizona, USA
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Loosen SH, Killer A, Luedde T, Roderburg C, Kostev K. Helicobacter pylori infection associated with an increased incidence of cholelithiasis: A retrospective real-world cohort study of 50 832 patients. J Gastroenterol Hepatol 2024; 39:1809-1815. [PMID: 38714499 DOI: 10.1111/jgh.16597] [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: 01/29/2024] [Revised: 04/07/2024] [Accepted: 04/21/2024] [Indexed: 05/10/2024]
Abstract
BACKGROUND AND AIM Helicobacter pylori (H. pylori) infection is a bacterial disease of the stomach that has been associated with an increased incidence of cholelithiasis. While the updated German guideline emphasizes the relevance of H. pylori as a pathogen and recommends eradication therapy, systematic data on the association between H. pylori infection, its eradication, and the subsequent diagnosis of cholelithiasis in Germany are missing. METHODS A total of 25 416 patients with and 25 416 propensity score-matched individuals without H. pylori infection were identified from the Disease Analyzer database (IQVIA) between 2005 and 2021. A subsequent diagnosis of cholelithiasis was analyzed as a function of H. pylori infection as well as its eradication using Cox regression models. RESULTS After 10 years of follow-up, 8.0% versus 5.8% of patients with and without H. pylori infection were diagnosed with cholelithiasis (P < 0.001). Regression analysis revealed a significant association between H. pylori infection and cholelithiasis (hazard ratio [HR]: 1.45; 95% confidence interval [CI]: 1.33-1.58), which was stronger in men (HR: 1.63; 95% CI: 1.41-1.90) than in women (HR: 1.36; 95% CI: 1.22-1.52). In terms of eradication therapy, both an eradicated H. pylori infection (HR: 1.48; 95% CI: 1.31-1.67) and a non-eradicated H. pylori infection (HR: 1.41; 95% CI: 1.25-1.60) were associated with a subsequent diagnosis of cholelithiasis. CONCLUSION The present study reveals a strong association between H. pylori infection and a subsequent diagnosis of cholelithiasis in a large real-world cohort from Germany. Eradication therapy was not associated with a reduced incidence of cholelithiasis in our cohort.
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Affiliation(s)
- Sven H Loosen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander Killer
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christoph Roderburg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Karel Kostev
- Department of Epidemiology, IQVIA, Frankfurt, Germany
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Pandey M, Bana M, Agrawal N, Agrawal M. An evaluation of haemodynamic responses to tracheal intubation following intravenous dexmedetomidine and fentanyl in patients undergoing laparoscopic cholecystectomy. Niger Med J 2024; 65:737-748. [PMID: 39633693 PMCID: PMC11612326 DOI: 10.60787/nmj-v65i3.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024] Open
Abstract
Background Laryngoscopy and tracheal intubation are related to sympathetic stimulation and lead to hypertension and tachycardia. These changes in hemodynamics may increase the risk of myocardial ischemia. As a result, effective blunting of these unpleasant responses is required. This study aimed to compare the effects of dexmedetomidine and fentanyl bolus administration on attenuation of hemodynamic response to tracheal intubation in patients undergoing laparoscopic cholecystectomy surgeries. Methodology A total of 136 patients of both genders undergoing elective laparoscopic cholecystectomy surgeries satisfying inclusion criteria were randomly allocated into 2 groups (group D and group F). Group D received 1mcg/Kg of dexmedetomidine (Dexa) intravenous (IV) in 100ml of normal saline over 10 minutes and 5ml of normal saline over 3 minutes before induction. Group F received Inj. Fentanyl 2mcg/Kg diluted in 100 ml of normal saline over 10 minutes and 5ml of normal saline 3 minutes before induction. The patients were ventilated for 3 minutes by bag and mask. After 3 minutes of ventilation, endotracheal intubation was done. Vitals (systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, heart rate) were recorded from the time of intubation to 10 minutes after that at 1 minute interval. Results In both groups, heart rate increased significantly immediately following intubation (p = 0.002). In dexmedetomidine group heart rate, mean arterial pressure, systolic and diastolic blood pressures were significantly controlled at various time points in comparison to fentanyl group after laryngoscopy and intubation. Conclusion Dexmedetomidine in a dose of 1mcg/kg causes greater and sustained attenuation of haemodynamic response to endotracheal intubation among the patients of cholelithiasis undergoing laparoscopic cholecystectomy surgeries as compared to fentanyl. Therefore, it can be used as an effective alternative to opioids for induction of general anaesthesia in patients undergoing laparoscopic cholecystectomy surgery.
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Affiliation(s)
- Monica Pandey
- Department of Anaesthesia, Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Mona Bana
- Department of Anaesthesia, Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Neha Agrawal
- Department of Anaesthesia, Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Madhuri Agrawal
- Department of Anaesthesia, Eternal Heart Care Centre and Research Institute, Jaipur, India
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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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10
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Wang J, Li H, Hu J, Shi R, Qin C, Chen X, Chen S, Zeng X, Luo H, Luo H, Zhou Y, Yang P, Wang D. Relationship of triglyceride-glucose index to gallstone prevalence and age at first gallstone surgery in American adults. Sci Rep 2024; 14:16749. [PMID: 39033195 PMCID: PMC11271289 DOI: 10.1038/s41598-024-67883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024] Open
Abstract
The triglyceride-glucose (TyG) index is a novel marker of insulin resistance that has been strongly associated with many diseases related to metabolic disorders, such as diabetes, coronary heart disease, myocardial infarction, obesity, nonalcoholic fatty liver disease, and stroke. However, whether the TyG index is associated with the prevalence of gallstones has not been determined. Therefore, the purpose of this study was to evaluate the relationship between the TyG index and the prevalence of gallstones in American adults, as well as the age at which adults in America undergo their first gallstone surgery. We selected individuals from the National Health and Nutrition Examination Survey (NHANES) database from 2017 to March 2020. Based on the goal of our study, comprehensive inclusion and exclusion criteria were created. A logistic regression analysis, dose-response curve, and subgroup analysis were computed to assess the relationship between the TyG index and gallstone prevalence and age at first surgery for gallstone. A total of 3905 participants aged > 20 years were included in our study, of whom 421 had a self-reported history of gallstones. A total of 1884 (48.2%) males and 2021 (51.8%) females were included. After confounders adjustment, it was found single-unit increases in the TyG index were linked with a 25.0% increase in gallstone prevalence (odds ratio [OR] = 1.25, 95% confidence interval [95%CI]: 1.04, 1.51). After conversion of the TyG index values from continuous to categorical variables with tertiles, a marked 48% increase in gallstone incidence was found in tertile 3 relative to tertile 1 (OR = 1.48, 95% CI: 1.09, 1.99). The dose-response curve results indicated positive associations between gallstone prevalence and the TyG index, while the latter was negatively associated with age at first gallstone surgery. Based on subgroup analysis, the positive association between TyG index and high-incidence of gallstones was more significant in females (OR = 1.39, 95% CI: 1.09, 1.77), age < 40 years (OR = 2.02, 95% CI: 1.23, 3.29), and other race (OR = 1.46, 95% CI: 1.06, 2.02). A higher TyG index is associated with a higher incidence of gallstones and may lead to an earlier age of first gallstone surgery. However, a causal relationship between TyG and gallstones cannot be established.
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Affiliation(s)
- Jianjun Wang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Han Li
- Department of Cardiology, The Fifth Hospital of Wuhan, Wuhan, 430050, China
| | - Junchao Hu
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Ruizi Shi
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Chuan Qin
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Xi Chen
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Sirui Chen
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Xintao Zeng
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Hua Luo
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Huiwen Luo
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Yulong Zhou
- Department of General Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Pei Yang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China.
| | - Decai Wang
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China.
- Department of Urology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China.
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11
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Fico V, La Greca A, Tropeano G, Di Grezia M, Chiarello MM, Brisinda G, Sganga G. Updates on Antibiotic Regimens in Acute Cholecystitis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1040. [PMID: 39064469 PMCID: PMC11279103 DOI: 10.3390/medicina60071040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
Acute cholecystitis is one of the most common surgical diseases, which may progress from mild to severe cases. When combined with bacteremia, the mortality rate of acute cholecystitis reaches up to 10-20%. The standard of care in patients with acute cholecystitis is early laparoscopic cholecystectomy. Percutaneous cholecystostomy or endoscopic procedures are alternative treatments in selective cases. Nevertheless, antibiotic therapy plays a key role in preventing surgical complications and limiting the systemic inflammatory response, especially in patients with moderate to severe cholecystitis. Patients with acute cholecystitis have a bile bacterial colonization rate of 35-60%. The most frequently isolated microorganisms are Escherichia coli, Klebsiella spp., Streptococcus spp., Enterococcus spp., and Clostridium spp. Early empirical antimicrobial therapy along with source control of infection is the cornerstone for a successful treatment. In these cases, the choice of antibiotic must be made considering some factors (e.g., the severity of the clinical manifestations, the onset of the infection if acquired in hospital or in the community, the penetration of the drug into the bile, and any drug resistance). Furthermore, therapy must be modified based on bile cultures in cases of severe cholecystitis. Antibiotic stewardship is the key to the correct management of bile-related infections. It is necessary to be aware of the appropriate therapeutic scheme and its precise duration. The appropriate use of antibiotic agents is crucial and should be integrated into good clinical practice and standards of care.
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Affiliation(s)
- Valeria Fico
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Istituto di Ricerca e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy; (V.F.); (A.L.G.); (G.T.); (M.D.G.); (G.S.)
| | - Antonio La Greca
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Istituto di Ricerca e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy; (V.F.); (A.L.G.); (G.T.); (M.D.G.); (G.S.)
- Catholic School of Medicine “Agostino Gemelli”, 00168 Rome, Italy
| | - Giuseppe Tropeano
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Istituto di Ricerca e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy; (V.F.); (A.L.G.); (G.T.); (M.D.G.); (G.S.)
| | - Marta Di Grezia
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Istituto di Ricerca e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy; (V.F.); (A.L.G.); (G.T.); (M.D.G.); (G.S.)
| | - Maria Michela Chiarello
- General Surgery Operative Unit, Department of Surgery, Azienda Sanitaria Provinciale Cosenza, 87100 Cosenza, Italy;
| | - Giuseppe Brisinda
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Istituto di Ricerca e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy; (V.F.); (A.L.G.); (G.T.); (M.D.G.); (G.S.)
- Catholic School of Medicine “Agostino Gemelli”, 00168 Rome, Italy
| | - Gabriele Sganga
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Istituto di Ricerca e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy; (V.F.); (A.L.G.); (G.T.); (M.D.G.); (G.S.)
- Catholic School of Medicine “Agostino Gemelli”, 00168 Rome, Italy
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12
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Proctor DW, Goodall R, Borsky K, Salciccioli JD, Marshall DC, Shanmugarajah K, Shalhoub J. Temporal Analysis of the Incidence, Mortality and Disability-Adjusted Life Years of Benign Gallbladder and Biliary Diseases in High-Income Nations, 1990-2019. ANNALS OF SURGERY OPEN 2024; 5:e453. [PMID: 38911626 PMCID: PMC11191896 DOI: 10.1097/as9.0000000000000453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Objective The aim of this observational study was to analyze trends in the incidence, mortality, and disability-adjusted life years (DALYs) of benign gallbladder and biliary diseases across high-income countries between 1990 and 2019. Background Benign gallbladder and biliary diseases place a substantial burden on healthcare systems in high-income countries. Accurate characterization of the disease burden may help optimize healthcare policy and resource distribution. Materials and methods Age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and DALYs data for gallbladder and biliary diseases in males and females were extracted from the 2019 Global Burden of Disease (GBD) study. A mortality-incidence index (MII) was also calculated. Joinpoint regression analysis was performed. Results The median ASIRs across the European Union 15+ countries in 2019 were 758/100,000 for females and 282/100,000 for males. Between 1990 and 2019 the median percentage change in ASIR was +2.49% for females and +1.07% for males. The median ASMRs in 2019 were 1.22/100,000 for females and 1.49/100,000 for males with a median percentage change over the observation period of -21.93% and -23.01%, respectively. In 2019, the median DALYs was 65/100,000 for females and 37/100,000 among males, with comparable percentage decreases over the observation period of -21.27% and -19.23%, respectively. Conclusions International variation in lifestyle factors, diagnostic and management strategies likely account for national and sex disparities. This study highlights the importance of ongoing clinical efforts to optimize treatment pathways for gallbladder and biliary diseases, particularly in the provision of emergency surgical services and efforts to address population risk factors.
