Optimal timing of cholecystectomy after necrotising biliary pancreatitis

Gut ◽  
2021 ◽  
pp. gutjnl-2021-324239
Author(s):  
Nora D Hallensleben ◽  
Hester C Timmerhuis ◽  
Robbert A Hollemans ◽  
Sabrina Pocornie ◽  
Janneke van Grinsven ◽  
...  
Keyword(s):  
Risk Ratio ◽  
Endoscopic Sphincterotomy ◽  
Primary Outcome ◽  
Optimal Timing ◽  
Biliary Pancreatitis ◽  
Limited Evidence ◽  
Infected Necrosis ◽  
Optimal Point ◽  
Timing Of Cholecystectomy ◽  
Post Hoc

ObjectiveFollowing an episode of acute biliary pancreatitis, cholecystectomy is advised to prevent recurrent biliary events. There is limited evidence regarding the optimal timing and safety of cholecystectomy in patients with necrotising biliary pancreatitis.DesignA post hoc analysis of a multicentre prospective cohort. Patients with biliary pancreatitis and a CT severity score of three or more were included in 27 Dutch hospitals between 2005 and 2014. Primary outcome was the optimal timing of cholecystectomy in patients with necrotising biliary pancreatitis, defined as: the optimal point in time with the lowest risk of recurrent biliary events and the lowest risk of complications of cholecystectomy. Secondary outcomes were the number of recurrent biliary events, periprocedural complications of cholecystectomy and the protective value of endoscopic sphincterotomy for the recurrence of biliary events.ResultsOverall, 248 patients were included in the analysis. Cholecystectomy was performed in 191 patients (77%) at a median of 103 days (P25–P75: 46–222) after discharge. Infected necrosis after cholecystectomy occurred in four (2%) patients with persistent peripancreatic collections. Before cholecystectomy, 66 patients (27%) developed biliary events. The risk of overall recurrent biliary events prior to cholecystectomy was significantly lower before 10 weeks after discharge (risk ratio 0.49 (95% CI 0.27 to 0.90); p=0.02). The risk of recurrent pancreatitis before cholecystectomy was significantly lower before 8 weeks after discharge (risk ratio 0.14 (95% CI 0.02 to 1.0); p=0.02). The complication rate of cholecystectomy did not decrease over time. Endoscopic sphincterotomy did not reduce the risk of recurrent biliary events (OR 1.40 (95% CI 0.74 to 2.83)).ConclusionThe optimal timing of cholecystectomy after necrotising biliary pancreatitis, in the absence of peripancreatic collections, is within 8 weeks after discharge.

Optimal timing of cholecystectomy after necrotising biliary pancreatitis

Pancreatology ◽  
2021 ◽  
Vol 21 ◽  
pp. S11-S12
Author(s):  
H. Timmerhuis ◽  
N. Hallensleben ◽  
R. Hollemans ◽  
S. Pocornie ◽  
J. van Grinsven ◽  
...  
Keyword(s):  
Optimal Timing ◽  
Biliary Pancreatitis ◽  
Timing Of Cholecystectomy

scholarly journals Optimal timing of cholecystectomy after necrotising biliary pancreatitis

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S817-S818
Author(s):  
H. Timmerhuis ◽  
N. Hallensleben ◽  
R. Hollemans ◽  
S. Pocornie ◽  
J. van Grinsven ◽  
...  
Keyword(s):  
Optimal Timing ◽  
Biliary Pancreatitis ◽  
Timing Of Cholecystectomy

Safety of early anticoagulation in patients treated with urgent reperfusion for acute ischemic stroke related to non-valvular atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Giustozzi
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Major Bleeding ◽  
Oral Anticoagulation ◽  
Primary Outcome ◽  
Oral Anticoagulants ◽  
Early Recurrence ◽  
Optimal Timing ◽  
Hemorrhagic Event

