scholarly journals Percutaneous cholecystostomy: a nonsurgical therapeutic option for acute cholecystitis in high-risk and critically ill patients

2003 ◽  
Vol 121 (6) ◽  
pp. 260-262 ◽  
Author(s):  
Guilherme de Castro Dabus ◽  
Sérgio San Juan Dertkigil ◽  
Jamal Baracat
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Option ◽  
Invasive Procedure ◽  
Acalculous Cholecystitis ◽  
Definitive Treatment ◽  
Distinct Advantage ◽  
Percutaneous Cholecystostomy

Percutaneous cholecystostomy offers a potentially important type of therapy for critically ill patients with acute cholecystitis who present high risk when undergoing laparotomy or laparoscopy under general anesthesia. It offers a distinct advantage for these kinds of patients by avoiding the risks of the surgical intervention. Percutaneous cholecystostomy is a safe and effective minimally invasive procedure with a high success rate and low procedure-related complications. It should be considered not only in temporary management of calculous cholecystitis, but also in definitive treatment in cases of acalculous cholecystitis.

Percutaneous Cholecystostomy Without Interval Cholecystectomy as Definitive Treatment of Acute Cholecystitis in Elderly and Critically Ill Patients

2008 ◽  
Vol 101 (6) ◽  
pp. 586-590 ◽  
Author(s):  
John Griniatsos ◽  
Athanasios Petrou ◽  
Paris Pappas ◽  
Konstantinos Revenas ◽  
Ioannis Karavokyros ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Definitive Treatment ◽  
Percutaneous Cholecystostomy

scholarly journals Percutaneous Cholecystostomy is a Reasonable Alternative for the Treatment of Acute Cholecystitis in Critically Ill Patients: a Single Center Analysis

2019 ◽  
Vol 18 (4) ◽  
pp. 246-253
Author(s):  
Povilas Ignatavicius ◽  
Mindaugas Kiudelis ◽  
Inga Dekeryte ◽  
Deimante Mikuckyte ◽  
Jolita Sasnauskaite ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Critically Ill ◽  
Treatment Option ◽  
Critically Ill Patients ◽  
Definitive Treatment ◽  
Safe Procedure ◽  
Percutaneous Cholecystostomy ◽  
Delayed Cholecystectomy ◽  
Alternative Treatment Option

Background / objective. Laparoscopic cholecystectomy is a safe procedure and the treatment of choice for acute cholecystitis. As an alternative treatment option in critically ill patients percutaneous cholecystostomy (PC) is performed.Methods. Retrospective review of patients who had undergone PC from 2008 to 2017 at the Department of Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics. Patients were reviewed for demographic features, laboratory tests, ASA class, complications, outcomes, hospital stay and mortality rate.Results. Fifty-four patients were included in the study. Forty patients (74%) were ASA III and ten patients (18.5%) – ASA IV. Statistically signi­ficant decrease in white blood cell count (from 14.26±6.61 to 8.65±5.15) and C-reactive protein level (from 226.22±106.60 to 51.91±63.70) following PC was observed. The median hospital stay was 13.06 (range 2–68) days and 30-day mortality rate 13%. There were no deaths directly related to procedure. For eleven patients (20.4%) delayed cholecystectomy was scheduled.Conclusions. PC is a reasonable treatment option for high-risk patients with acute cholecystitis and co-morbidities. It can be used as a temporizing treatment option or as a definitive treatment with a low number of delayed cholecystectomies.

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 Cholecystectomy in the Intensive Care Patient

1998 ◽  
Vol 13 (2) ◽  
pp. 78-84
Author(s):  
John P. Mcgahan
Keyword(s):  
Intensive Care ◽  
Acute Cholecystitis ◽  
Intensive Care Patient ◽  
Acalculous Cholecystitis ◽  
Care Patient ◽  
Definitive Treatment ◽  
Acute Acalculous Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
Diagnostic Dilemma ◽  
Definitive Therapy

The diagnosis of acute cholecystitis in the intensive care patient is often problematic. While most patients with acute cholecystitis present with fever, increased white count, or symptomatology pertaining to the gallbladder, occasionally these patients may be comatose and often present a diagnostic dilemma. Surgical cholecystectomy is the treatment of choice for acute cholecystitis, but this therapy carries with it a high mortality rate in the desperately ill patient. Thus surgical cholecystostomy has been advocated as a temporizing procedure to be performed until these patients stabilize. More recently percutaneous cholecystostomy, performed at the patient's bedside under ultrasound guidance, has been successfully performed using small-size catheters. This is a low-risk temporizing procedure when performed by well-trained personnel. In fact, percutaneous cholecystostomy has been shown to be a definitive treatment in patients with acute acalculous cholecystitis. Patients with calculous cholecystitis may require more definitive therapy, such as cholecystectomy. Presented is a review of the development and the current applications of percutaneous cholecystostomy in intensive care patients with suspected acute cholecystitis.