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Affiliation(s)
- Dominic W. Proctor
- From the Department of Undergraduate Medical Education, Royal Free London NHS Foundation Trust, London, UK
| | - Richard Goodall
- Department of Surgery and Cancer, Imperial College London, UK
| | - Kim Borsky
- Department of Plastic Surgery, Salisbury Hospital, Salisbury, UK
| | - Justin D. Salciccioli
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | | | | | - Joseph Shalhoub
- Department of Surgery and Cancer, Imperial College London, UK
- Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
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13
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Innes K, Ahmed I, Hudson J, Hernández R, Gillies K, Bruce R, Bell V, Avenell A, Blazeby J, Brazzelli M, Cotton S, Croal B, Forrest M, MacLennan G, Murchie P, Wileman S, Ramsay C. Laparoscopic cholecystectomy versus conservative management for adults with uncomplicated symptomatic gallstones: the C-GALL RCT. Health Technol Assess 2024; 28:1-151. [PMID: 38943314 PMCID: PMC11228691 DOI: 10.3310/mnby3104] [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: 07/01/2024] Open
Abstract
Background Gallstone disease is a common gastrointestinal disorder in industrialised societies. The prevalence of gallstones in the adult population is estimated to be approximately 10-15%, and around 80% remain asymptomatic. At present, cholecystectomy is the default option for people with symptomatic gallstone disease. Objectives To assess the clinical and cost-effectiveness of observation/conservative management compared with laparoscopic cholecystectomy for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones in secondary care. Design Parallel group, multicentre patient randomised superiority pragmatic trial with up to 24 months follow-up and embedded qualitative research. Within-trial cost-utility and 10-year Markov model analyses. Development of a core outcome set for uncomplicated symptomatic gallstone disease. Setting Secondary care elective settings. Participants Adults with symptomatic uncomplicated gallstone disease referred to a secondary care setting were considered for inclusion. Interventions Participants were randomised 1: 1 at clinic to receive either laparoscopic cholecystectomy or observation/conservative management. Main outcome measures The primary outcome was quality of life measured by area under the curve over 18 months using the Short Form-36 bodily pain domain. Secondary outcomes included the Otago gallstones' condition-specific questionnaire, Short Form-36 domains (excluding bodily pain), area under the curve over 24 months for Short Form-36 bodily pain domain, persistent symptoms, complications and need for further treatment. No outcomes were blinded to allocation. Results Between August 2016 and November 2019, 434 participants were randomised (217 in each group) from 20 United Kingdom centres. By 24 months, 64 (29.5%) in the observation/conservative management group and 153 (70.5%) in the laparoscopic cholecystectomy group had received surgery, median time to surgery of 9.0 months (interquartile range, 5.6-15.0) and 4.7 months (interquartile range 2.6-7.9), respectively. At 18 months, the mean Short Form-36 norm-based bodily pain score was 49.4 (standard deviation 11.7) in the observation/conservative management group and 50.4 (standard deviation 11.6) in the laparoscopic cholecystectomy group. The mean area under the curve over 18 months was 46.8 for both groups with no difference: mean difference -0.0, 95% confidence interval (-1.7 to 1.7); p-value 0.996; n = 203 observation/conservative, n = 205 cholecystectomy. There was no evidence of differences in quality of life, complications or need for further treatment at up to 24 months follow-up. Condition-specific quality of life at 24 months favoured cholecystectomy: mean difference 9.0, 95% confidence interval (4.1 to 14.0), p < 0.001 with a similar pattern for the persistent symptoms score. Within-trial cost-utility analysis found observation/conservative management over 24 months was less costly than cholecystectomy (mean difference -£1033). A non-significant quality-adjusted life-year difference of -0.019 favouring cholecystectomy resulted in an incremental cost-effectiveness ratio of £55,235. The Markov model continued to favour observation/conservative management, but some scenarios reversed the findings due to uncertainties in longer-term quality of life. The core outcome set included 11 critically important outcomes from both patients and healthcare professionals. Conclusions The results suggested that in the short term (up to 24 months) observation/conservative management may be a cost-effective use of National Health Service resources in selected patients, but subsequent surgeries in the randomised groups and differences in quality of life beyond 24 months could reverse this finding. Future research should focus on longer-term follow-up data and identification of the cohort of patients that should be routinely offered surgery. Trial registration This trial is registered as ISRCTN55215960. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/192/71) and is published in full in Health Technology Assessment; Vol. 28, No. 26. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Karen Innes
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Irfan Ahmed
- Department of Surgery, NHS Grampian, Aberdeen, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rodolfo Hernández
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rebecca Bruce
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Victoria Bell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jane Blazeby
- Center for Surgical Research, NIHR Bristol and Western Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Samantha Wileman
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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14
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Karabacak H, Balas Ş. Percutaneous cholecystostomy as a bridge therapy in the geriatric age group with acute cholecystitis. Ir J Med Sci 2024; 193:1411-1418. [PMID: 37889395 DOI: 10.1007/s11845-023-03550-z] [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: 09/14/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the efficacy of percutaneous cholecystostomy (PC) in the geriatric patients with acute cholecystitis. MATERIALS AND METHODS The records of geriatric patients with high surgical risk who underwent percutaneous cholecystostomy for acute cholecystitis were reviewed retrospectively. RESULTS The median age of 134 patients who underwent percutaneous cholecystostomy was 77 (65-98) years and 63.4% were women. The mean length of hospital stay was 5 (4-18) days, and the follow-up period until the procedure was 2 (1-6) days. Murphy's sign was positive in 79.1% of patients on physical examination, and the remaining patients (20.9%) had only tenderness on examination. As USG findings, 59.0% of the patients had a gall bladder wall thickness (> 4 mm) with pericholecystic fluid. Additional imaging method, abdominal CT, was performed in 29 patients (21.6%), MRCP was performed in three patients (2.2%), and ERCP was performed in one patient (0.7%). Bacterial growth was detected in 27.6% of the bile cultures performed. During the follow-up period, laparoscopic cholecystectomy was performed in 60.4% of the patients and open cholecystectomy was performed in 5.2% of the patients electively. 34.3% of the patients did not undergo any surgery. Bile leakage was detected in two patients (1.5%) as a procedure-related complication, and no mortality was observed. CONCLUSION Abdominal ultrasonography-guided PC is a safe and effective method in the management of acute cholecystitis in high-risk patients in the geriatric age group.
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Affiliation(s)
- Harun Karabacak
- General Surgery Clinic, Ankara Etlik City Hospital, Ankara, 06500, Turkey.
| | - Şener Balas
- Department of General Surgery and Transplantation, Başkent University, Ankara, Turkey
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15
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Huang W, Xu H, Guo Y, Li M, Peng G, Wu T. Efficacy of early laparoscopic cholecystectomy compared with percutaneous transhepatic gallbladder drainage in treating acute calculous cholecystitis in elderly patients. Acta Chir Belg 2024; 124:178-186. [PMID: 37578137 DOI: 10.1080/00015458.2023.2232672] [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: 11/20/2022] [Accepted: 06/28/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Acute calculous cholecystitis is a common acute disease in elderly patients. This study aimed to evaluate the efficacy of early laparoscopic cholecystectomy (ELC) compared to percutaneous transhepatic gallbladder drainage (PTGD) for treating acute calculous cholecystitis in elderly patients. METHODS This retrospective study compared the clinical outcomes of two groups of elderly patients treated with ELC (group A) and PTGD (group B) from January 2018 to December 2021. Preoperative clinical characteristics and postoperative treatment outcomes were analyzed for both groups. RESULTS There were no statistically significant differences in preoperative clinical characteristics between the ELC and PTGD groups. ELC took longer to perform (69.8 ± 15.9 min vs. 29.6 ± 5.3 min, p < 0.001) but resulted in a significantly shorter duration of pain (1.9 ± 0.9 days vs. 3.9 ± 1.0 days, p < 0.001) and hospital stay (6.3 ± 2.5 days vs. 9.9 ± 3.6 days, p < 0.001), and a lower rate of sepsis (3.4% vs. 16.9%, p < 0.019). Time to soft diet was faster in the ELC group (1.5 ± 0.9 days vs. 3.0 ± 1.6 days, p < 0.001). Fewer patients in the ELC group experienced surgical reintervention than in the PTGD group (0% vs. 5.6%, p = 0.043). The incidence of postoperative complications and readmission rates in the ELC group were significantly lower than those in the PTGD group (ELC, 3.6%; PTGD, 25.4%, p = 0.001). CONCLUSIONS ELC is an effective treatment option for acute calculous cholecystitis in elderly patients, and has the added benefits of low postoperative complication rates, rapid recovery, shorter duration of pain, and excellent curative effects as compared to PTGD.
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Affiliation(s)
- Wenhao Huang
- The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Haisong Xu
- The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Yuehua Guo
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Mingyue Li
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Gongze Peng
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Tianchong Wu
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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16
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Feng X, Wu S, Ke B, Liang Y. Elevated TyG index associated with increased prevalence of gallstones in a United States cross-sectional study. Front Public Health 2024; 12:1351884. [PMID: 38883189 PMCID: PMC11177685 DOI: 10.3389/fpubh.2024.1351884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Objective This study aimed to investigate the correlation between the triglyceride-glucose (TyG) index and the incidence of cholelithiasis. Research approach In this investigation, a cross-sectional analysis was undertaken utilizing data from the US National Health and Nutrition Examination Survey (NHANES) spanning the years 2017 to 2020. The TyG index served as an independent predictor, while gallstone prevalence was considered the dependent variable of interest. We employed a multivariate logistic regression model to evaluate the interplay between these independent and dependent variables. To assess the presence of potential non-linear associations, sensitivity analysis was executed, utilizing inverse probability weighted validation, smooth curve fitting, and threshold effect analysis. In cases where non-linear relationships were observed, likelihood ratios were utilized to pinpoint potential inflection points. Ultimately, subgroup analyses were conducted to identify specific populations demonstrating heightened susceptibility to gallstone prevalence. Results Encompassing 838 patients who self-reported gallstones, a total of 7,794 participants were included in the analytical cohort. A statistically significant disparity in the TyG index was observed when all individuals were categorized into gallstone patients and non-patients (p < 0.05). Logistic regression findings indicated a positive correlation between the TyG index and gallstone disease prevalence (OR = 1.28, 95% CI: 1.12, 1.47), with a strengthening association as the TyG index increased (p trend <0.01). The results were corroborated by the use of inverse probability weighting. Additionally, a non-linear connection between the TyG index and gallstone prevalence was identified (log-likelihood ratio p < 0.01), with the optimal inflection point for TyG calculated at 8.96. In subgroup analysis, the positive relationship between the TyG index and gallstone prevalence was notably pronounced among black Americans under the age of 40 and female participants. Conclusion Alterations in the TyG index may potentially correlate with shifts in the prevalence of gallstones among adult populations in the United States. Elevated TyG index values may coincide with an augmented likelihood of gallstone occurrence.
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Affiliation(s)
- Xueyi Feng
- Department of General Surgery, Lu'an Hospital Affiliated of Anhui Medical University (Lu'an City People’s Hospital), Lu'an, Anhui, China
| | - Shenwei Wu
- Department of General Surgery, Lu'an Hospital Affiliated of Anhui Medical University (Lu'an City People’s Hospital), Lu'an, Anhui, China
| | - Bin Ke
- Department of Gastrointestinal Surgery, The Second People's Hospital of Wuhu City (Affiliated Wuhu Hospital of East China Normal University), Wuhu, China
| | - Yongkang Liang
- Department of General Surgery, Lu'an Hospital Affiliated of Anhui Medical University (Lu'an City People’s Hospital), Lu'an, Anhui, China
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17
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Öztürk SÖ. Comparison of Triglyceride-Glucose Index between Patients with Gallstone and Healthy Individuals. IRANIAN JOURNAL OF PUBLIC HEALTH 2024; 53:888-894. [PMID: 39444468 PMCID: PMC11493571 DOI: 10.18502/ijph.v53i4.15565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2024]
Abstract
Background Triglyceride-glucose index is a product of triglycerides and fasting plasma glucose (FPG) and is a new index of insulin resistance found to correlate with direct measurements. This study aimed to evaluate the relationship between gallstones and triglyceride-glucose index (TGI). Methods A total of 210 patients were included in this retrospective study. Overall, 105 patients with gallstones were included in the patient group. Patients with diabetes mellitus, chronic diseases, malignant diseases, and patients using cholesterol-lowering drugs were excluded from the study. Healthy individuals (105 cases) were selected for the control group. TGI was calculated separately for each individual using the following formula: (TGI) = ln (fasting TG (mg/dL) × fasting glucose (mg/dL)/2). Results Plasma triglyceride levels were significantly higher in patients with gallstones compared to the control group (P=0.001). Plasma HDL, LDL, and total cholesterol did not differ between the groups (P>0.05). Fasting blood glucose was significantly higher in patients with gallstones compared to the control group (P=0.001). The triglyceride glucose index was significantly higher in patients with gallstones compared to the control group (P<0.001). When the relationship between body mass index and TGI was analyzed, TGI was lower in patients with normal BMI compared to overweight or obese patients (P<0.001). Conclusion Increased triglyceride/glucose index in patients with gallstones is an indicator of insulin resistance. It is instrumental in demonstrating the presence of insulin resistance in patients with gallstones and may be a useful guide in earlier detection, prevention, and treatment of insulin resistance.