Abstract Background The optimal timing for starting anticoagulation after an acute ischemic stroke related to non-valvular atrial fibrillation (AF) remains a challenge, especially in patients treated with systemic thrombolysis or mechanical thrombectomy. Purpose We aimed to assess the rates of early recurrence and major bleeding in patients with acute ischemic stroke and AF treated with thrombolytic therapy and/or thrombectomy who received oral anticoagulants for secondary prevention. Methods We combined the dataset of the RAF and the RAF-NOACs studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. We included consecutive patients with acute ischemic stroke and AF treated with either vitamin K antagonists (VKAs) or new oral anticoagulants (NOACs). Primary outcome was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding within 90 days from the inclusion. Results A total of 2,159 patients were included in the RAF and RAF-NOACs trials, of which 564 patients (26%) were treated with urgent reperfusion therapy. After acute stroke, 505 (90%) patients treated with reperfusion and 1,287 out of the 1,595 (81%) patients not treated with reperfusion started oral anticoagulation. Timing of starting oral anticoagulation was similar in reperfusion-treated and untreated patients (13.5±23.3 vs 12.3±18.3 days, respectively, p=0.287). At 90 days, the composite rate of recurrence and major bleeding occurred in 37 (7%) of patients treated with reperfusion treatment and in 139 (9%) of untreated patients (p=0.127). Twenty-four (4%) reperfusion-treated patients and 82 (5%) untreated patients had early recurrence while major bleeding occurred in 13 (2%) treated and in 64 (4%) untreated patients, respectively. Seven patients in the untreated group experienced both an ischemic and hemorrhagic event. Figure 1 shows the risk of early recurrence and major bleeding over time in patients treated and not treated with reperfusion treatments. The use of NOACs was associated with a favorable rate of the primary outcome compared to VKAs (Odd ratio 0.4, 95% Confidence Interval 0.3–0.7). Conclusions Reperfusion treatment did not influence the risk of early recurrence and major bleeding in patients with AF-related acute ischemic stroke who started anticoagulant treatment. Figure 1 Funding Acknowledgement Type of funding source: None

545 Outcomes of Patients With Non-Severe Biliary Pancreatitis With or Without Endoscopic Sphincterotomy During the First Hospitalization Undergoing Delayed Cholecystectomy

2017 ◽  
Vol 85 (5) ◽  
pp. AB80-AB81
Author(s):  
Santi Kulpatcharapong ◽  
Panida Piyachaturawat ◽  
Wiriyaporn Ridtitid ◽  
Phonthep Angsuwatcharakon ◽  
Pradermchai Kongkam ◽  
...  
Keyword(s):  
Endoscopic Sphincterotomy ◽  
Biliary Pancreatitis ◽  
Delayed Cholecystectomy

scholarly journals Mo1577 Timing of Cholecystectomy in Children With Biliary Pancreatitis, Early Versus Delayed Surgery: A Single Pediatric Center Review

2014 ◽  
Vol 146 (5) ◽  
pp. S-1056 ◽  
Author(s):  
Tom K. Lin ◽  
Joseph J. Palermo ◽  
Jaimie D. Nathan ◽  
Greg M. Tiao ◽  
Maisam Abu-El-Haija
Keyword(s):  
Biliary Pancreatitis ◽  
Delayed Surgery ◽  
Timing Of Cholecystectomy ◽  
Pediatric Center

scholarly journals Algorithm for the Diagnosis and Treatment of Acute Biliary Pancreatitis

2005 ◽  
Vol 94 (2) ◽  
pp. 124-129 ◽  
Author(s):  
N. Alexakis ◽  
J. P. Neoptolemos
Keyword(s):  
Endoscopic Sphincterotomy ◽  
Severe Disease ◽  
Developed Countries ◽  
Needle Aspiration ◽  
Evidence Base ◽  
Infected Necrosis ◽  
Mild Disease ◽  
Long Term Follow Up ◽  
Clinically Significant ◽  
High Level

Gallstones are the commonest cause of acute pancreatitis in developed countries. There is now a considerable evidence base consolidated by a series of systematic reviews, metaanalyses and guidelines that has established a clear algorithm for diagnosis and management. In the majority of patients the combination of ultrasonography and serum alanine transaminase <60 iu/l >48 hours of symptoms will identify gallstones as the cause. The simplest method of severity assessment is a high level of serum C-reactive protein (> 150 mg/l up to 72 hours after symptoms). In mild disease, all fit patients must undergo laparoscopic cholecystectomy with intraoperative cholangiography or if not fit for surgery then endoscopic sphincterotomy during the same admission to prevent further attacks. All patients with severe disease should undergo endoscopic sphincterotomy in less than 72 hours. Patients with >30% necrosis should undergo fine needle aspiration for bacteriology. Necrosectomy is indicated for infected necrosis or sterile necrosis if there are persisting clinically significant symptoms. There is increasing evidence for the use of minimally invasive pancreatic necrosectomy. Enteral nutrition should be instituted whenever possible but antibiotics should be reserved for patients with proven sepsis. The presence of fungal infection requires active anti-fungal therapy. Patients with severe disease should undergo cholecystectomy at a later stage. Patients who have undergone necrosectomy require long-term follow-up because of delayed complications.

