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Efficacy and safety of conversion of percutaneous cholecystostomy to endoscopic transpapillary gallbladder stenting in high-risk surgical patients

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Hepatobiliary & Pancreatic Diseases International 2021年第5期20卷 478-484页

作者： Hyung Ku Chon Chan Park Dong Eun Park Tae Hyeon Kim Division of Biliopancreas Department of Internal MedicineWonkwang University College of Medicine and Hospital895 MuwangRoIksanSouth Korea Institute of Wonkwang Medical Science Wonkwang University College of Medicine and HospitalIksanSouth Korea Department of Surgery Wonkwang University College of Medicine and HospitalIksanSouth Korea

Background:Endoscopic transpapillary gallbladder stenting(ETGBS)has been used as an alternative to percutaneous cholecystostomy in patients with acute cholecystitis who are considered unfit for surgery.However,there are few data on the efficacy and safety of ETGBS replacement of percutaneous cholecystostomy in high-risk surgical patients.This study aimed to evaluate the feasibility,efficacy,and safety of ETGBS to replace percutaneous cholecystostomy in high-risk surgical patients.Methods:This single center retrospective study reviewed the data of patients who attempted ETGBS to replace percutaneous cholecystostomy between January 2017 and September 2019.The technical success,clinical success,adverse events,and stent patency were evaluated.Results:ETGBS was performed in 43 patients(24 male,mean age 80.7±7.4 years)to replace percutaneous cholecystostomy due to high surgical risk.The technical success rate and clinical success rate were 97.7%(42/43)and 90.5%(38/42),respectively.Procedure-related adverse events and stent-related late adverse events occurred in 7.0%(3/43)and 11.6%(5/43),respectively.Of the patients who successfully underwent ETGBS(n=42),only one had recurrent acute cholecystitis during follow-up.The median stent patency was 415 days(interquartile range 240–528 days).Conclusions:ETGBS,as a secondary intervention for the purpose of internalizing gallbladder drainage in patients following placement of a percutaneous cholecystostomy,is safe,effective,and technically feasible.Thus,conversion of percutaneous cholecystostomy to ETGBS may be considered as a viable option in high-risk surgical patients.

关键词： Cholecystitis percutaneous cholecystostomy Endoscopic transpapillary gallbladder stenting High surgical risk

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Call for action:Increased healthcare utilization with growing use of percutaneous cholecystectomy tube over initial cholecystectomy in cirrhotics

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Hepatobiliary & Pancreatic Diseases International 2022年第1期21卷 56-62页

作者： Srikanth Vedachalam Sajid Jalil Somashaker G Krishna Kyle Porter Na Li Sean G Kelly Lanla Conteh Khalid Mumtaz Department of Internal Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210USA Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210USA Center for Biostatistics Department of Biomedical InformaticsThe Ohio State University Wexner Medical CenterColumbusOH 43210USA

Background:Acute calculous cholecystitis(ACC)is frequently seen in cirrhotics,with some being poor candidates for initial cholecystectomy.Instead,these patients may undergo percutaneous cholecystostomy tube(PCT)placement.We studied the healthcare utilization and predictors of cholecystectomy and PCT in patients with ACC.Methods:The National Database was queried to study all cirrhotics and non-cirrhotics with ACC between 2010-2014 who underwent initial PCT(with or without follow-up cholecystectomy)or cholecystectomy.Cirrhotic patients were divided into compensated and decompensated cirrhosis.Independent predictors and outcomes of initial PCT and failure to undergo subsequent cholecystectomy were studied.Results:Out of 919189 patients with ACC,13283(1.4%)had cirrhosis.Among cirrhotics,cholecystec-tomy was performed in 12790(96.3%)and PCT in the remaining 493(3.7%).PCT was more frequent in cirrhotics(3.7%)than in non-cirrhotics(1.4%).Multivariate analyses showed increased early readmis-sions[odds ratio(OR)=2.12,95%confidence interval(CI):1.43-3.13,P<0.001],length of stay(effect ratio=1.39,95%CI:1.20-1.61,P<0.001),calendar-year hospital cost(effect ratio=1.34,95%CI:1.28-1.39,P<0.001)and calendar-year mortality(hazard ratio=1.89,95%CI:1.07-3.29,P=0.030)in cir-rhotics undergoing initial PCT compared to cholecystectomy.Decompensated cirrhosis(OR=2.25,95%CI:1.67-3.03,P<0.001)had the highest odds of getting initial PCT.Cirrhosis,regardless of compensated(OR=0.56,95%CI:0.34-0.90,P=0.020)or decompensated(OR=0.28,95%CI:0.14-0.59,P<0.001),reduced the chances of getting a subsequent cholecystectomy.Conclusions:Cirrhotic patients undergo fewer cholecystectomy incurring initial PCT instead.Moreover,the rates of follow-up cholecystectomy are lower in cirrhotics.Increased healthcare utilization is seen with initial PCT amongst cirrhotic patients.This situation reflects suboptimal management of ACC in cirrhotics and a call for action.

关键词： National Healthcare Cholecystectomy percutaneous cholecystostomy Cirrhosis Decompensated cirrhosis

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percutaneous Cholecystomy Guided by Ultrasound for Acute Cholecystitis in High-risk Aged Patients

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Journal of Nanjing Medical University 2001年第2期15卷 98-100页

作者：张峰林红军王学浩胡淑芳 Departmentof General Surgery the First Affiliated Hospital of Nanjing Medical University Ultrasonic Diagnosis the First Affiliated Hospital of Nanjing Medical University

Objective The aim of the present study was to assess experience with percutaneous cholecystostomy (PC) in high risk aged patients with presumed acute cholecystitis. Methods\ PC was performed by transhepatic route under local anaesthesia guided by ultrasonography cholecystostomy catheters. The catheters used include the Cope loop(produced by Japan hakko). Results\ PC was performed successfully in all 18 patients, without immediate procedural or technical complications. Symptoms and clinical signs of cholecystitis resolved within 24 48 h after the procedures in all but one patient. Conclusion\ PC is a cost effective ,mini invasive, and reliable alternative to surgical placement of cholecystostomy tubes in critically ill patient. This study also can be used in hepatic abscess, obstructive jaundice and necrostic pancreatitis caused by stone or tumor.\;

关键词： percutaneous cholecystostomy aged patient acute cholecystitis

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