Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years’ experience at a tertiary care centre

Abstract Background Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. Patients and Methods We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male–female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient’s performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. Results PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79–20.56), clinical progression (OR 7.62; CI 2.64–22.05) and the need for emergency CCY (OR 14.75; CI 3.07–70.81) were mostly determined by AC severity grade. Conclusion PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.

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Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1)

Gut ◽

10.1136/gutjnl-2019-319996 ◽

2020 ◽

Vol 69 (6) ◽

pp. 1085-1091 ◽

Cited By ~ 14

Author(s):

Anthony Y B Teoh ◽

Masayuki Kitano ◽

Takao Itoi ◽

Manuel Pérez-Miranda ◽

Takeshi Ogura ◽

...

Keyword(s):

High Risk ◽

Adverse Events ◽

Acute Cholecystitis ◽

Clinical Success ◽

Controlled Trial ◽

Definitive Treatment ◽

Percutaneous Cholecystostomy ◽

Gallbladder Drainage ◽

Pain Scores ◽

Very High

ObjectiveThe optimal management of acute cholecystitis in patients at very high risk for cholecystectomy is uncertain. The aim of the current study was to compare endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) to percutaneous cholecystostomy (PT-GBD) as a definitive treatment in these patients under a randomised controlled trial.DesignConsecutive patients suffering from acute calculous cholecystitis but were at very high-risk for cholecystectomy were recruited. The primary outcome was the 1-year adverse events rate. Secondary outcomes include technical and clinical success, 30-day adverse events, pain scores, unplanned readmissions, re-interventions and mortalities.ResultsBetween August 2014 to February 2018, 80 patients were recruited. EUS-GBD significantly reduced 1 year adverse events (10 (25.6%) vs 31 (77.5%), p<0.001), 30-day adverse events (5 (12.8%) vs 19 (47.5%), p=0.010), re-interventions after 30 days (1/39 (2.6%) vs 12/40 (30%), p=0.001), number of unplanned readmissions (6/39 (15.4%) vs 20/40 (50%), p=0.002) and recurrent cholecystitis (1/39 (2.6%) vs 8/40 (20%), p=0.029). Postprocedural pain scores and analgesic requirements were also less (p=0.034). The technical success (97.4% vs 100%, p=0.494), clinical success (92.3% vs 92.5%, p=1) and 30-day mortality (7.7% vs 10%, p=1) were statistically similar. The predictor to recurrent acute cholecystitis was the performance of PT-GBD (OR (95% CI)=5.63 (1.20–53.90), p=0.027).ConclusionEUS-GBD improved outcomes as compared to PT-GBD in those patients that not candidates for cholecystectomy. EUS-GBD should be the procedure of choice provided that the expertise is available after a multi-disciplinary meeting. Further studies are required to determine the long-term efficacy.Trial registration numberNCT02212717

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Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with a silicone-covered nitinol short bilaterally flared stent: a case series

Endoscopy International Open ◽

10.1055/s-0043-118659 ◽

2017 ◽

Vol 05 (11) ◽

pp. E1111-E1116 ◽

Cited By ~ 2

Author(s):

Raffaele Manta ◽

Claudio Zulli ◽

Angelo Zullo ◽

Edoardo Forti ◽

Alberto Tringali ◽

...

Keyword(s):