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Affiliation(s)
- Semra Özkan Öztürk
- Department of Internal Medicine, Mersin City Teaching and Research Hospital, Mersin, Türkiye
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18
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Terrone A, Di Martino M, Saeidi S, Ranucci C, Di Saverio S, Giuliani A. Percutaneous cholecystostomy in elderly patients with acute cholecystitis: a systematic review and meta-analysis. Updates Surg 2024; 76:363-373. [PMID: 38372956 DOI: 10.1007/s13304-023-01736-9] [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: 11/19/2023] [Accepted: 12/15/2023] [Indexed: 02/20/2024]
Abstract
Percutaneous cholecystostomy (PC) is often preferred over early cholecystectomy (EC) for elderly patients presenting with acute cholecystitis (AC). However, there is a lack of solid data on this issue. Following the PRISMA guidelines, we searched the Medline and Web of Science databases for reports published before December 2022. Studies that assessed elderly patients (aged 65 years and older) with AC treated using PC, in comparison with those treated with EC, were included. Outcomes analyzed were perioperative outcomes and readmissions. The literature search yielded 3279 records, from which 7 papers (1208 patients) met the inclusion criteria. No clinical trials were identified. Patients undergoing PC comprised a higher percentage of cases with ASA III or IV status (OR 3.49, 95%CI 1.59-7.69, p = 0.009) and individuals with moderate to severe AC (OR 1.78, 95%CI 1.00-3.16, p = 0.05). No significant differences were observed in terms of mortality and morbidity. However, patients in the PC groups exhibited a higher rate of readmissions (OR 3.77, 95%CI 2.35-6.05, p < 0.001) and a greater incidence of persistent or recurrent gallstone disease (OR 12.60, 95%CI 3.09-51.38, p < 0.001). Elderly patients selected for PC, displayed greater frailty and more severe AC, but did not exhibit increased post-interventional morbidity and mortality compared to those undergoing EC. Despite their inferior life expectancy, they still presented a greater likelihood of persistent or recurrent disease compared to the control group.
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Affiliation(s)
- Alfonso Terrone
- Division of Hepatobiliary and Liver Transplantation Surgery, A.O.R.N. Cardarelli, Naples, Italy
| | - Marcello Di Martino
- Division of Hepatobiliary and Liver Transplantation Surgery, A.O.R.N. Cardarelli, Naples, Italy.
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
- Department of Surgery, University Maggiore Hospital Della Carità, Novara, Italy.
| | - Sara Saeidi
- Department of General Surgery, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Chiara Ranucci
- Department of Surgery, Ospedale Santa Maria Della Stella, Orvieto, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Antonio Giuliani
- Department of Surgery, San Giuseppe Moscati Hospital, Aversa, Italy
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19
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Cha B, Lee J, Lee J, Park JS, Jeong S, Lee DH. Clinical correlation of cholelithiasis in patients undergoing percutaneous endoscopic gastrostomy. Sci Rep 2023; 13:22039. [PMID: 38086971 PMCID: PMC10716124 DOI: 10.1038/s41598-023-49417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Abstract
The risk factor for cholelithiasis include low physical activity. With an aging society, the number of bedridden patients who undergo percutaneous endoscopic gastrostomy (PEG) has increased, and cholelithiasis has often been found in these patients. This study aimed to evaluate the risk factors correlated with cholelithiasis in adults who underwent PEG. This retrospective single-center design study reviewed patients who underwent PEG and were confirmed to have cholelithiasis through imaging from March 1996 to December 2021. The investigated variables were age, sex, body mass index (BMI, kg/m2), cause of PEG insertion, initial physical activity status, laboratory findings on PEG insertion day, and incidence of acute cholecystitis. The differences between categorical and continuous variables were analyzed using Student's t test and chi-square test. We enrolled 576 eligible patients who underwent PEG insertion. A total of 161 patients were detected with cholelithiasis (28.0%). The overall independent risk factors for cholelithiasis in patients who underwent PEG insertion were increased C-reactive protein (CRP) levels and decreased physical activity status (bedridden state). The incidence of cholelithiasis was increased by up to 30.7%, especially in patients with bedridden status. However, the incidence of acute cholecystitis among cholelithiasis group was only 5.6%. BMI and total cholesterol were positively correlated with the size of gallbladder (GB) stones. One of the major risk factors for cholelithiasis is decreased physical activity, especially in patients who underwent PEG insertion. Abdominal imaging is recommended to confirm the presence of cholelithiasis and to consider prophylaxis for cholelithiasis, especially in bedridden patients with elevated initial CRP levels at the time of PEG insertion.
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Grants
- NRF-2022R1F1A1067621 the National Research Foundation of Korea (NRF) grant funded by the Korea government
- (Project Number: 9991006975, KMDF_PR_20200901_0155) the Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, Ministry of Trade, Industry and Energy, Ministry of Health & Welfare, and the Ministry of Food and Drug Safety)
- (NTIS, KMDF-RnD 202016B01) the Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, Ministry of Trade, Industry and Energy, Ministry of Health & Welfare, and the Ministry of Food and Drug Safety)
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Affiliation(s)
- Boram Cha
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jungnam Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jaehyuk Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jin-Seok Park
- Department of Internal Medicine, Shihwa medical center, Siheung, Republic of Korea.
| | - Seok Jeong
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Don Haeng Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
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20
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Kivivuori A, Salminen P, Ukkonen M, Ilves I, Vihervaara H, Zalevskaja K, Pajari J, Paajanen H, Rantanen T. Laparoscopic cholecystectomy versus antibiotic therapy for acute cholecystitis in patients over 75 years: Randomized clinical trial and retrospective cohort study. Scand J Surg 2023; 112:219-226. [PMID: 37572012 DOI: 10.1177/14574969231178650] [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: 08/14/2023]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of acute cholecystitis among elderly patients is increasing. The aim of this study was to compare laparoscopic cholecystectomy (LC) to antibiotics in elderly patients with acute cholecystitis. METHODS A randomized multicenter clinical trial including patients over 75 years with acute calculous cholecystitis was conducted in four hospitals in Finland between January 2017 and December 2019. Patients were randomized to undergo LC or antibiotic therapy. Due to patient enrollment challenges, the trial was prematurely terminated in December 2019. To assess all eligible patients, we performed a retrospective cohort study including all patients over 75 years with acute cholecystitis during the study period. The primary outcome was morbidity. Predefined secondary outcomes included mortality, readmission rate, and length of hospital stay. RESULTS Among 42 randomized patients (LC n = 24, antibiotics n = 18, mean age 82 years, 43% women), the complication rate was 17% (n = 4/24) after cholecystectomy and 33% (n = 6/18, 5/6 patients underwent cholecystectomy due to antibiotic treatment failure) after antibiotics (p = 0.209). In the retrospective cohort (n = 630, mean age 83 years, 49% women), 37% (236/630) of the patients were treated with cholecystectomy and 63% (394/630) with antibiotics. Readmissions were less common after surgical treatment compared with antibiotics in both randomized and retrospective cohort patients (8% vs 44%, p < 0.001% and 11 vs 32%, p < 0.001, respectively). There was no 30-day mortality within the randomized trial. In the retrospective patient cohort, overall mortality was 6% (35/630). CONCLUSIONS LC may be superior to antibiotic therapy for acute cholecystitis in the selected group of elderly patients with acute cholecystitis.
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Affiliation(s)
- Antti Kivivuori
- Kuopio University Hospital Puijonlaaksontie 270210 Kuopio Finland
| | - Paulina Salminen
- Turku University Hospital, Turku, Finland
- University of Turku, Turku, Finland
| | | | - Imre Ilves
- Mikkeli Central Hospital, Mikkeli, Finland
| | - Hanna Vihervaara
- Turku University Hospital, Turku, Finland
- University of Turku, Turku, Finland
| | | | | | - Hannu Paajanen
- Mikkeli Central Hospital, Mikkeli, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Tuomo Rantanen
- Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
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21
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Al-Huniti M, Alsardia Y, Odeh A, Bdour B, Hassanat R, Aloun A, Sha'ban BW, Nseirat SM. Ursodeoxycholic Acid Prophylaxis and the Reduction of Gallstone Formation After Bariatric Surgery: An Updated Meta-Analysis of Randomized Controlled Trials. Cureus 2023; 15:e50649. [PMID: 38229797 PMCID: PMC10790195 DOI: 10.7759/cureus.50649] [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: 12/16/2023] [Indexed: 01/18/2024] Open
Abstract
Gallstone formation following bariatric surgery poses a significant clinical concern, prompting various preventive strategies, including ursodeoxycholic acid (UDCA) prophylaxis. This systematic review and meta-analysis aimed to assess the efficacy of UDCA in preventing gallstone formation after bariatric surgery. A comprehensive literature search was conducted in major databases up to September 2023, identifying 12 randomized controlled trials (RCTs) meeting the inclusion criteria. The studies, spanning from 1993 to 2022, involved 2,767 patients who underwent diverse bariatric procedures. The primary outcome was the overall incidence of cholelithiasis, with secondary outcomes encompassing gallstone occurrences at three, six, and 12 months; symptomatic cholelithiasis; and rates of cholecystectomy. The Cochrane risk-of-bias tool was utilized for evaluating study quality, and statistical analyses were conducted using the RevMan software (Cochrane Collaboration, London, UK). Patients receiving UDCA demonstrated a significantly lower overall incidence of gallstones post-bariatric surgery (risk ratio [RR] 0.13; P < 0.0001). Subgroup analyses confirmed reduced gallstone incidence at three months (P = 0.04), six months (P < 0.00001), and one year (P < 0.00001) with UDCA prophylaxis. Symptomatic cholelithiasis incidence was also lower in the UDCA group (RR 5.70; P < 0.00001), and cholecystectomy rates were significantly reduced (RR 3.05; P = 0.002). This meta-analysis supports the efficacy of UDCA prophylaxis in preventing gallstone formation after bariatric surgery. The findings suggest that UDCA administration not only lowers overall gallstone incidence but also reduces the occurrence of symptomatic cholelithiasis and mitigates the need for cholecystectomy. However, caution is warranted due to heterogeneity, diverse surgical procedures, and limited long-term follow-up in the included studies. Further research with standardized protocols and extended observational periods is recommended to strengthen the evidence base and guide clinical practice.
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Affiliation(s)
- Mohammad Al-Huniti
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Yousef Alsardia
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Alaa Odeh
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Belal Bdour
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Ramadan Hassanat
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Ali Aloun
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Ban W Sha'ban
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Sara M Nseirat
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
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22
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Li ZZ, Guan LJ, Ouyang R, Chen ZX, Ouyang GQ, Jiang HX. Global, regional, and national burden of gallbladder and biliary diseases from 1990 to 2019. World J Gastrointest Surg 2023; 15:2564-2578. [PMID: 38111771 PMCID: PMC10725539 DOI: 10.4240/wjgs.v15.i11.2564] [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: 05/25/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Gallbladder and biliary diseases (GABDs) are a major public health issue. AIM To analysis the cause-specific incidence, prevalence, and years lived with disability (YLDs) and its temporal trends of GABDs at the global, regional, and national level. Data on GABD were available from the Global Burden of Disease study 2019. METHODS The estimated annual percentage change (EAPC) was used to quantify temporal trend in GABD age-standardized incidence rates (ASIRs), age-standardized prevalence rate (ASPR), and age-standardized YLD rate (ASYR) by region, sex. We analyzed the relationship between the GABD burden and country development level using the human development index (HDI). RESULTS In 2019, the incident cases of GABD were 52003772, with an ASIR of 63432/100000 population. Globally, the number of incident cases and ASIR of GABD increased 97% and 58.9% between 1990 and 2019. Although, the ASPR and ASYR decreased from 1990 to 2019, the number of prevalent and YLDs cases increased. The highest ASIR was observed in Italy, and the highest ASPR and ASYR was observed in United Kingdom. The highest burden of GABD was found in low-SDI region, and the burden in female was significantly higher than males. A generally negative correlation (ρ = -0.24, P < 0.05) of GABD with the EAPC and human development index (HDI) (in 2021) were observed for ASIR. What's more, no correlation in ASPR (ρ = -0.06, P = 0.39) and ASYR (ρ = -0.07, P = 0.36) of GABD with the EAPC and HDI (in 2021) were observed, respectively. CONCLUSION GABD remain a major global public health challenge; however, the burden of GABD varies geographically. Globally, the number of incident cases and ASIR of GABD increased between 1990 and 2019. The results of our study provide insight into the global disease burden of GABD and may assist policymakers in formulating effective policies to mitigate modifiable risk factors.