Percutaneous cholecystostomy in critically ill patients with acute cholecystitis: Complications and late outcome

2014 ◽  
Vol 69 (6) ◽  
pp. e247-e252 ◽  
Author(s):  
E. Atar ◽  
G.N. Bachar ◽  
S. Berlin ◽  
C. Neiman ◽  
E. Bleich-Belenky ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Percutaneous Cholecystostomy ◽  
Late Outcome

scholarly journals Acalculous Acute Cholecystitis in Previously Healthy Children: General Overview and Analysis of Pediatric Infectious Cases

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Dimitri Poddighe ◽  
Matteo Tresoldi ◽  
Amelia Licari ◽  
Gian Luigi Marseglia
Keyword(s):  
Infectious Diseases ◽  
Acute Cholecystitis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pediatric Population ◽  
Acalculous Cholecystitis ◽  
Clinical Aspects ◽  
Acute Acalculous Cholecystitis ◽  
Healthy Children ◽  
General Overview

Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder, which does not appear to be associated with the presence of gallstones. AAC is estimated to represent more than 50% of cases of acute cholecystitis in the pediatric population. Although this pathology was initially described in critically ill patients, actually most pediatric cases have been observed during several infectious diseases. Particularly, here we reviewed pediatric infectious acute acalculous cholecystitis and analyzed the pathophysiological and clinical aspects of bacterial and viral forms.

scholarly journals Recent advances in management of acalculous cholecystitis

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1660 ◽  
Author(s):  
Bryan Balmadrid
Keyword(s):  
Gastrointestinal Tract ◽  
High Risk ◽  
Critically Ill ◽  
Acalculous Cholecystitis ◽  
Gallbladder Perforation ◽  
Percutaneous Cholecystostomy ◽  
Imaging Findings ◽  
Metal Stent ◽  
Ultrasound Guided ◽  
Life Threatening

Acalculous cholecystitis is a life-threatening gallbladder infection that typically affects the critically ill. A late diagnosis can have devastating outcomes because of the high risk of gallbladder perforation if untreated. The diagnosis is not straightforward as Murphy’s sign is difficult to illicit in the critically ill and many imaging findings are either insensitive or non-specific. This article reviews the current imaging literature to improve the interpretation of findings. Management involves a percutaneous cholecystostomy, surgical cholecystectomy, or more recently an endoscopically placed metal stent through the gastrointestinal tract into the gallbladder. This article reviews the current literature assessing the outcomes of each treatment option and suggests a protocol in determining the modality of choice on the basis of patient population. Specifically, endoscopic ultrasound-guided gallbladder drainage is a novel drainage approach for patients who are poor candidates for surgery and obviates the need for a percutaneous drain and all its complications. It has promising results but has caveats in its uses.

scholarly journals Percutaneous Cholecystostomy for Severe Acute Cholecystitis: A Useful Procedure in High-Risk Patients for Surgery

2018 ◽  
Vol 108 (2) ◽  
pp. 124-129 ◽  
Author(s):  
S. Aroori ◽  
C. Mangan ◽  
L. Reza ◽  
N. Gafoor
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Length Of Hospital Stay ◽  
Acalculous Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Risk Patients ◽  
Physiological Reserve ◽  
American Society

Background: Acute cholecystitis has the potential to cause sepsis and death, particularly in patients with poor physiological reserve. The gold standard treatment of acute cholecystitis (cholecystectomy) is often not safe in high-risk patients and recourse is made to percutaneous cholecystostomy as either definite treatment or temporizing measure. The aim of this study is to evaluate early and late outcomes following percutaneous cholecystostomy in patients with acute cholecystitis treated at our institution. Methods: All patients who underwent percutaneous cholecystostomy for acute cholecystitis (excluding patients with malignancy) between January 2005 and September 2014 were included in the study. Results: A total of 53 patients (22 female, median age, 74 years; range, 27–95 years) underwent percutaneous cholecystostomy during the study period. In total, 12 patients (22.6%) had acalculous cholecystitis. The main indications for percutaneous cholecystostomy were significant co-morbidities (n = 28, 52.8%) and patients too unstable for surgery (n = 21, 39.6%). The median time to percutaneous cholecystostomy from diagnosis of acute cholecystitis was 3.6 days (range, 0–45 days). The median length of hospital stay was 27 (range, 4–87) days. The overall 90-day mortality was 9.3% with two further deaths at 12-month follow up. The mortality was significantly higher in patients with American Society of Anesthesiology grade 4–5 (18% vs 0% in American Society of Anesthesiology grade 2–3, p = 0.026) and in patients with acalculous cholecystitis (25% vs 4.5%, p = 0.035). The overall readmission rate was 18%. A total of 24 (45.2%) patients had surgery: laparoscopic cholecystectomy, n = 11; laparoscopic converted to open, n = 5; open total cholecystectomy, n = 5; open cholecystectomy, n = 1; laparotomy and washout, n = 1; laparotomy partial cholecystectomy and closure of perforated small intestine and gastrostomy, n = 1. Conclusion: Percutaneous cholecystostomy is a useful temporary or permanent procedure in patients with acute cholecystitis of both calculous and acalculous origin, who are unfit for surgery.

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