Percutaneous cholecystostomy is an effective treatment option for acute calculous cholecystitis: a 10-year experience

Horn, Torben; Christensen, Sara Dahl; Kirkegård, Jakob; Larsen, Lars; Knudsen, Aage; Mortensen, Frank Viborg

doi:10.1111/hpb.12360

Cited by 90 publications

(75 citation statements)

References 30 publications

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“…Our data are consistent with previous studies report recurrence of cholecystitis in 11% to 41% of patients who undergo tube placement 10,15,20,21,30 and readmission rates ranging from 23% to 41%. 21,31 Readmission rates for patients without a cholecystostomy tube were only 9%, likely due to the higher rate of cholecystectomy in this cohort. In addition to cost to the healthcare system, the cost to the patient in the long-term when considering hospitalstay, repeated procedures, and discomfort should be considered.…”

Section: Discussionmentioning

confidence: 87%

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: 87%

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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“…This minimally invasive procedure avoids the risk associated with general anesthesia and can be performed either as a bridge to surgery or as a definitive treatment [29,30] . In the literature, it is described as a rather uncomplicated procedure with low complication rates and high success rates [31][32][33] . The reported 30-day mortality, however, is higher than that of acute cholecystectomy, but this may likely be a result of selection bias since the available literature is mainly retrospective [13] .…”

Section: Discussionmentioning

confidence: 99%

Early Cholecystectomy for Acute Cholecystitis in the Elderly Population: A Systematic Review and Meta-Analysis

et al. 2017

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Background: In the era of advanced surgical techniques and improved perioperative care, the willingness to perform emergency operations in elderly patients continues to increase. This systematic review aimed at assessing the clinical outcomes of early cholecystectomy in elderly patients with acute cholecystitis. Methods: Medline, Embase, and Cochrane Library databases were systematically searched for studies reporting on early cholecystectomy for acute cholecystitis in patients aged ≥70 years. The conversion rate, perioperative morbidity, and mortality were calculated using a random-effects model. Results: Eight articles fell within the scope of this study. In total, 592 patients were identified. The mean age was 81 years. Early cholecystectomy was performed laparoscopically in 316 patients (53%) and open in 276 patients (47%). The procedure was associated with a conversion rate of 23% (95% CI 18.6-28.3), a perioperative morbidity of 24% (95% CI 20.5-27.5), and a mortality of 3.5% (95% CI 2.3-5.4). Conclusion: Early cholecystectomy seems to be a feasible treatment in elderly patients with acute cholecystitis. To reduce morbidity, patients who may benefit from surgery ought to be selected carefully. Future prospective studies should compare early cholecystectomy with alternative treatments to select the treatment that is most appropriate for elderly patients.

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“…Therefore, PC is not inevitable in geriatric and high-risk patients. [20,21] On the other hand, PC is an interventional treatment and is associated with some risks and complications. The rates of complications associated with PC decrease wen Pc is performed by experienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis; percutaneous cholecystostomy

Zeren¹,

Bayhan²,

Koçak³

et al. 2017

Ulus Travma Acil Cerrahi Derg

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Percutaneous cholecystostomy is an effective treatment option for acute calculous cholecystitis: a 10-year experience

Abstract: The present study, which is the largest ever conducted in this treatment area, supports the hypothesis that PC is an effective treatment modality for critically ill patients with ACC unfit for surgery and results in a low rate of 30-day mortality.

Cited by 90 publications

References 30 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

Early Cholecystectomy for Acute Cholecystitis in the Elderly Population: A Systematic Review and Meta-Analysis

Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis; percutaneous cholecystostomy

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