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Affiliation(s)
- Zhong-Zhuan Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Department of Gastroenterology, Liuzhou Workers’ Hospital (The Fourth Affiliated Hospital of Guangxi Medical University), Liuzhou 545007, Guangxi Zhuang Autonomous Region, China
| | - Lin-Jing Guan
- Department of Abdomen Ultrasound, Nanning Sixth People’s Hospital, Nanning 530002, Guangxi Zhuang Autonomous Region, China
| | - Rong Ouyang
- Department of Gastroenterology, Liuzhou Workers’ Hospital (The Fourth Affiliated Hospital of Guangxi Medical University), Liuzhou 545007, Guangxi Zhuang Autonomous Region, China
| | - Zhi-Xin Chen
- Department of Gastroenterology, Liuzhou Workers’ Hospital (The Fourth Affiliated Hospital of Guangxi Medical University), Liuzhou 545007, Guangxi Zhuang Autonomous Region, China
| | - Guo-Qing Ouyang
- Department of General Surgery, Liuzhou People’s Hospital Affiliated to Guangxi Medical University, Liuzhou 545006, Guangxi Zhuang Autonomous Region, China
| | - Hai-Xing Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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23
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Brandaleone L, Franchellucci G, Facciorusso A, Samanta J, Moon JH, Vargas-Madrigal J, Robles Medranda C, Barbera C, Di Matteo F, Bulajic M, Auriemma F, Paduano D, Calabrese F, Gentile C, Massidda M, Bianchi M, De Luca L, Polverini D, Masoni B, Poletti V, Marcozzi G, Hassan C, Repici A, Mangiavillano B. The Use of a New Dedicated Electrocautery Lumen-Apposing Metal Stent for Gallbladder Drainage in Patients with Acute Cholecystitis. Diagnostics (Basel) 2023; 13:3341. [PMID: 37958236 PMCID: PMC10650170 DOI: 10.3390/diagnostics13213341] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
Aims: Lumen-apposing metal stents (LAMSs) in ultrasonography-guided gallbladder drainage (EUS-GBD) have become increasingly important for high-risk surgical patients. Our study aims to evaluate the technical and clinical success, safety, and feasibility of endoscopic ultrasonography-guided gallbladder drainage using a new dedicated LAMS. Methods: This is a retrospective multicenter study that included all consecutive patients not suitable for surgery who were referred to a tertiary center for EUS-GBD using a new dedicated electrocautery LAMS for acute cholecystitis at eight different centers. Results: Our study included 54 patients with a mean age of 76.48 years (standard deviation: 12.6 years). Out of the 54 endoscopic gallbladder drainages performed, 24 (44.4%) were cholecysto-gastrostomy, and 30 (55.4%) were cholecysto-duodenostomy. The technical success of LAMS placement was 100%, and clinical success was achieved in 23 out of 30 patients (76.67%). Adverse events were observed in two patients (5.6%). Patients were discharged after a median of 5 days post-stenting. Conclusions: EUS-GBD represents a valuable option for high-surgical-risk patients with acute cholecystitis. This new dedicated LAMS has demonstrated a high rate of technical and clinical success, along with a high level of safety.
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Affiliation(s)
- Luca Brandaleone
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Gianluca Franchellucci
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Biomedical Science, Foggia University Hospital, 71122 Foggia, Puglia, Italy;
| | - Jayanta Samanta
- Gastroenterology PGIMER, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon 31538, Republic of Korea;
| | - Jorge Vargas-Madrigal
- Department of Gastroenterology and Endoscopy, Hospital Enrique Baltodano Briceño, Liberia 50101, Costa Rica;
| | - Carlos Robles Medranda
- Instituto Ecuatoriano de Enfermedades Digestivas—IECED, Gastroenterology Av Abel Romero Castillo, Guayaquil 090505, Guayas, Ecuador;
| | - Carmelo Barbera
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Rome, Italy;
| | - Francesco Di Matteo
- GIUnit, Digestive Diseases, Campus Bio Medico University, 00128 Rome, Rome, Italy;
| | - Milutin Bulajic
- Digestive Endoscopy, Fatebenefratelli Isola Tiberina—Gemelli Isola, 00186 Rome, Rome, Italy;
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit—Humanitas Mater Domini, 21100 Castellanza, Varese, Italy; (F.A.); (D.P.); (F.C.); (C.G.)
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit—Humanitas Mater Domini, 21100 Castellanza, Varese, Italy; (F.A.); (D.P.); (F.C.); (C.G.)
| | - Federica Calabrese
- Gastrointestinal Endoscopy Unit—Humanitas Mater Domini, 21100 Castellanza, Varese, Italy; (F.A.); (D.P.); (F.C.); (C.G.)
| | - Carmine Gentile
- Gastrointestinal Endoscopy Unit—Humanitas Mater Domini, 21100 Castellanza, Varese, Italy; (F.A.); (D.P.); (F.C.); (C.G.)
| | - Marco Massidda
- Gastroenterology and Digestive Endoscopy Unit, Mater Olbia Hospital, 07026 Olbia, Sassari, Italy;
| | - Marco Bianchi
- Policlinico Casilino Hospital, 00169 Rome, Rome, Italy;
| | - Luca De Luca
- Endoscopic Unit, ASST Santi Paolo e Carlo, 20142 Milan, Milan, Italy;
| | - Davide Polverini
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Benedetta Masoni
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Valeria Poletti
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Giacomo Marcozzi
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Cesare Hassan
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Alessandro Repici
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Benedetto Mangiavillano
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
- Gastrointestinal Endoscopy Unit—Humanitas Mater Domini, 21100 Castellanza, Varese, Italy; (F.A.); (D.P.); (F.C.); (C.G.)
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24
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Ke B, Sun Y, Dai X, Gui Y, Chen S. Relationship between weight-adjusted waist circumference index and prevalence of gallstones in U.S. adults: a study based on the NHANES 2017-2020. Front Endocrinol (Lausanne) 2023; 14:1276465. [PMID: 37964952 PMCID: PMC10641849 DOI: 10.3389/fendo.2023.1276465] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Objective We aimed to assess the association between weight-adjusted waist circumference index (WWI) and gallstone prevalence in US adults. Methods We selected individuals from the National Health and Nutrition Examination Survey (NHANES) database from 2017 to 2020 and used logistic regression analyses, subgroup analyses, and dose-response curves to assess the association between WWI and gallbladder stone prevalence and age, sex, and ethnicity. Results A total of 7971 participants aged ≥20 years were enrolled in our study; 828 patients had a self-reported history of gallstones. After correcting for confounders, for each unit of WWI after Ln conversion, the prevalence of gallbladder stones increased by 34% (OR=1.34, 95% CI:1.20, 1.50). Dose-response curves showed a positive correlation between WWI and gallbladder stone prevalence.According to the subgroup analysis, the positive association between TyG index and high-frequency HI was more significant in males(OR=1.34, 95% CI:1.07, 1.69), <40 years old(OR=1.42, 95% CI:1.18, 1.71), white people Americans(OR=1.35, 95% CI:1.08, 1.68) and other races(OR= 1.56, 95% CI:1.13, 2.14). Conclusion Higher WWI was positively associated with the prevalence of gallbladder stones and was associated with gender, age, and ethnicity. This is noteworthy, although a causal relationship could not be established.
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Affiliation(s)
- Bin Ke
- Department of Gastrointestinal Surgery, The Second People’s Hospital of Wuhu City (Affiliated Wuhu Hospital of East China Normal University), Wuhu, China
| | - Ying Sun
- Department of Nursing, The Second People’s Hospital of Wuhu City (Affiliated Wuhu Hospital of East China Normal University), Wuhu, China
| | - Xin Dai
- Department of Gastrointestinal Surgery, The Second People’s Hospital of Wuhu City (Affiliated Wuhu Hospital of East China Normal University), Wuhu, China
| | - Yang Gui
- Department of Gastrointestinal Surgery, The Second People’s Hospital of Wuhu City (Affiliated Wuhu Hospital of East China Normal University), Wuhu, China
| | - Song Chen
- Department of Gastrointestinal Surgery, The Affliated Chuzhou Hospital of Anhui Medical University (The First People’s Hospital of Chuzhou), Chuzhou, China
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25
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Yuan Y, Tian W, Jin Z, Wang L, Zhu S. Cholecystitis in older patients following hip fracture: a case series and literature review. BMC Geriatr 2023; 23:694. [PMID: 37875814 PMCID: PMC10598889 DOI: 10.1186/s12877-023-04336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE This study's aim is to describe the characteristics of perioperative acute cholecystitis in older patients with hip fracture. METHODS From January 1, 2018, to April 30, 2023, 7,746 medical records were retrospectively collected for patients aged ≥ 65 years who were hospitalised for hip fracture in Beijing Jishuitan Hospital, Capital Medical University. We reviewed 10 cases with confirmed diagnoses of acute cholecystitis. RESULTS Of these 10 cases, five femoral neck fractures and five intertrochanteric fractures received orthopaedic surgery. The ratio of males to females was 2:8, the median age was 83.1 years (71-91 years), and there was a median BMI of 25.35 (15.56-35.16). 50% of cases had a poor functional capacity before fracture of below four metabolic equivalents. The median onset time of acute cholecystitis was five days (2-14 days) after fracture, including five cases before orthopaedic surgery and five cases after orthopaedic surgery. All patients had anorexia and fever during the course of the disease. In seven cases of calculous cholecystitis, two underwent percutaneous transhepatic biliary drainage, and one underwent percutaneous cholecystostomy. Two cases of calculous cholecystitis had poor prognosis; one died 49 days after fracture operation, and the reason for death was multiple organ failure caused by severe infection. The other one developed acute cerebellar infarction after gallbladder surgery through treatment in an intensive care unit and neurology department. The case was discharged with dysphasia, and the duration from fracture to discharge was 92 days. CONCLUSION This is the first study on the characteristics of acute cholecystitis in older patients with hip fracture in China. The incidence of acute cholecystitis in our study was 0.13%, with a high risk of in-hospital mortality and elevated hospitalisation costs. Our 10 cases with hip fractures accompanied by acute cholecystitis have common characteristics of poor-to-moderate functional capacity before fracture, increased blood glucose levels and enhanced protein metabolism after fracture. The death and the severe case have similar characteristics of low BMI, multiple underlying diseases, high plasma osmotic pressure and calculous cholecystitis, which occurred after orthopaedic surgery. These issues require attention and prompt, active intervention. Related issues require further research.
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Affiliation(s)
- Yuan Yuan
- Department of Geriatrics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Wei Tian
- Department of Geriatrics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Zhenzhen Jin
- Department of Ultrasound, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Shiwen Zhu
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
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26
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Lee CE, Lee SJ, Moon JI, Choi IS, Yoon DS, Choi WJ, Lee SE, Sung NS, Kwon SU, Bae IE, Roh SJ, Kim SG. Acute cholecystitis in old adults: the impact of advanced age on the clinical characteristics of the disease and on the surgical outcomes of laparoscopic cholecystectomy. BMC Gastroenterol 2023; 23:328. [PMID: 37749524 PMCID: PMC10521416 DOI: 10.1186/s12876-023-02954-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/10/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Impact of advanced age on disease characteristics of acute cholecystitis (AC), and surgical outcomes after laparoscopic cholecystectomy (LC) has not been established. METHODS This single-center retrospective study included patients who underwent LC for AC between April 2010 and December 2020. We analyzed the disease characteristics and surgical outcomes according to age: Group 1 (age < 60 years), Group 2 (60 ≤ age < 80 years), and Group 3 (age ≥ 80 years). Risk factors for complications were assessed using logistic regression analysis. RESULTS Of the 1,876 patients (809 [43.1%] women), 723 were in Group 1, 867 in Group 2, and 286 in Group 3. With increasing age, the severity of AC and combined common bile duct stones increased. Group 3 demonstrated significantly worse surgical outcomes when compared to Group 1 and 2 for overall (4.0 vs. 9.1 vs. 18.9%, p < 0.001) and serious complications (1.2 vs. 4.2 vs. 8.0%, p < 0.001), length of hospital stay (2.78 vs. 3.72 vs. 5.87 days, p < 0.001), and open conversion (0.1 vs. 1.0 vs. 2.1%, p = 0.007). Incidental gallbladder cancer was also the most common in Group 3 (0.3 vs. 1.5 vs. 3.1%, p = 0.001). In the multivariate analysis, body mass index < 18.5, moderate/severe AC, and albumin < 2.5 g/dL were significant risk factors for serious complications in Group 3. CONCLUSION Advanced age was associated with severe AC, worse surgical outcomes, and a higher rate of incidental gallbladder cancer following LC. Therefore, in patients over 80 years of age with AC, especially those with poor nutritional status and high severity grading, urgent surgery should be avoided, and surgery should be performed after sufficient supportive care to restore nutritional status before LC.
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Affiliation(s)
- Cho Eun Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Seung Jae Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea.
| | - Ju Ik Moon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - In Seok Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Dae Sung Yoon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Won Jun Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Sang Eok Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Nak Song Sung
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Seong Uk Kwon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - In Eui Bae
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Seung Jae Roh
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Sung Gon Kim
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
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Scala A, Trunfio TA, Improta G. Classification and regression model to manage the hospitalization for laparoscopic cholecystectomy. Sci Rep 2023; 13:14700. [PMID: 37679406 PMCID: PMC10485042 DOI: 10.1038/s41598-023-41597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
Gallstone disease (GD) is one of the most common morbidities in the world. Laparoscopic Cholecystectomy (LC) is currently the gold standard, performed in about 96% of cases. The most affected groups are the elderly, who generally have higher pre- and post-operative morbidity and mortality rates and longer Length of Stay (LOS). For this reason, several indicators have been defined to improve quality and efficiency and contain costs. In this study, data from patients who underwent LC at the "San Giovanni di Dio e Ruggi d'Aragona" University Hospital of Salerno in the years 2010-2020 were processed using a Multiple Linear Regression (MLR) model and Classification algorithms in order to identify the variables that most influence LOS. The results of the 2352 patients analyzed showed that pre-operative LOS and Age were the independent variables that most affected LOS. In particular, MLR model had a R2 value equal to 0.537 and the best classification algorithm, Decision Tree, had an accuracy greater than 83%. In conclusion, both the MLR model and the classification algorithms produced significant results that could provide important support in the management of this healthcare process.