scholarly journals Timing of Antenatal Corticosteroid Administration in Monoamniotic Twins

2019 ◽  
Vol 09 (02) ◽  
pp. e153-e159
Author(s):  
Carolina Bibbo ◽  
Sarah Easter ◽  
Michael Saadeh ◽  
Sarah Little ◽  
Julian Robinson
Keyword(s):  
Generalized Estimating Equations ◽  
Primary Outcome ◽  
Fetal Heart ◽  
Clinical Status ◽  
Fetal Monitoring ◽  
Optimal Timing ◽  
Antenatal Corticosteroid ◽  
Single Institution ◽  
Corticosteroid Administration ◽  
Univariate Analyses

Objective This study was aimed to determine if different strategies of antenatal corticosteroid (ACS) administration in monoamniotic twins leads to receipt within 7 days of delivery. Study Design This is a retrospective cohort of monoamniotic twins managed at a single institution from 2007 to 2017. Patients were classified as to whether ACS were administered upon admission or at a predetermined gestational age (grouped together as “routine”) or for a change in clinical status (“indicated”). We used univariate analyses to associate ACS administration strategies with our primary outcome: receipt of ACS within 7 days of delivery. We then used generalized estimating equations to examine associations between fetal monitoring patterns and delivery within 1 week. Results Twenty-four patients were included: eighteen patients in the “routine” group and six patients in the “indicated” group. There was no difference in optimal timing of ACS administration. Women experiencing delivery within the week were thrice more likely to spend on average more than 3 hours/day on the fetal monitor when compared with those who remained undelivered. Conclusion Administration of ACS on admission is not effective. Fetal heart rate tracing surveillance might be a better methodology to predict delivery and guide ACS administration.

scholarly journals P092: Combatting sedentary lifestyles; can exercise prescriptions in the emergency department lead to a behavioural change in patients?

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S89-S89
Author(s):  
D. Lewis ◽  
K. Leech-Porter ◽  
F. Milne ◽  
J. Fraser ◽  
S. Hull ◽  
...  
Keyword(s):  
Emergency Department ◽  
Primary Outcome ◽  
Exercise Prescription ◽  
Behavioural Change ◽  
Significant Proportion ◽  
Intervention Group ◽  
Routine Care ◽  
Control Group ◽  
Post Hoc

Introduction: Patients with chronic diseases are known to benefit from exercise. Such patients often visit the emergency department (ED). There are few studies examining prescribing exercise in the ED. We wished to study if exercise prescription in the ED is feasible and effective. Methods: In this pilot prospective block randomized trial, patients in the control group received routine care, whereas the intervention group received a combined written and verbal prescription for moderate exercise (150 minutes/week). Both groups were followed up by phone at 2 months. The primary outcome was achieving 150 min of exercise per week. Secondary outcomes included change in exercise, and differences in reported median weekly exercise. Comparisons were made by Mann-Whitney and Fishers tests (GraphPad). Results: Follow-up was completed for 22 patients (11 Control; 11 Intervention). Baseline reported median (with IQR) weekly exercise was similar between groups; Control 0(0-0)min; Intervention 0(0-45)min. There was no difference between groups for the primary outcome of 150 min/week at 2 months (Control 3/11; Intervention 4/11, RR 1.33 (95%CI 0.38-4.6;p=1.0). There was a significant increase in median exercise from baseline in both groups, but no difference between the groups (Control 75(10-225)min; Intervention 120(52.5-150)min;NS). 3 control patients actually received exercise prescription as part of routine care. A post-hoc comparison of patients receiving intervention vs. no intervention, revealed an increase in patients meeting the primary target of 150min/week (No intervention 0/8; Intervention 7/14, RR 2.0 (95%CI 1.2-3.4);p=0.023). Conclusion: Recruitment was feasible, however our study was underpowered to quantify an estimated effect size. As a significant proportion of the control group received the intervention (as part of standard care), any potential measurable effect was diluted. The improvement seen in patients receiving intervention and the increase in reported exercise in both groups (possible Hawthorne effect) suggests that exercise prescription for ED patients may be beneficial.

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