Outcome of conservative percutaneous cholecystostomy in high-risk patients with acute cholecystitis and risk factors leading to surgery

Jang, Won Seok; Lim, Jun Uk; Joo, Kwang Ro; Myung, Jae; Shin, Hyun Phil; Joo, Sun Hyung

doi:10.1007/s00464-014-3961-4

Cited by 58 publications

(46 citation statements)

References 16 publications

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“…Many prior studies demonstrate that cholecystostomy tube placement is a safe alternative to cholecystectomy for patients with acute gallbladder disease, but primarily report this intervention as “safe” and “feasible.” 4–6,8,10,11,15–19 Yet, simply reporting feasibility of an intervention does not translate to overall outcomes in these patients and still may have severe consequences including mortality.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis

Dimou

Adhikari

Mehta

et al. 2017

Journal of the American College of Surgeons

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Background The Tokyo guidelines recommend initial cholecystostomy tube drainage, antibiotics, and delayed cholecystectomy in patients with grade III cholecystitis. Study Design We used Medicare data (1996–2010) to identify patients ≥66 years admitted with grade III acute cholecystitis. We evaluated adherence to the Tokyo guidelines and compared mortality, readmission, and complication rates with and without cholecystostomy tube placement in a propensity-matched (1:3) cohort of patients with grade III cholecystitis. Results 8,818 patients were admitted with grade III cholecystitis; 565 patients (6.4%) had a cholecystostomy tube placed. Cholecystostomy tube placement increased from 3.9% to 9.7% over the study period. Compared to 1,689 propensity-matched controls, patients with cholecystostomy tube placement had higher 30-day (HR 1.26, 95% CI 1.05–1.50), 90-day (HR 1.26, 95% CI 1.08–1.46) and 2-year mortality (HR 1.19, 95% CI 1.04–1.36) and were less likely to undergo cholecystectomy in the 2-years after initial hospitalization (33.4% vs. 64.4%, HR 0.26, 95% CI 0.21–0.31). Readmissions were also higher at 30 days (HR 2.93, 95% CI 2.12–4.05), 90 days (HR 3.48, 95% CI 2.60–4.64), and 2 years (HR 3.08, 95% CI 2.87–4.90). Conclusions Since introduction of the Tokyo Guidelines (2007), use of cholecystostomy tubes in patients with grade III cholecystitis has increased, but the majority of patients do not get cholecystostomy tube drainage as first line therapy. Cholecystostomy tube placement was associated with lower rates of definitive treatment with cholecystectomy, higher mortality and higher readmission rates. These data suggest a need for further evaluation and refinement of the Tokyo guidelines.

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Section: Discussionmentioning

confidence: 99%

Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis

Dimou

Adhikari

Mehta

et al. 2017

Journal of the American College of Surgeons

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“…Pri teh bolnikih se poleg podpornega zdravljenja priporoča urgentna holecistektomija pri biliarnem peritonitisu po perforaciji žolčnika. Če je pri bolniku operacija zelo tvegana, se lahko napravi perkutano dreniranje žolčnika oziroma perkutana holecistostoma ter kasneje odložena holecistektomija, ko je bolnik stabilen in v izboljšanem stanju (24).…”

Section: Kirurško Zdravljenjeunclassified

“…Gre za minimalno invaziven poseg, ki ga opravi interventni radiolog pod nadzorom UZ (24). Svetuje se pristop skozi jetra, torej dreniranje žolčnika skozi jetrni parenhim zaradi manjše možnosti iztekanja vsebine žolč-nika v trebušno votlino in nevarnosti za biliarni peritonitis (24).…”

Section: Perkutano Dreniranje žOlčnika -Perkutana Holecistostomaunclassified

“…Vstavitev drenažne cevke v žolčnik je kratek in malo invaziven poseg, ki lahko hitro privede do izboljšanja stanja bolnika. Tehnično je tak poseg možen pri 95-100 % bolnikov v rokah izkušenega interventnega radiologa (24). Umrljivost po perkutani holecistostomiji naj bi znašala 0-3 %, medtem ko naj bi se pojavljali lažji zapleti, povezni s posegom, pri 4-18 % bolnikov.…”

Section: Perkutano Dreniranje žOlčnika -Perkutana Holecistostomaunclassified

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Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