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Affiliation(s)
- Arianna Scala
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Teresa Angela Trunfio
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Giovanni Improta
- Department of Public Health, University of Naples "Federico II", Naples, Italy
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples "Federico II", Naples, Italy
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Xia Y, Xu Y, Liu Q, Zhang J, Zhang Z, Jia Q, Tang Q, Jing X, Li J, Chen J, Xiong Y, Li Y, He J. Glutaredoxin 1 regulates cholesterol metabolism and gallstone formation by influencing protein S-glutathionylation. Metabolism 2023:155610. [PMID: 37277061 DOI: 10.1016/j.metabol.2023.155610] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Cholesterol gallstone disease (CGD) is closely related to cholesterol metabolic disorder. Glutaredoxin-1 (Glrx1) and Glrx1-related protein S-glutathionylation are increasingly being observed to drive various physiological and pathological processes, especially in metabolic diseases such as diabetes, obesity and fatty liver. However, Glrx1 has been minimally explored in cholesterol metabolism and gallstone disease. METHODS We first investigated whether Glrx1 plays a role in gallstone formation in lithogenic diet-fed mice using immunoblotting and quantitative real-time PCR. Then a whole-body Glrx1-deficient (Glrx1-/-) mice and hepatic-specific Glrx1-overexpressing (AAV8-TBG-Glrx1) mice were generated, in which we analyzed the effects of Glrx1 on lipid metabolism upon LGD feeding. Quantitative proteomic analysis and immunoprecipitation (IP) of glutathionylated proteins were performed. RESULTS We found that protein S-glutathionylation was markedly decreased and the deglutathionylating enzyme Glrx1 was greatly increased in the liver of lithogenic diet-fed mice. Glrx1-/- mice were protected from gallstone disease induced by a lithogenic diet because their biliary cholesterol and cholesterol saturation index (CSI) were reduced. Conversely, AAV8-TBG-Glrx1 mice showed greater gallstone progression with increased cholesterol secretion and CSI. Further studies showed that Glrx1-overexpressing greatly induced bile acid levels and/or composition to increase intestinal cholesterol absorption by upregulating Cyp8b1. In addition, liquid chromatography-mass spectrometry and IP analysis revealed that Glrx1 also affected the function of asialoglycoprotein receptor 1 (ASGR1) by mediating its deglutathionylation, thereby altering the expression of LXRα and controlling cholesterol secretion. CONCLUSION Our findings present novel roles of Glrx1 and Glrx1-regulated protein S-glutathionylation in gallstone formation through the targeting of cholesterol metabolism. Our data advises Glrx1 significantly increased gallstone formation by simultaneously increase bile-acid-dependent cholesterol absorption and ASGR1- LXRα-dependent cholesterol efflux. Our work suggests the potential effects of inhibiting Glrx1 activity to treat cholelithiasis.
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Affiliation(s)
- Yan Xia
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ying Xu
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Qinhui Liu
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jinhang Zhang
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Zijing Zhang
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Qingyi Jia
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Qin Tang
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiandan Jing
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiahui Li
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiahao Chen
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yimin Xiong
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yanping Li
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Jinhan He
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Altalhi RA, Alsaqqa RM, Alasmari RM, Aljuaid A, Althobaiti L, Mahfouz MEM. The Incidence of Cholelithiasis After Bariatric Surgery in Saudi Arabia and Its Associated Risk Factors. Cureus 2023; 15:e40549. [PMID: 37465782 PMCID: PMC10350650 DOI: 10.7759/cureus.40549] [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: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Saudi Arabia has one of the highest obesity rates (35.4%) in the world, and bariatric surgery (BS) has emerged as the most effective treatment for obesity and its comorbidities. Despite its effectiveness, it is a known risk factor for cholelithiasis. The aim of this study is to identify the incidence and risk factors that contribute to the development of symptomatic cholelithiasis after different types of bariatric surgery in Saudi Arabia. METHODS This is a cross-sectional study conducted among the Saudi adult population. The sample size was 706 participants who underwent bariatric surgery from all over Saudi Arabia. Data collection was done through a validated online self-reported survey. RESULTS Out of 706 participants who fulfilled the inclusion criteria, it was found that the incidence of gallstones (GS) after bariatric surgery was 18.8%. The most incidence was during the first year of surgery, where the number of individuals reached 80.4%. The majority were in females (22.9%) and those who underwent Roux-en-Y gastric bypass (RYGB) surgery (51.2%). Patients who had a body mass index (BMI) of >25 kg/m² significantly had a higher incidence of gallstones (23.1%) compared to those who had a lesser BMI (15.8%). As the analysis showed, the medication used to prevent the occurrence of gallstones can be considered one of the protective factors, where 85.4% of individuals who used these medications did not develop cholelithiasis. CONCLUSION The incidence of gallstones after bariatric surgery was high, particularly within the first year of surgery. The increase in postoperative gallstone formation is correlated with hyperlipidemia and Roux-en-Y gastric bypass as basic predictive factors. On the contrary, the medication used to prevent the occurrence of gallstones is considered a protective factor.
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Karaca Bozdağ Z, Bozdağ E, Sonmez S, Pamukcu Beyhan A, Atasever A. Comparison of the cystocholedochal angle in patients with choledocholithiasis and only cholelithiasis. Clin Anat 2023; 36:675-686. [PMID: 36795311 DOI: 10.1002/ca.24027] [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: 11/19/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023]
Abstract
This study aims to evaluate the relation between the cystocholedochal angle (SCA) and choledocholithiasis. The data of 3.350 patients were reviewed retrospectively and a total of 628 patients who met the criteria were included in the study. The patients included in the study were divided into three groups as patients with choledocholithiasis (Group I), patients with only cholelithiasis (Group II), and patients without gallstones as control group (Group III). Measurements of SCA, cystic, bile, and common hepatic ducts (CHDs) were made on magnetic resonance cholangiopancreatography (MRCP) images. Laboratory findings and demographic characteristics of the patients were also recorded. Of the patients included in the study 64.2% were female, 35.8% were male, and their age ranged from 18 to 93 (mean 53.37 ± 18.87 years). While the mean SCA values of all patient groups were 35.44° ± 10.44°, the mean length of cystic, bile and CHDs were 28.91 ± 9.30, 40.28 ± 12.91, 27.09 ± 9.68 mm respectively. All measurements were higher in Group I in comparison to other groups, whereas all measurements of Group II were higher than those of Group III (p < 0.001). Statistical analysis suggests that a SCA of 33.5° and above is an important criterion for diagnosis of choledocholithiasis. Increase of SCA raises the likelihood of choledocholithiasis, as it facilitates the passage of stones from gallbladder into the bile ducts. This is the first study to compare SCA in patients with choledocholithiasis and those with only cholelithiasis. Therefore, we think that this study is important and will be a guide for clinical evaluation.
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Affiliation(s)
- Zekiye Karaca Bozdağ
- Faculty of Medicine, Department of Anatomy, Istanbul Yeni Yüzyıl University, Istanbul, Turkey.,Faculty of Medicine, Department of Anatomy, Istanbul Medipol University, Istanbul, Turkey
| | - Emre Bozdağ
- Kanuni Sultan Süleyman TRH, Gastroenterology Surgery Clinic, Health Sciences University, Istanbul, Turkey
| | - Suleyman Sonmez
- Kanuni Sultan Süleyman TRH, Radiology Clinic, Health Sciences University, Istanbul, Turkey
| | - Ayça Pamukcu Beyhan
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Ege University, Izmir, Turkey
| | - Alper Atasever
- Faculty of Medicine, Department of Anatomy, Istanbul Medipol University, Istanbul, Turkey
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Ban T, Kubota Y, Takahama T, Sasoh S, Tanida S, Ando T, Nakamura M, Joh T. Potential Risk of Misjudgment in the Decision-making Process Based on the 2018 Tokyo Guidelines in Older Patients with Acute Cholecystitis. Intern Med 2022; 62:1425-1430. [PMID: 36198593 DOI: 10.2169/internalmedicine.0352-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Objective The 2018 Tokyo Guidelines (TG18) were published to facilitate the decision-making processes (DMP), including the diagnosis and operation of acute cholecystitis (AC). However, only a few guidelines consider older adults. This study evaluated the DMP based on the TG18, focusing on older patients with AC. Methods This was a single-armed, single-center retrospective study. The primary outcome measure was the "undiagnosable" AC rate, and the secondary outcome measure was the degree of concordance of "unfit for surgery" decisions. Patients Two hundred and nine patients with AC. Results Sixty (28.7%) of 209 patients with AC were "undiagnosable" on admission based on the TG18 criteria. The numbers and rate of "undiagnosable" AC in patients ≤59, 60-79, and ≥80 years old were 4 (10.0%), 20 (24.4%), and 36 (41.4%), respectively (P<0.001). The multiple logistic regression analysis following the univariate analysis revealed that age >73 years old was the most significant risk factor for undiagnosable AC (P=0.006, odds ratio [OR]: 3.06, 95% confidence interval [CI]: 1.38-6.81). Female sex (P=0.033, OR: 2.09, 95% CI: 1.06-4.09) and severe AC (P=0.049, OR: 2.97, 95% CI: 1.01-8.76) were also significant risk factors for undiagnosable AC. The number of cases unfit for surgery based on the Charlson Comorbidity Index and American Society of Anesthesiologists physical status was 90 (43.1%) and 75 (35.9%), respectively. The κ value between these 2 indicators revealed a minimal concordance of 0.33 (95% CI: 0.20-0.47). Conclusion The DMP based on the TG18 potentially harbors a misjudgment risk, especially in older patients with AC (UMIN000047715).
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Affiliation(s)
- Tesshin Ban
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Japan
| | - Yoshimasa Kubota
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Japan
| | - Takuya Takahama
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Japan
| | - Shun Sasoh
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Japan
| | - Satoshi Tanida
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Japan
| | - Tomoaki Ando
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Japan
| | - Makoto Nakamura
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Japan
| | - Takashi Joh
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Japan
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USTA MA, TAYAR S, REİS ME, ULUŞAHİN M, ALHAN E. Önemli komorbid durumları olan yaşlı hastalarda epidural anestezi altında kolesistektomi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: The aim of this study was to evaluate the surgical treatment of gallstone disease with open cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions.
Materials and Methods: We retrospectively analyzed 80 consecutive elderly patients over 65 years of age with significant comorbid conditions who underwent open cholecytectomy under epidural anesthesia for the surgical treatment of gallstone disease between January 1, 2009 and December 31, 2019, all performed by one surgeon.
Results: Mean age was found 77 ± 16 years. Fifty of the patients (62.5%) were females. Forty-seven patients (58.75%) showed an American Society of Anesthesiologist Physical Status (ASA, PS) of 3. The most frequently associated comorbidity involved the cardiovascular system (46 patients, 57.5%). Surgical indications were acute cholecystitis (AC) in 37 patients (46.25%) and chronic cholecystitis in 32 patients (40%). Mean operation time was 55 ± 22 minutes. Hospital stay was mean 12 ± 5 days. Total complication rate was 38.75%, and pulmonary complication was the most frequently encountered (13.75%). 30-day mortality was seen in 5 patients (6.25%).
Conclusion: In older, high-risk gallstone patients, an open cholecystectomy with epidural anesthesia may be recommended. For this patient population, the mortality and morbidity rates are acceptable.
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Affiliation(s)
| | - Serkan TAYAR
- Erzurum Regional Training and Research Hospital, General Surgery Clinic,
| | | | | | - Etem ALHAN
- KARADENİZ TEKNİK ÜNİVERSİTESİ, TIP FAKÜLTESİ
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Odongo CN, Dreque CC, Mutiibwa D, Bongomin F, Oyania F, Sikhondze MM, Acan M, Atwine R, Kirya F, Situma M. Etiology, Clinical Presentations, and Short-Term Treatment Outcomes of Extrahepatic Obstructive Jaundice in South-Western Uganda. Clin Exp Gastroenterol 2022; 15:79-90. [PMID: 35721671 PMCID: PMC9199528 DOI: 10.2147/ceg.s356977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background The diagnosis of extrahepatic obstructive jaundice (EHOJ) remains a challenge and is often made late in low-resource settings. Systematic data are limited on the etiology and prognosis of patients with obstructive jaundice in Uganda. The objective of this study was to determine the etiology, clinical presentations, and short-term treatment outcomes of patients managed for EHOJ at Mbarara Regional Referral Hospital (MRRH) in south-western Uganda. Methods Between September 2019 and May 2020, we prospectively enrolled a cohort of patients who presented with EHOJ at MRRH. A pretested, semi-structured data collection tool was used to abstract data from both the study participants and their files. Results A total of 72 patients, 42 (58.3%) of whom were male with a median age of 56 (range of 2 months to 95 years) were studied. Forty-two (58.3%) participants had malignancies: Pancreatic head tumors 20 (27.8%), cholangiocarcinoma 13 (18.1%), duodenal cancers 5 (6.94%), and gall bladder cancer 4 (5.6%). The remaining 30 (41.7%) participants had benign etiologies: choledocholithiasis 10 (13.9%), biliary atresia 7 (9.7%), pancreatic pseudo cyst 6 (8.3%), Mirizzi syndrome 5 (6.9%) and 1 (1.4%) each of chronic pancreatitis and choledochal cyst. Sixty-seven (93.1%) patients presented with right upper quadrant tenderness, 65 (90.3%) abdominal pain and 55 (76.3%) clay-colored stool. Cholecystectomy 11 (25.6%) and cholecystojejunostomy + jejunojejunostomy 8 (18.6%) were the commonest procedures performed. Twelve (17.0%) of cases received chemotherapy (epirubicin/cisplatin/capecitabine) for pancreatic head tumors and (gemcitabine/oxaliplatine) for cholangiocarcinoma. Mortality rate was 29.2% in the study, of which malignancy carried the highest mortality 20 (95.24%). Conclusion Malignancy was the main cause of EHOJ observed in more than half of the patients. Interventions aimed at early recognition and appropriate referral are key in this population to improve outcomes.