Acute Cholecystitis ◽

Endoscopic Ultrasound ◽

Clinical Success ◽

Symptom Relief ◽

Case Series ◽

Metal Stents ◽

Success Rates ◽

Gallbladder Drainage ◽

First Case

Abstract Background and study aim Gallbladder drainage in patients with cholecystitis who are unsuitable for surgery may be performed by endoscopic ultrasound (EUS)-guided placement of specifically designed fully covered metal stents. We describe the first case series of patients treated with a silicone-covered nitinol stent with bilateral anchor flanges. Patients and methods Data from consecutive patients with acute cholecystitis who were deemed unsuitable candidates for surgery were collected. The stent placement procedure was performed in two tertiary endoscopy centers by four experienced endoscopists. Technical and clinical success rates, as well as adverse events and clinical outcome at follow-up, were assessed. Results EUS-guided drainage for cholecystitis was performed in 16 patients (mean age 84 years; nine males). Technical and clinical success rates were 100 % (16/16) and 94 % (15/16), respectively; an early failure due to stone impaction occurred in the remaining case and required placement of a new stent. Symptom relief occurred in 11/15 cases (73 %) within 1 day, and within 2 days in the remaining 4 patients. Bleeding occurred in two patients (13 %): in one patient intraprocedural bleeding was successfully stopped during endoscopy; and delayed bleeding occurred in one patient requiring arterial embolization for catastrophic bleeding (patient died 10 days later). No cases of cholecystitis recurrence or biliary obstruction were observed during a median follow-up of 112 days (range 49 – 180 days). Conclusions Our data showed that EUS-guided gallbladder drainage with a specially designed stent is feasible and successful in patients with acute cholecystitis who are unfit for surgery.

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Percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy for acute cholecystitis

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2020.4.2 ◽

2020 ◽

Vol 10 (4) ◽

Author(s):

Minh Hai Pham ◽

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Medical Center ◽

Case Series ◽

Morbidity Rate ◽

Safe Procedure ◽

Gallbladder Drainage ◽

Percutaneous Transhepatic Gallbladder Drainage ◽

Grade Ii ◽

Grade Iii

Abstract Introduction: Laparoscopic cholecystectomy (LC) has been considered as main treatment for acute cholecystitis due to gallstones. However, LC is not entirely safe for patients with severe comorbidities, high risk of surgery. In such circumstances, two-stage treatment including percutaneous transhepatic gallbladder drainage (PTGBD) first and then LC is an appropriate choice. PTGBD followed by LC or LC after PTGBD might be technically difficult. This article was written to evaluate the feasibility and the safety of PTGBD followed by LC (PTGBD + LC). Materials and Methods: This case series report was conducted on patients who underwent PTGBD + LC in University Medical Center, Ho Chi Minh City, Vietnam, from June 2018 to June 2020. We applied TG 2018 criteria for diagnosis and severity grading of cholecystitis in all patients. The comorbidities were evaluted according to Charlson comorbidity index (CCI) and American Society of Anesthesiologists physical status (ASA-PS) classification. Indications for PTGBD were grade II or grade III acute cholecystitis and the presence of a severe comorbidities (CCI > 6 and/or ASA > III). Results: From June 2018 to June 2020, there were 13 cases performed PTGBD + LC. There were 84,6% of grade II cholecystitis cases and 15,4% of grade III cholecystitis cases according to Tokyo guidelines 2018 criteria with comorbidities (30,8% of cases with CCI > 6, 100% of cases with ASA > III). Mean operative time: 126 minutes; one case needed transfusion due to bleeding from gallbladder inflammatory; no conversion to open surgery; morbidity rate was 23,1% (1 bile leakage successfully treated with preservation, 1 surgical site infection, 1 pneumoniae); mean hospital stay was 5,25 days; no mortality was observed in this series. Conclusions: PTGBD followed up by LC is feasible and safe procedure for acute cholecystitis in selected patients.

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Evaluation of results of laparoscopic cholecystectomy after cholecystostomy for acute calculous cholecystitis

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2020.2.7 ◽

2020 ◽

Vol 10 (2) ◽

Author(s):

Tuấn Ngọc Nguyễn ◽

Keyword(s):

