scholarly journals P-EGS23 Efficacy of Percutaneous Cholecystostomy and Timing of Tube Removal: An Observational Study from a busy District General Hospital

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Clarisa TP Choh ◽  
Agata Majkowska ◽  
Claire Heugh ◽  
Andrew S Cowie ◽  
Richard Byrom ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Median Time ◽  
Surgical Intervention ◽  
Symptom Relief ◽  
District General Hospital ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Percutaneous Cholecystostomy ◽  
Tube Removal

Abstract Background Percutaneous cholecystostomy (PC) has traditionally been reserved for high-risk patients with cholecystitis who are unfit for surgical intervention, or as a temporizing measure for septic biliary patients to relieve sepsis and symptoms. However, there are currently no guidelines regarding the timing of tube removal following PC. The aim of this study is to evaluate the timing of tube removal following resolving inflammation and patency of biliary ducts, and its associated risks. Methods Patient notes and imaging reports were retrospectively reviewed from those who underwent percutaneous cholecystostomy from January 2015-Dec 2020. Data collected included demographic details, symptom presentation, requirement of ITU admissions, details of cholecystostomy, post-operative complications from the tube, outcomes following PC, and mortality rates within 30 days of the procedure. Patients were graded by their severity of their cholecystitis according to the 2018 Tokyo Guidelines, and these were correlated with morbidity and mortality outcomes within 1 year of the procedure. Results There were 55 females and 65 males, with a mean age of 75.2 years (range 45-96 years). Approximately 45% of patients were diabetic and had comorbidities. On presentation, 54% (65/120) patients had elevated inflammatory markers (WCC/CRP), and 20% of patients had associated deranged liver function tests. Majority of patients had moderate or severe acute cholecystitis, with over 25% (31/120) of patients presenting with sepsis, and 6 required admission to intensive care. The median time from diagnosis of acute cholecystitis to percutaneous cholecystostomy was 8.5 days (range 1-64 days). Tube removal was performed after a median time of 31 days (range 1-142 days). Morbidity rate was observed to be 8-10%, comprising of complications such as tube displacement, leakage around the drain, bleeding and liver abscesses. Only 18.3% (22/120) of patients were deemed to be fit for further surgical intervention, of which 13 of those underwent a cholecystectomy thereafter. Unsurprisingly, 38% of these patients had recurrent biliary symptoms, and a 30% mortality rate.   Conclusions Percutaneous cholecystostomy is a safe option in high-risk surgical patients for symptom relief, and is a crucial step in temporizing and de-escalating sepsis. However, this study suggests that timing of cholecystostomy removal is variable, and is associated with high morbidity. Consideration needs to be given to shorten the time to tube removal, to minimise risks, if certain criteria are met to ensure safety and efficacy.

scholarly journals Heterotopic caval valve implantation for the management of severe tricuspid regurgitation: a case series

2020 ◽  
Author(s):  
Aidan Sharkey ◽  
Ronny Munoz Acuna ◽  
Kiran Belani ◽  
Ravi K Sharma ◽  
Omar Chaudhary ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Tricuspid Regurgitation ◽  
Surgical Intervention ◽  
Symptom Relief ◽  
Vena Cava ◽  
Case Series ◽  
High Morbidity ◽  
Severe Tricuspid Regurgitation ◽  
Maximal Medical Therapy ◽  
Valve Implantation

Abstract Background Severe tricuspid regurgitation (TR) is a complex condition that can be difficult to treat medically, and often surgical intervention is prohibited due to the high morbidity and mortality associated with this intervention. In patients who have failed maximal medical therapy and have progressive symptoms related to their severe TR, heterotopic caval valve implantation (CAVI) offers potential for symptom relief for these patients. Case summary We present two cases of patients with severe TR with symptoms of heart failure that were refractory to medical therapy. Due to extensive comorbidities in these patient’s surgical intervention was deemed unsuitable and the decision was made to proceed with heterotopic CAVI in order to try and control their symptoms. Both patients successfully underwent the procedure and had an Edwards SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) implanted in the inferior vena cava/right atrium junction. In both patients, there was improvement in the postoperative haemodynamics as measured by invasive and non-invasive methods. Successful discharge was achieved in both patients with improvement in their symptoms. Discussion Selective use of heterotopic CAVI to treat symptomatic severe TR that is refractory to medical therapy may be a viable option to improve symptoms in those patients that are unsuitable for surgical intervention.