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Affiliation(s)
| | | | - David Mutiibwa
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Felix Bongomin
- Department of Microbiology and Immunology, and Internal Medicine, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Felix Oyania
- Department of Surgery, Faculty of Medicine, Kabale University, Kabale, Uganda
| | | | - Moses Acan
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Raymond Atwine
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Fred Kirya
- Department of Anatomy, Faculty of Medicine, Soroti University, Soroti, Uganda
| | - Martin Situma
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Di Martino M, Gancedo Quintana Á, Vaello Jodra V, Sanjuanbenito Dehesa A, Morales García D, Caiña Ruiz R, García-Moreno Nisa F, Mendoza-Moreno F, Alonso Batanero S, Quiñones Sampedro JE, Lora Cumplido P, Arango Bravo A, Rubio-Perez I, Asensio-Gomez L, Pardo Aranda F, Sentí Farrarons S, Ruiz Moreno C, Martinez Moreno CM, Sarriugarte Lasarte A, Prieto Calvo M, Aparicio-Sánchez D, Perea Del Pozo EP, Pellino G, Martin-Perez E. Early laparoscopic cholecystectomy in oldest-old patients: a propensity score matched analysis of a nationwide registry. Updates Surg 2022; 74:979-989. [PMID: 35253094 DOI: 10.1007/s13304-022-01254-0] [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: 08/09/2021] [Accepted: 02/10/2022] [Indexed: 12/07/2022]
Abstract
The role of early laparoscopic cholecystectomy (ELC) in "oldest-old" patients with acute calculous cholecystitis (ACC) is still controversial. The aim of this study is to assess the safety of ELC for ACC in ≥ 85-year-old patients. Multicentric retrospective study that analysed data of patients who underwent ELC for ACC between 2013 and 2018. Patients ≥ 85-year-old (oldest-old patients) were compared with younger patients, before and after propensity score matching (PSM). The main outcomes were mortality, post-operative complications, length of stay (LOS), and readmissions. The study included 1670 patients. The unmatched comparison revealed a selection bias towards the oldest-old group, which was associated with higher Charlson Comorbidity Index (5 vs 1, p < 0.001), more ASA III/IV subjects (54.2% vs 19.3%, p < 0.001), class II/III ACC (80.1% vs 69.1%, p = 0.016) and higher Chole-Risk Score (p > 0.001). The oldest-old also required more conversion to open surgery (20% vs 10.3%, p = 0.005). Postoperatively, they had a higher 90-day mortality rate (7.6% vs 1%, p < 0.001), more total complications (40.6% vs 17.7%, p < 0.001), complications ≥ IIIa Clavien-Dindo (14.4% vs 5.8%, p = 0.002), longer LOS (6 vs 5 days, p < 0.001), and more readmissions (6.6% vs 2.6%, p < 0.001). After PSM (n = 206), the two groups were comparable in terms of baseline characteristics and intraoperative outcomes. No differences were observed in post-operative complications; bile leak; incisional, intrabdominal, urinary or respiratory tract infections; LOS or readmissions. In the oldest-old, ELC for ACC is still associated with significant morbidity and mortality. However, it seems to be safe in selected patients. Therefore, age itself should not be regarded as a contraindication to ELC for ACC.
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Affiliation(s)
- Marcello Di Martino
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62, 4th Floor, 28006, Madrid, Spain.
| | - Álvaro Gancedo Quintana
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62, 4th Floor, 28006, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aingeru Sarriugarte Lasarte
- General Surgery Department, Cruces University Hospital, BioCruces Research Institute, University of the Basque Country, Bilbao, Spain
| | - Mikel Prieto Calvo
- General Surgery Department, Cruces University Hospital, BioCruces Research Institute, University of the Basque Country, Bilbao, Spain
| | | | | | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Elena Martin-Perez
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62, 4th Floor, 28006, Madrid, Spain
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Ullah S, Yang BH, Liu D, Lu XY, Liu ZZ, Zhao LX, Zhang JY, Liu BR. Are laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery gallbladder preserving cholecystolithotomy truly comparable? A propensity matched study. World J Gastrointest Surg 2022; 14:470-481. [PMID: 35734621 PMCID: PMC9160690 DOI: 10.4240/wjgs.v14.i5.470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/18/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones. However, another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection. AIM To compare the feasibility, safety and effectiveness of pure natural orifice transluminal endoscopic surgery (NOTES) gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy (LC) for symptomatic gallstones. METHODS We adopted propensity score matching (1:1) to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones. We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020; 517 patients met the matching criteria (NOTES, 110; LC, 407), yielding 86 pairs. RESULTS The technical success rate for the NOTES group was 98.9% vs 100% for the LC group. The median procedure time was 119 min [interquartile ranges (IQRs), 95-175] with NOTES vs 60 min (IQRs, 48-90) with LC (P < 0.001). The frequency of post-operative pain was similar between NOTES and LC: 4.7% (4/85) vs 5.8% (5/95) (P = 0.740). The median duration of post-procedure fasting with NOTES was 1 d (IQRs, 1-2) vs 2 d with LC (IQRs, 1-3) (P < 0.001). The median post-operative hospital stay for NOTES was 4 d (IQRs, 3-6) vs 4 d for LC (IQRs, 3-5), (P = 0.092). During follow-up, diarrhea was significantly less with NOTES (5.8%) compared to LC (18.6%) (P = 0.011). Gallstones and cholecystitis recurrence within a median of 12 mo (range: 6-40 mo) following NOTES was 10.5% and 3.5%, respectively. Concerns regarding the presence of abdominal wall scars were present in 17.4% (n = 15/86) of patients following LC (mainly women). CONCLUSION NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy. This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder. Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.
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Affiliation(s)
- Saif Ullah
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Bao-Hong Yang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- Department of Oncology, Weifang People's Hospital, Weifang 261000, Shandong Province, China
| | - Dan Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xue-Yang Lu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Zhen-Zhen Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Li-Xia Zhao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Ji-Yu Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Bing-Rong Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou University, Zhengzhou 450052, Henan Province, China
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Sleeve Gastrectomy and Cholecystectomy are Safe in Obese Patients with Asymptomatic Cholelithiasis. A Multicenter Randomized Trial. World J Surg 2022; 46:1721-1733. [PMID: 35397750 PMCID: PMC9174306 DOI: 10.1007/s00268-022-06557-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 11/03/2022]
Abstract
Background Obesity is a severe health problem. Gallstones may symptomatize after sleeve gastrectomy (SG). Concomitant laparoscopic cholecystectomy (LC) with SG is controversial. The effects of SG and LC versus delayed LC following SG in obese patients with asymptomatic gallbladder stones were evaluated. Methods A randomized trial of 222 morbidly obese patients with gallbladder stones divided them into two equal groups: SG + LC and SG-only. This multicenter study conducted from January 2016 to January 2019. Results Except for operative time and postoperative hospital stay, there was no statistically significant difference between LSG + LC group and SG group (P < 0.001). In SG + LC group, LC added 40.7 min to SG, three patients (3%) required conversion, early postoperative complications occurred in 9 cases (9/111, 9%), three cases required re-intervention (3%). In SG group, the complicated cases required LC were 61 cases (61/111, 55%). Acute cholecystitis (26/61, 42.7%) was the most common gallstone symptoms. Most complicated cases occurred in the first-year follow-up (52/61, 85%). In the delayed LC group (61 patients), operative time was 50.13 ± 1.99 min, open conversion occurred in 2 cases (2/61, 3.2%), early postoperative complications occurred in four patients (4/61, 6.4%) and postoperative re-intervention were due to bile leaks and cystic artery bleeding (2/61, 3.2%). Conclusions SG with LC prolongs the operative time and hospital stay, but the perioperative complications are the same as delayed LC; LC with SG minimizes the need for a second surgery. Concomitant LC with SG is safe.
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Khoury T, Sbeit W. Diabetes mellitus is associated with a higher rate of acute cholangitis among patients with common bile duct stones: A retrospective study. Medicine (Baltimore) 2022; 101:e28687. [PMID: 35089221 PMCID: PMC8797537 DOI: 10.1097/md.0000000000028687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/06/2021] [Accepted: 01/01/2022] [Indexed: 01/05/2023] Open
Abstract
Common bile duct (CBD) stone is a commonly encountered disease that is associated with various clinical presentations ranging from the mild form of biliary colic to the severe complication of acute cholangitis. Recently, diabetes mellitus (DM) has been linked to the development of biliary diseases; however, no data regarding the association of DM with acute cholangitis development in the setting of CBD stone exist. The aim of the current study was to investigate whether DM represents a risk factor for acute cholangitis in patients with CBD stone. We performed a retrospective cross-sectional study from January 1, 2010 till June 1, 2020 of all patients presenting to Galilee Medical Center with various clinical presentations of documented CBD stone, including cholangitis, biliary pancreatitis, and biliary colic with abnormal liver enzymes. Overall, 687 patients were included in the final analysis. Among them, 101 patients (14.7%) had CBD stone associated with acute cholangitis (group A), as compared to 586 patients (85.3%) without acute cholangitis (group B). The average ages in groups A and B were 77.7 ± 13.6 and 62.5 ± 20.5 years, respectively (P < .0001). The prevalence of DM was significantly higher in group A as compared to group B (52.5% vs 36.3%, P = .001). On univariate analysis, age (odds ratio [OR] 1.05, P < .0001), male gender (OR 1.54, P = .04), and DM (OR 1.92, P = .002) were associated with acute cholangitis development, and on multivariate logistic regression analysis, the correlation was preserved for DM (OR 1.93, 95% confidence interval 1.26-2.96, P = .002). DM showed a significant association with acute cholangitis development among patients with CBD stone. Identification of bile duct stones in diabetic patients is of paramount importance since early diagnosis and treatment might prevent further life-threatening complications.
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Affiliation(s)
- Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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Gallstone Disease in Cirrhosis-Pathogenesis and Management. J Clin Exp Hepatol 2022; 12:551-559. [PMID: 35535063 PMCID: PMC9077239 DOI: 10.1016/j.jceh.2021.09.011] [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: 06/24/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022] Open
Abstract
Gallstones are more common in patients with cirrhosis of the liver, and the incidence increases with severity of liver disease. Pigment stones are the most frequent type of gallstones (GSs) in cirrhotics, and majority remain asymptomatic. Hepatitis C virus infection and nonalcoholic fatty liver disease are the underlying etiologies of liver diseases that most often associated with GSs. Multiple altered mechanisms in cirrhosis such as chronic hemolysis due to hypersplenism, reduced bile acid synthesis and transport, decreased cholesterol secretion, decreased apolipoprotein A-I and A-II secretion, gallbladder hypo-motility, autonomic dysfunction, and portal hypertension collectively lead to increased risk of lithogenesis. Asymptomatic GSs should be followed up closely and offered laparoscopic cholecystectomy once symptomatic in Child-Pugh class A and B patients. The model for the end-stage liver disease score is the best predictor of the outcome after cholecystectomy. In patients of Child-Pugh class C, conservative or minimally invasive approaches should be used to treat complications of GSs.
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Key Words
- ACLF, acute-on-chronic liver failure
- CBD, common bile duct
- CTP, Child-Pugh
- Child-Pugh class
- EPBD, Endoscopic papillary balloon dilatation
- EST, endoscopic sphincterotomy
- EUS, endoscopic ultrasound
- FXR, farnesoid X receptors
- GSs, Gallstones
- HBV, hepatitis B virus
- HCV, Hepatitis C virus
- IR, insulin resistance
- LC, laparoscopic cholecystectomy
- MELD, Model for end-stage liver disease
- NAFLD, non-alcoholic fatty liver disease
- NS 5A, non-structural protein 5A
- cirrhosis
- gallstone
- laparoscopic cholecystectomy
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Wang J, Yang J, Chen Y, Rui J, Xu M, Chen M. Association of METS-IR index with prevalence of gallbladder stones and the age at the first gallbladder stone surgery in US adults: A cross-sectional study. Front Endocrinol (Lausanne) 2022; 13:1025854. [PMID: 36263324 PMCID: PMC9574223 DOI: 10.3389/fendo.2022.1025854] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the correlation between the metabolic score for insulin resistance (METS-IR) index and gallbladder stoneprevalence in US adults, as well as the age at first gallbladder stone surgery. METHODS A logistic regression analysis, subgroup analysis, and dose-response curve were computed for participants in the 2017-2018 National Health and Nutrition Examination Survey (NHANES) to assess the relationship between the METS-IR index and gallbladder stone prevalence and age at first surgery for gallbladder stones. RESULTS This study ultimately included 9452 participants aged >20 years, of whom 534 self-reported a history of gallbladder stones, and after adjusting for all confounders, each unit increase in METS-IR index was associated with a 3.3% increase in gallbladder stone prevalence (OR= 1.033, 95% CI: 1.0258, 1.0403) along with an earlier age at first gallbladder stone surgery 0.26 years (β= -0.26, 95% CI: -0.35, -0.17), stratified analysis showed that increased METS-IR index was associated with increased prevalence of gallbladder stones in all subgroups, and the dose-response curve showed a positive linear correlation between METS-IR index and prevalence of gallbladder stones, while a negative linear correlation was observed between increased METS-IR index and age at first gallbladder stone There was a negative linear correlation between age at surgery. CONCLUSION The METS-IR index has been positively associated with gallbladder stone prevalence, thereby contributing to age at first surgery for gallbladder stones. However, the causal relationship between the METS-IR and gallbladder stones cannot be concluded.