Janež¹

2018

SlovMedJour

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IzvlečekAkutno vnetje žolčnika oziroma akutni holecistitis je pogosta bolezen, ki večkrat zahteva sprejem v bolnišnico in kirurško zdravljenje. Najpogosteje se pojavlja pri ljudeh, ki imajo žolčne kamne, pojavi pa se lahko tudi v odsotnosti žolčnih kamnov. Diagnozo akutnega holecistitisa postavimo na osnovi klinične slike, laboratorijskih izvidov in ultrazvoka trebuha. Algoritmi za bolnike, ki imajo akutno vnetje žolčnika brez pridruženih bolezni, so znani; odločitev za kirurški poseg pri bolnikih s pridruženimi boleznimi pa je odvisna od več dejavnikov. Laparoskopska holecistektomija je metoda izbire zdravljenja bolnikov z akutnim holecistitisom. Rezultati zdravljenja so bistveno boljši, kadar kirurški poseg napravimo znotraj 72 ur od nastopa kliničnih znakov.V prispevku so predstavljena najnovejša priporočila za obravnavo bolnikov z akutnim holecistitisom, povzeta po smernicah iz Tokia ter smernicah Svetovnega združenja za urgentno kirurgijo iz leta 2016 ter na koncu še izsledki in izkušnje nekaterih kliničnih študij in metaanaliz. AbstractAcute cholecystitis is a common disease, which often requires admission to hospital and surgical treatment. Acute cholecystitis is defined as inflammation of the gallbladder and usually occurs due to cystic duct obstruction from stones or sludge. It is a relatively common complication of gallstones, but it can also occur without gallstones. A combination of relevant clinical symptoms and ultrasound evidence is required to make a diagnosis of acute cholecystitis. Early surgery is recommended for all patients that are in good physical condition. There is still a debate how to treat high-risk and critically ill patients. Laparoscopic cholecystectomy is the method of choice for treatment of patients with acute cholecystitis. Early laparoscopic cholecystectomy should be done within 72 hours from the onset of symptoms. This article presents current guidelines according to the Tokyo guidelines and the World Society of Emergency Surgery guidelines, and at the end, experiences of some clinical trials. UvodAkutno vnetje žolčnika oziroma akutni holecistitis je pogosto bolezen, ki velikokrat zahteva bolnišnično zdravljenje in operacijo. Najpogosteje se pojavlja pri ljudeh z žolčnimi kamni, lahko pa tudi brez njih (1). Vnetje žolčnika brez prisotnosti kamnov je pogostejše pri kritično bolnih, ki so dlje časa na parenteralni prehrani, pri politravmatiziranih bolnikih, pri večjih opeklinah in pri bolnikih po srčnih operacijah (2). Akutni holecistitis je še posebej pogost vzrok

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“…These older patients generally have comorbidities, which increases the risk of perioperative complications associated with cholecystectomy [2][3][4]. Thus, several studies have indicated the clinical benefits of non-surgical measures such as percutaneous transhepatic gallbladder aspiration (PTGBA) and percutaneous transhepatic gallbladder drainage (PTGBD) as treatment options for acute cholecystitis [5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Validation of Tokyo Guideline 2013 as Treatment of Acute Cholecystitis by Real World Data

Harai¹,

Mochizuki²,

Kojima³

et al. 2019

Dig Dis

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Background: The Tokyo Guidelines (TG; 2013) indicated that emergency cholecystectomy is an important early treatment option for acute cholecystitis; however, surgical intervention is not necessarily indicated in patients with advanced age. We evaluated percutaneous transhepatic gallbladder aspiration (PTGBA), percutaneous transhepatic gallbladder drainage (PTGBD), and the administration of antibiotics alone as treatment options for acute cholecystitis. Methods: From January 2010 to December 2017, 159 patients with acute cholecystitis were treated at our institution. The data from these patients were retrospectively analyzed. Results: Of these 159 cases, 109 underwent PTGBA, 28 underwent PTGBD, and 22 were administered antibiotics alone. None of the 159 patients needed urgent (early) cholecystectomy, and all patients were discharged without mortality. PTGBA was unsuccessful in only 6 of 109 patients; PTGBD was performed in these 6 cases. Long-term follow-up was conducted in all cases. Of the 159 patients, 146 had gallbladder stones initially, while 13 had none at the time of presentation. Of these 146 patients with gallbladder stones, 84 underwent elective cholecystectomy, while 62 did not. Of the 84 patients who underwent elective cholecystectomy, 2 developed choledocholithiasis; of the 62 patients who did not undergo elective cholecystectomy, 5 developed choledocholithiasis and 2 developed acute cholecystitis. The incidences of choledocholithiasis and acute cholecystitis did not significantly differ between the 2 groups (p = 0.06). Conclusions: Despite the recommendations in the TG (2013), emergency cholecystectomy was not needed in any of the present patients with acute cholecystitis. Acute cholecystitis can be successfully treated with PTGBA or PTGBD, which are simple procedures with good short- and long-term safety. These procedures are highly recommended for patients with acute cholecystitis, especially in the elderly population.

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Outcome of conservative percutaneous cholecystostomy in high-risk patients with acute cholecystitis and risk factors leading to surgery

Abstract: PC is a safe and effective therapeutic option in high-risk patients with acute cholecystitis, or for preoperative management. The decisive risk factors for surgery after PC were age, ASA score, and CVA.

Cited by 58 publications

References 16 publications

Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis

Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis

Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

Validation of Tokyo Guideline 2013 as Treatment of Acute Cholecystitis by Real World Data

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