Percutaneous cholecystostomy for high-risk patients with acute cholecystitis

2005 ◽  
Vol 19 (9) ◽  
pp. 1256-1259 ◽  
Author(s):  
K. Welschbillig-Meunier ◽  
P. Pessaux ◽  
J. Lebigot ◽  
E. Lermite ◽  
Ch. Aube ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Is percutaneous cholecystostomy acceptable as a bridge treatment for acute cholecystitis in high risk patients who has a biliary problem?

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S334
Author(s):  
Kwangyeol Paik ◽  
Ji Seon Oh ◽  
Chul Seung Lee ◽  
Sung Hoon Yoon ◽  
Dong Do You
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Risk Patients

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

Percutaneous cholecystostomy to treat acute cholecystitis in patients with high risk for surgery

2016 ◽  
Vol 58 (2) ◽  
pp. 136-144
Author(s):  
R. Cortázar García ◽  
P. Sánchez Rodríguez ◽  
M. Ramos García
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Percutaneous Cholecystostomy

scholarly journals Long-term outcome following percutaneous cholecystostomy in high-risk patients with acute cholecystitis

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e669
Author(s):  
V. Costas-Fernandez ◽  
S. Cea-Pereira ◽  
M. Casal-Rivas ◽  
E. Casal-Nuñez ◽  
F. Ausania
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals APACHE IV system helps to determine cholecystostomy role in elderly patients with acute cholecystitis

2020 ◽  
Author(s):  
Hua Jiang ◽  
Guo Guo ◽  
Zhimin Yao ◽  
Yuehua Wang
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Therapeutic Effect ◽  
Scoring System ◽  
Scoring Systems ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Before And After ◽  
Risk Patients ◽  
Apache Iv

Abstract Background Cholecystostomy offers an alternative method for patients unfit to undergo immediate cholecystectomy. Nevertheless, the role of cholecystostomy in the clinical management of high-risk surgical patients remains unclear. One of the main problems concerning the therapeutic effect in critically ill patients with acute cholecystitis is the lack of validated, well-established scoring systems to stratify the severity of patient disease states. APACHE IV scoring system was useful to estimate the hospital mortality for high-risk patients. We try to evaluate the performance of the APACHE IV scoring system in patients over 65 years of age with acute cholecystitis and the therapeutic effect of percutaneous cholecystostomy. Methods 597 patients over 65 years of age with acute cholecystitis between January 2011 and December 2018 were retrospectively analyzed with the APACHE IV scores. Results Among the 597 patients, 52 successfully underwent cholecystectomy (2 died, 3.85%), 65 underwent percutaneous cholecystostomy (1 died, 1.54%), and 480 received conservative therapy (27 died, 5.63%). The fitness of the APACHE IV score prediction is good with the area under the ROC curve of 0.894. The APACHE IV models were well-calibrated (with the Hosmer-Lemeshow statistic). Using the method of binary regression analysis, for the patients whose estimated mortality rate was more than 10%, cholecystostomy was an important factor for prognosis (P = 0.048). The estimated mortality of PC patients before and after operation was compared, which indicated that the estimated mortality after puncture was significantly decreased, either in the whole patient group (P = 0.004) or in the group with an estimated mortality greater than 10% (P = 0.008). Conclusion The APACHE IV scoring system showed that cholecystostomy was a safe and effective treatment for elderly high-risk patients with acute cholecystitis.

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