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Affiliation(s)
- Jin Wang
- Department of General Surgery, The Traditional Chinese Medicine Hospital of Wuhu, Wuhu City, China
| | - Junping Yang
- Department of General Practice, Wuhu City Second People‘s Hospital, Wuhu City, China
| | - Yan Chen
- Department of General Practice, Wuhu City Second People‘s Hospital, Wuhu City, China
| | - Jing Rui
- Department of General Surgery, The Traditional Chinese Medicine Hospital of Wuhu, Wuhu City, China
| | - Maoqi Xu
- Department of General Surgery, The Traditional Chinese Medicine Hospital of Wuhu, Wuhu City, China
| | - Mingwei Chen
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei City, China
- *Correspondence: Mingwei Chen,
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40
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Liang KW, Huang HH, Wang L, Lu WY, Chou YH, Tantoh DM, Nfor ON, Chiu NY, Tyan YS, Liaw YP. Risk of gallstones based on ABCG8 rs11887534 single nucleotide polymorphism among Taiwanese men and women. BMC Gastroenterol 2021; 21:468. [PMID: 34906072 PMCID: PMC8672562 DOI: 10.1186/s12876-021-02060-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gallstones are abnormal masses caused by impaired metabolism of cholesterol, bilirubin, or bile salts in the gallbladder or biliary tract. ATP-binding cassette subfamily G member 8 (ABCG8) is a protein that regulates cholesterol efflux from the liver. Genome-wide association studies (GWAS) and meta-analyses of GWAS revealed the ABCG8 rs11887534 variant as the most common genetic determinant of gallstones in humans. These findings have not been extensively replicated in Taiwanese. Therefore, we appraised the relationship between gallstones and rs11887534 in a relatively large Taiwanese sample. METHODS We retrieved data collected through questionnaires, physical and biochemical tests from the Taiwan Biobank Bank (TWB). The study participants comprised 7388 men and 13,880 women who voluntarily enrolled in the Taiwan Biobank project between 2008 and 2019. Gallstones were self-reported. RESULTS The overall sample size was 21,268 comprising 938 gallstone patients and 20,330 non-gallstone individuals. Among the participants, 20,640 had the GG and 628 had the GC + CC genotype. At p-value < 0.05, the baseline genotypes and gallstone status between men and women were not significantly different. The risk of gallstones was higher in participants having the GC + CC compared to the GG genotype: odds ratio (OR); 95% confidence interval (CI) = 1.698; 1.240-2.325), but was lower in men compared to women (OR = 0.763; 95% CI = 0.638-0.913). Compared to men with the rs11887534 GG genotype, women with the GG and GC + CC genotypes had a higher risk of gallstone (OR; 95% CI = 1.304; 1.087-1.565 for GG and 2.291; 1.514-3.467 for GC + CC). The positive association between GC + CC and gallstones was retained after we restricted the analysis to the female participants (OR; 95% CI = 1.789 = 1.208-2.648). Hormone use was associated with an elevated risk of gallstones (OR; 95% CI = 1.359; 1.107-1.668). Relative to GG and no hormone use, we found a significantly high risk among hormone users with the GC + CC genotype (OR; 95% CI = 3.596; 1.495-8.650). CONCLUSIONS The rs11887534 GC + CC genotype was independently associated with a higher risk of gallstones. This risk was much higher among women, especially those who used hormones for various gynecological purposes.
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Grants
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
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Affiliation(s)
- Keng-Wei Liang
- Institute of Medicine, Chung Shan Medical University, Taichung City, 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan
| | - Hsin-Hui Huang
- School of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan
| | - Lee Wang
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Wen-Yu Lu
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Ying-Hsiang Chou
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, 40201, Taiwan
- Department of Radiation Oncology, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Disline Manli Tantoh
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Oswald Ndi Nfor
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 40201, Taiwan.
| | - Neng-Yu Chiu
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan
| | - Yeu-Sheng Tyan
- School of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, 40201, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan
| | - Yung-Po Liaw
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan.
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 40201, Taiwan.
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Rosa F, Covino M, Cozza V, Fransvea P, Quero G, Fiorillo C, Simeoni B, Sganga G, Gasbarrini A, Franceschi F, Alfieri S. Management of acute cholecystitis in elderly patients: A propensity score-matched analysis of surgical vs. medical treatment. Dig Liver Dis 2021; 53:1620-1626. [PMID: 33500239 DOI: 10.1016/j.dld.2021.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/09/2020] [Accepted: 01/13/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute cholecystitis (AC) is a life-threatening emergency in elderly patients. AIMS To compare the commonly used management strategies for elderly patients with AC as well as resulting morbidity, mortality and length of hospital stay (LOS). METHODS All patients ≥ 65 years admitted to our emergency department for AC between January 1st, 2014 and December 31st, 2018 were included in the study. We compared patients that received medical treatment to patients who received operative procedures. In order to correct for baseline covariates and factors associated to clinical management, we used a 1:1 propensity score matching (PSM) analysis. The primary outcome was the overall in-hospital mortality. Secondary outcomes included occurrence of major complications and LOS. RESULTS A total of 1075 patients were enrolled: 483 patients received a medical treatment and 592 patients underwent interventional procedures. After PSM, 770 patients (385 for each treatment group) were included in the analysis. The analysis revealed that both mortality and cumulative major complications were similar in medical and interventional group. We found that among comorbidities, Charlson comorbidity index and congestive heart failure were significantly higher in the medical treatment group (5 [4-6] vs. 4 [3-6] and 11.7% vs. 4.7%, respectively; p<0.001). LOS was slightly lower in the medical treatment group (7.0 days [4.9-11.1] vs. 7.9 [4.9-13.5]; p = 0.046). CONCLUSION Medical management outcomes for AC in elderly patients were similar to operative treatments in terms of mortality and cumulative major complications. A conservative approach should always be considered.
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Affiliation(s)
- Fausto Rosa
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Marcello Covino
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Cozza
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Pietro Fransvea
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giuseppe Quero
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Fiorillo
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Benedetta Simeoni
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gabriele Sganga
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Alfieri
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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Palomba G, Dinuzzi VP, Amendola A, Palomba R, DE Palma GD, Aprea G. Laparoscopic cholecystectomy for acute cholecystitis: onset of symptoms and severity grade as a tool for choosing the optimal timing. Minerva Surg 2021; 76:415-422. [PMID: 33890437 DOI: 10.23736/s2724-5691.21.08511-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND Acute cholecystitis is an acute inflammation of the gallbladder. It represents one-third of all surgical emergency hospital admissions and has significant socioeconomic impact. Laparoscopic cholecystectomy, regardless of age, is the gold standard for this disease, but the optimal timing of surgical intervention is an open issue since the 2007 Tokyo guidelines. METHODS We recruited from March 2015 to June 2018, in a retrospective study, 144 patients with acute cholecystitis and treated with laparoscopic cholecystectomy. The patients were divided into two groups: group A (N.=66), operated within 72 hours and group B (N.=78), between 72 hours and 1 week after the onset of symptoms. After, the two groups were further stratified by the grade of severity of acute cholecystitis in according to the Tokyo guidelines: in group A, 39 patients were grade I and 27 grade II; in group B, 48 patients were grade I and 30 grade II. RESULTS The operative time was longer in group B patients versus group A. In group B, there was a greater difficulty in dissecting and detecting the Calot's triangle, more conversions to open, a greater mean length of hospital stay and more post-operative days. In patients with grade II, especially in the group B, were greater inflammation stage, conversions to open, difficulty in the dissection of the Calot's triangle, mean length of hospital stay and post-operative days. The operative timing within 72 hours in patients with grade I, have only advantage in the mean length of hospital stay, while in grade II, the advantages are also in the lesser difficulty in dissecting the Calot's triangle, fewer conversions and fewer post-operative days. CONCLUSIONS Early laparoscopic cholecystectomy for acute cholecystitis should be performed considering not only the onset of symptoms, but above all the grade of severity of AC in according with TG. Grade II, particularly, must be treated within 72 hours and by experienced surgeon.
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Affiliation(s)
- Giuseppe Palomba
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy -
| | - Vincenza P Dinuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Alfonso Amendola
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberto Palomba
- Unit of General and Emergency Surgery, Ospedali Riuniti del Golfo Vesuviano, Naples, Italy
| | - Giovanni D DE Palma
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Yang JD. Is cholecystectomy safe in extremely elderly patients? JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:126-127. [PMID: 35600109 PMCID: PMC8977385 DOI: 10.7602/jmis.2021.24.3.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 11/08/2022]
Abstract
Gallstone disease is the most common global indication for abdominal surgery. Especially acute cholecystitis in the elderly is frequently encountered due to an increasingly elderly population. Although cholecystectomy is the gold standard treatment for acute cholecystitis, the surgical management in the elderly presents specific challenges due to associated comorbidities, the severity of their presenting disease, and a greater likelihood of suffering postoperative complications and prolonged hospital stay. Further effort to provide firm evidence to clarify the safety and feasibility of cholecystectomy for acute cholecystitis in extremely elderly patients such as octogenarians and even nonagenarians.
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Affiliation(s)
- Jae Do Yang
- Department of Surgery, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
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Wenning L, Xiangfei M, Rong W, Liping Z, Chaoyang L, Rui C. The case report of surgical and medical co-management in a triple organs resection surgery. Ann Med Surg (Lond) 2021; 69:102669. [PMID: 34484718 PMCID: PMC8405951 DOI: 10.1016/j.amsu.2021.102669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION and Importance: There have been few studies in the literature that report patient have triple combined procedures done via minimally invasive approaches. We report a co-management SMC intervention helped an 88-years-old patient with multiple surgery risk factors have combined procedures done via robotic-assisted approaches at one sitting with excellent surgical outcomes. CASE PRESENTATION We describe the surgical and medical co-management (SMC) intervention of a 88-year-old male patient who was found to have colonic carcinoma, right renal carcinoma, gall bladder stones, hypertension, plumonary interstital fibrosis, atrioventricular block. The patient underwent simultaneous triple robotic-assisted laparoscopic surgery procedure consisting of right partial nephrectomy, right hemicolecomy and cholecystectomy using robot. Perioperative optimization approach was recommended and planned after consultation with group comprises internists and surgeons. The internists rounds on the patient daily and helps to manage all chronic medical comorbidities. He was discharged without any severe complications. CONCLUSIONS This case shows the feasibility and safety of the synchronously triple robotic surgical treatments, with clinic outcomes that is better with that of the separately. SMC approach may maximize therapy efficiency and patient recovery in elder patients with chronic disease who has significantly higher postoperative complications.
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Affiliation(s)
- Lu Wenning
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital, Beijing, 100853, China
| | - Meng Xiangfei
- Department of Hepatobiliary, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Wang Rong
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhang Liping
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital, Beijing, 100853, China
| | - Liu Chaoyang
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital, Beijing, 100853, China
| | - Cheng Rui
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital, Beijing, 100853, China
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Abdullah BH, Jassam SA, Hadi WA, Hameed B. Gallbladder stone formation in Iraqi patients is associated with bacterial infection and HLA class II-DRB1 antigens. INDIAN J PATHOL MICR 2021; 63:570-574. [PMID: 33154307 DOI: 10.4103/ijpm.ijpm_841_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Background Gallbladder stone is recently increased among the Iraqi society due to many risk factors such as bacterial infection and some HLA class II antigens. Aim(s) This study investigates the types of bacterial infection and HLA-DRB1 antigens' ratio that may be correlated with gallbladder stone formation. Setting and Design: The study included 45 patients and the same number of healthy individuals as a control group. Patients were with multiple gallstones. Gallstone bacterial culture was demonstrated to diagnose viable bacteria. HLA-DRB1 alleles' frequency was investigated using sequence-specific oligonucleotide probes (PCR-SSOP). Results Irrespective of gallstone type and size, different types of living viable bacteria were isolated from the cores of the studied gallstones in 80% of the studied cases versus 20% of sterile gallstones. Gram-negative bacteria cultures were the dominant (89.3%), including Escherichia coli, Klebsiella spp., Proteus spp., Acinetobacter spp., and Enterobacter spp. Mixed infection of Gram-positive and negative bacteria was noted: Escherichia coli and Enterococus spp. and the others of Escherichia coli and Acitobacter spp., and Klebsiella spp. and Pseudomonas spp. Gram-positive bacteria cultures were also detected at lower rate (10.7%) including Staphylococci spp. The frequency of HLA-DRB1*03:01, HLA-DRB1*4:03, HLA-DRB1*13:22, and HLA-DRB1*15:10 alleles was significantly elevated in patients compared to the healthy control group. Conclusion Results ensured the viability of the bacteria isolated from the core of gallstones and showed positive correlation between gallbladder stone and different bacterial infection. In addition, HLA-DRB1 alleles were significantly high in patients compared to healthy control group suggesting them as risk factors (P < 0.05).