Laparoscopic Cholecystectomy ◽

Conversion Rate ◽

Cross Sectional Study ◽

High Rate ◽

Cross Sectional ◽

Female Ratio ◽

Gallbladder Drainage ◽

Acute Calculous Cholecystitis ◽

Percutaneous Transhepatic Gallbladder Drainage ◽

Calculous Cholecystitis

Tóm tắt Đặt vấn đề: Xác định tỷ lệ phẫu thuật nội soi (PTNS) thành công và một số yếu tố liên quan của PTNS cắt túi mật (TM) sau dẫn lưu túi mật (DLTM) qua da xuyên gan hoặc DLTM qua da trong viêm túi mật cấp (VTMC) do sỏi. Phương pháp nghiên cứu: Nghiên cứu cắt ngang người bệnh (NB) được PTNS cắt TM sau DLTM do VTMC do sỏi tại Bệnh viện Trưng Vương từ tháng 01/2013 đến tháng 6/2019. Kết quả: 72 NB được DLTM, 35 nam, 37 nữ, tỉ lệ nam/nữ 0,94. Tuổi trung bình là 57,8 ± 14,3. DLTM thành công 100%. Tỉ lệ chuyển mổ mở của PTNS cắt TM sau DLTM là 1,4 % (1 NB). Kết luận: DLTM trong VTMC do sỏi là kỹ thuật dễ thực hiện, an toàn, tỉ lệ thành công cao (100%), không có tai biến, và biến chứng nghiêm trọng. PTNS cắt TM sau DLTM thành công cao (98,6%), tỉ lệ chuyển mổ mở thấp, tai biến, biến chứng không đáng kể. DLTM là phương pháp điều trị tạm thời hiệu quả để chuẩn bị cho PTNS cắt TM sau đó. Abstract Introduction: Identification of successful rate of laparoscopic cholecystectomy (LC) and analysis of factors related to results of LC for post-percutaneous transhepatic gallbladder drainage or percutaneous gallbladder drainage (PTGBD) in acute calculous cholecystitis (ACC). Materials and Methods: Cross-sectional study. The patients with cholecystostomy due to ACC underwent LC at Trung Vuong hospital from January 2013 to June 2019 enrolled. Results: 72 patients had PTGBD including 35 male and 37 female, male/ female ratio was 0.94. The mean age was 57.8 ± 14.3 years old. The success rate of PTGBD was 100%. The LC has performed successfully for PTGBD and conversion rate to open surgery was 1,4% (1 patient). Conclusion: PTGBD for ACC is a feasilble and safe technique, high rate of success (100%) without any serious accidents and complications. LC after PTGBD has conducted successfully at high rate (98,6%), very low conversion rate and minimal complications. PTGBD is an effective temporary management for preparation of subsequent laparoscopic cholecystectomy Keywords: Cholecystitis, Percutaneous Transhepatic Gallbladder Drainage.

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Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis

Updates in Surgery ◽

10.1007/s13304-020-00894-4 ◽

2020 ◽

Author(s):

Shao-Zhuo Huang ◽

Hao-Qi Chen ◽

Wei-Xin Liao ◽

Wen-Ying Zhou ◽

Jie-Huan Chen ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Blood Loss ◽

Acute Cholecystitis ◽

Conversion Rate ◽

Operative Time ◽

Meta Analysis ◽

Cochrane Library ◽

Intraoperative Blood Loss ◽

Gallbladder Drainage ◽

Percutaneous Transhepatic Gallbladder Drainage

Abstract Laparoscopic cholecystectomy and percutaneous transhepatic gallbladder drainage (PTGBD) are common treatments for patients with acute cholecystitis. However, the safety and efficacy of emergency laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) after PTGBD in patients with acute cholecystitis remain unclear. The PubMed, EMBASE, and Cochrane Library databases were searched through October 2019. The quality of the included nonrandomized studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS). The meta-analysis was performed using STATA version 14.2. A random-effects model was used to calculate the outcomes. A total of fifteen studies involving 1780 patients with acute cholecystitis were included in the meta-analysis. DLC after PTGBD was associated with a shorter operative time (SMD − 0.51; 95% CI − 0.89 to − 0.13; P = 0.008), a lower conversion rate (RR 0.43; 95% CI 0.26 to 0.69; P = 0.001), less intraoperative blood loss (SMD − 0.59; 95% CI − 0.96 to − 0.22; P = 0.002) and longer time of total hospital stay compared to ELC (SMD 0.91; 95% CI 0.57–1.24; P < 0.001). There was no difference in the postoperative complications (RR 0.68; 95% CI 0.48–0.97; P = 0.035), biliary leakage (RR 0.65; 95% CI 0.34–1.22; P = 0.175) or mortality (RR 1.04; 95% CI 0.39–2.80; P = 0.933). Compared to ELC, DLC after PTGBD had the advantages of a shorter operative time, a lower conversion rate and less intraoperative blood loss.

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