269 Endosonography-Guided Gallbladder Drainage Versus Percutaneous Cholecystostomy As a Definitive Management for Acute Cholecystitis in Patients That Are Unfit for Surgery

2015 ◽  
Vol 81 (5) ◽  
pp. AB130-AB131 ◽  
Author(s):  
Anthony Y. Teoh ◽  
Carlos De La Serna ◽  
Irene PeñAs ◽  
Enders K. Ng ◽  
Francis K.L. Chan ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
Gallbladder Drainage ◽  
Definitive Management

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 ◽  
2020 ◽  
Vol 69 (6) ◽  
pp. 1085-1091 ◽  
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

scholarly journals COVID-19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matteo Barabino ◽  
Gaetano Piccolo ◽  
Arianna Trizzino ◽  
Veronica Fedele ◽  
Carlo Ferrari ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
Disease Evolution ◽  
Tokyo Guidelines ◽  
Gallbladder Drainage ◽  
National Health Care ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Italian National Health ◽  
Grade Ii ◽  
The Mean

Abstract Background COVID-19 pandemic has impacted the Italian National Health Care system at many different levels, causing a complete reorganization of surgical wards. In this context, our study retrospectively analysed the management strategy for patients with acute cholecystitis. Methods We analysed all patients admitted to our Emergency Department for acute cholecystitis between February and April 2020 and we graded each case according to 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. We focused on patients submitted to cholecystostomy during the acute phase of pandemic and their subsequent disease evolution. Results Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II, 8 grade III). According to Tokyo Guidelines (2018), patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage (PC) and laparoscopic cholecystectomy (LC) in 29.7%, 21.6% and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to bedside percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous cholecystostomy was of 87.5%. The mean post-procedural hospitalization length was 9 days, and no related adverse events were observed apart from transient parietal bleeding, conservatively treated. Once discharged, two patients required readmission because of acute biliary symptoms. Median time of drainage removal was 43 days and only 50% patients thereafter underwent cholecystectomy. Conclusions Percutaneous cholecystostomy has shown to be an effective and safe treatment thus acquiring an increased relevance in the first phase of the pandemic. Nowadays, considering we are forced to live with the SARS-CoV-2 virus, PC should be considered as a virtuous, alternative tool for potentially all COVID-19 positive patients and selectively for negative cases unresponsive to conservative therapy and unfit for surgery.

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