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Affiliation(s)
- Baydaa H Abdullah
- Depatment of Clinical Laboratory Science, Pharmacy College, Mustansiryah University, Baghdad, Iraq
| | - Samah A Jassam
- Depatment of Clinical Laboratory Science, Pharmacy College, Mustansiryah University, Baghdad, Iraq
| | - Wafaa A Hadi
- Department of Pathology, Teaching Hospital of Kadhimiya, Baghdad, Iraq
| | - Bassam Hameed
- Department of Surgery, Teaching Hospital of Al-Yarmouk, Baghdad, Iraq
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Morimoto M, Matsuo T, Mori N. Management of Porcelain Gallbladder, Its Risk Factors, and Complications: A Review. Diagnostics (Basel) 2021; 11:1073. [PMID: 34200963 PMCID: PMC8230643 DOI: 10.3390/diagnostics11061073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
The porcelain gallbladder condition describes gallbladder calcification. While gallbladder calcification is believed to increase the risk of developing gallbladder cancer, recent reports have shown that the malignancy risk is much lower than previously reported. Symptomatic patients with porcelain gallbladder should be recommended for cholecystectomy, but the management of asymptomatic patients is debatable. Based on recent evidence, prophylactic cholecystectomy is not routinely recommended in all patients with porcelain gallbladder. From the assessment of the current literature, there are three essential factors in the management of patients with porcelain gallbladder: (1) symptoms or complications of gallbladder disease, (2) calcification pattern and (3) patient age and comorbidities. Patients who do not undergo cholecystectomy should be educated about the symptoms of gallbladder diseases, and a thorough discussion is essential between patients and clinicians.
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Affiliation(s)
- Masaya Morimoto
- Department of Infectious Diseases, St. Luke’s International Hospital, Tokyo 104-8560, Japan; (T.M.); (N.M.)
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Kube I, Tardio LB, Hofmann U, Ghallab A, Hengstler JG, Führer D, Zwanziger D. Hypothyroidism Increases Cholesterol Gallstone Prevalence in Mice by Elevated Hydrophobicity of Primary Bile Acids. Thyroid 2021; 31:973-984. [PMID: 33231505 DOI: 10.1089/thy.2020.0636] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Thyroid hormone (TH) deficiency has been associated with increased cholesterol gallstone prevalence. Hypothyroidism impacts hepatic lipid homeostasis, biliary secretion, gallbladder motility, and gallstone (LITH) gene expression, all potential factors contributing to cholesterol gallstone disease (CGD). However, how TH deficiency may lead to gallstone formation is still poorly understood. Therefore, we performed molecular studies in a CGD mouse model under lithogenic conditions and modulation of TH status. Methods: Male, three-month-old C57BL/6 mice were randomly divided into a control (euthyroid) group, a hypothyroid (hypo) group, a gallstone (litho) group, and a gallstone+hypothyroid (litho+hypo) group and were treated for 2, 4, and 6 weeks (n = 8/treatment period). Gallstone prevalence, biliary composition and cholesterol crystals, hepatic expression of genes participating in cholesterol, bile acid (BA), and phosphatidylcholine synthesis (Hmgcr, Cyp7a1, Pcyt1a), and canalicular transport (Abcg5, Bsep, Abcb4) were investigated. Results: Increased cholesterol gallstone prevalence was observed in hypothyroid mice under lithogenic diet after 4 and 6 weeks of treatment (4 weeks: 25% vs. 0%; 6 weeks: 75% vs. 37.5%). Interestingly, neither the composition of the three main biliary components, cholesterol, BAs, and phosphatidylcholine, nor the hepatic expression of genes involved in synthesis and transport could explain the differences in cholesterol gallstone formation in the mice. However, TH deficiency resulted in significantly increased hydrophobicity of primary BAs in bile. Furthermore, downregulation of hepatic sulfonation enzymes Papss2 and Sult2a8 as well as diminished biliary BA sulfate concentrations in mice were observed under hypothyroid conditions all contributing to a lithogenic biliary milieu as evidenced by microscopic cholesterol crystals and macroscopic gallstone formation. Conclusions: We describe a novel pathogenic link between TH deficiency and CGD and suggest that the increased hydrophobic character of biliary BAs due to the diminished expression of hepatic detoxification enzymes promotes cholesterol crystal precipitation and enhances cholesterol gallstone formation in the bile of hypothyroid mice.
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Affiliation(s)
- Irina Kube
- Department of Endocrinology, Diabetes and Metabolism and Clinical Chemistry, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - Luca Bartolomeo Tardio
- Department of Endocrinology, Diabetes and Metabolism and Clinical Chemistry, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - Ute Hofmann
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology and University of Tübingen, Stuttgart, Germany
| | - Ahmed Ghallab
- Department of Toxicology/Systems Toxicology, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Jan G Hengstler
- Department of Toxicology/Systems Toxicology, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism and Clinical Chemistry, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - Denise Zwanziger
- Department of Endocrinology, Diabetes and Metabolism and Clinical Chemistry, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
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Montenegro A, Andújar X, Fernández-Bañares F, Esteve M, Loras C. Usefulness of endoscopic ultrasound in patients with minilithiasis and/or biliary sludge as a cause of symptoms of probable biliary origin after cholecystectomy. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:91-98. [PMID: 34023476 DOI: 10.1016/j.gastrohep.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Endoscopic ultrasound (EUS) is a more sensitive technique than transabdominal ultrasound for the diagnosis of gallstones. This greater sensitivity, especially in the diagnosis of microlithiasis/biliary sludge, facilitates the indication of cholecystectomy in patients with symptoms of probable biliary origin but may result in over-indication of this surgery. OBJECTIVES Evaluate the role of EUS in the diagnosis of minilithiasis/biliary sludge in patients with digestive symptoms of probable biliary origin by resolving the symptoms after cholecystectomy. Analyse factors related to the remission of symptoms following cholecystectomy. PATIENTS AND METHODS Retrospective, longitudinal, single-centre study based on a prospective database of 1.121 patients undergoing EUS. Seventy-four patients were identified as meeting inclusion-exclusion criteria (diagnosed with minilithiasis/sludge by EUS after presenting digestive symptoms of probable biliary origin without a history of complicated cholelithiasis). A telephone questionnaire for symptoms was conducted with cholecystectomized patients. Factors related to a good response were analysed with logistic regression analysis. RESULTS Of the 74 patients, 50 were cholecystectomized (67.5%), mean age 49 years (SEM 2.26) (41 women). Seventy percent of patients (35/50) presented remission of symptoms with median follow-up 353.5 days (95% CI, 270-632.2). The only variable associated with remission of symptoms was the presence of typical biliary colic with an OR of 7.8 (95% CI, 1.8-34; p=0.006). No complications associated with EUS were recorded. One patient (2%) suffered haemoperitoneum and 18% (9/50) suffered diarrhoea following cholecystectomy. CONCLUSIONS EUS is a very useful technique for the indication of cholecystectomy in patients with minilithiasis/sludge and typical symptoms of biliary colic.
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Affiliation(s)
- Andrea Montenegro
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrrassa, Catalonia, Spain; Department of Gastroenterology, Hospital Universitari General de Catalunya, Catalonia, Spain
| | - Xavier Andújar
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrrassa, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Fernando Fernández-Bañares
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrrassa, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - María Esteve
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrrassa, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Carme Loras
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrrassa, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
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Alimoğulları M, Buluş H. Effectiveness of ursodeoxycholic acid treatment in the prevention of gallstone formation after laparoscopic sleeve gastrectomy. Acta Chir Belg 2021; 121:109-114. [PMID: 33252027 DOI: 10.1080/00015458.2020.1857569] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bariatric surgery is a critical risk factor for cholelithiasis. This study aimed to investigate the role of treatment with ursodeoxycholic acid (UDCA) in the prevention of gallstone formation after laparoscopic sleeve gastrectomy (SG) in morbidly obese patients. METHODS Patients who underwent SG for morbid obesity from January 2016 to September 2016 were evaluated. Patients without hepatobiliary disorders were included. Patients were divided into two groups based on whether they did (Group I) or did not receive treatment with UDCA (Group II). Indication for UDCA treatment was symptomatic alkaline reflux. Demographic characteristics, comorbid diseases, preoperative blood parameters, early and late period weight loss rates, and gallstone development were monitored and compared between the groups. RESULTS Ninety-six of 155 patients met the inclusion criteria. Group I and II included 49 and 47 patients, respectively. The mean age was 39.1 ± 10.8 (range 18-69) years and the mean follow-up period was 20.75 ± 6.6 (range 12-34) months. Gallstone formation was significantly lower in Group I compared to Group II [5 patients (10.2%) vs. 21 patients (44.6%), p<.001]. Moreover, the absence of UDCA treatment was independently and significantly associated with gallstone formation (hazard ratio: 3.08; 95% confidence interval: 1.73-5.50; p<.001) in multivariate analyses. There was no difference in weight loss rates between the two groups at the early or late periods. CONCLUSIONS Treatment with UDCA seems to be effective in the prevention of gallstone formation after sleeve gastrectomy. Furthermore, early and late period weight loss rates were not found to have significant effects on the risk of cholelithiasis.
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Affiliation(s)
- Mustafa Alimoğulları
- Department of General Surgery, University of Medical Sciences Keçiören Training and Research Hospital, Ankara, Turkey
| | - Hakan Buluş
- Department of General Surgery, University of Medical Sciences Keçiören Training and Research Hospital, Ankara, Turkey
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50
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Ahmed I, Innes K, Brazzelli M, Gillies K, Newlands R, Avenell A, Hernández R, Blazeby J, Croal B, Hudson J, MacLennan G, McCormack K, McDonald A, Murchie P, Ramsay C. Protocol for a randomised controlled trial comparing laparoscopic cholecystectomy with observation/conservative management for preventing recurrent symptoms and complications in adults with uncomplicated symptomatic gallstones (C-Gall trial). BMJ Open 2021; 11:e039781. [PMID: 33766835 PMCID: PMC7996370 DOI: 10.1136/bmjopen-2020-039781] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Gallstone disease (cholelithiasis) is common. In most people it is asymptomatic and does not require treatment, but in about 20% it can become symptomatic, causing pain and other complications requiring medical attention and/or surgery. A proportion of symptomatic people with uncomplicated gallstone disease do not experience further episodes of pain and, therefore, could be treated conservatively. Moreover, surgery carries risks of perioperative and postoperative complications. METHODS AND ANALYSIS C-Gall is a pragmatic, multicentre, randomised controlled trial and economic evaluation to assess whether cholecystectomy is cost-effective compared with observation/ conservative management (here after referred to as medical management) at 18 months post-randomisation (with internal pilot). PRIMARY OUTCOME MEASURE Patient-reported quality of life (QoL) (36-Item Short Form Survey (SF-36) bodily pain domain) up to 18 months after randomisation.The primary economic outcome is incremental cost per quality-adjusted life year gained at 18 months. SECONDARY OUTCOME MEASURES Secondary outcome measures include condition-specific QoL, SF-36 domains, complications, further treatment, persistent symptoms, healthcare resource use, and costs assessed at 18 and 24 months after randomisation. The bodily pain domain of the SF-36 will also be assessed at 24 months after randomisation.A sample size of 430 participants was calculated. Computer-generated 1:1 randomisation was used.The C-Gall Study is currently in follow-up in 20 UK research centres. The first patient was randomised on 1 August 2016, with follow-up to be completed by 30 November 2021. STATISTICAL ANALYSIS Statistical analysis of the primary outcome will be intention-to-treat and a per-protocol analysis. The primary outcome, area under the curve (AUC) for the SF-36 bodily pain up to 18 months, will be generated using the Trapezium rule and analysed using linear regression with adjustment for the minimisation variables (recruitment site, sex and age). For the secondary outcome, SF-36 bodily pain, AUC up to 24 months will be analysed in a similar way. Other secondary outcomes will be analysed using generalised linear models with adjustment for minimisation and baseline variables, as appropriate. Statistical significance will be at the two-sided 5% level with corresponding CIs. ETHICS AND DISSEMINATION The North of Scotland Research Ethics Committee approved this study (16/NS/0053). The dissemination plans include Health Technology Assessment monograph, international scientific meetings and publications in high-impact, open-access journals. TRIAL REGISTRATION NUMBER ISRCTN55215960; pre-results.
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Affiliation(s)
- Irfan Ahmed
- Department of Surgery, NHS Grampian, Aberdeen, UK
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Karen Innes
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Rumana Newlands
- Health Services Research Unit, University of Aberdeen College of Life Sciences and Medicine, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Rodolfo Hernández
- Health Economics Research Unit (HERU), University of Aberdeen, Aberdeen, UK
| | - Jane Blazeby
- Centre for Surgical Research and NIHR Bristol and Weston Biomedical Research Centre, University of Bristol, Bristol, UK
| | | | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Kirsty McCormack
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Peter Murchie
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
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