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Asian Journal of Surgery Apr 2023The lack of a specific biomarker that can be used in the diagnosis of acute cholecystitis, a common cause of admission to the emergency department, delays physician...
BACKGROUND
The lack of a specific biomarker that can be used in the diagnosis of acute cholecystitis, a common cause of admission to the emergency department, delays physician efforts to diagnose and treat these patients. Therefore, the aim of this study was to measure plasma YKL-40 levels and investigate their diagnostic value in patients with acute cholecystitis (AC).
METHODS
This study was carried out between February 2020 and September 2020 in the adult emergency department of a tertiary university hospital. Permission was obtained from the Ethics Committee of Scientific Research on 03/02/2020 with Decision No. 03/16. The study included 80 patients who were diagnosed with acute cholecystitis and 80 healthy volunteers without known chronic diseases.
RESULTS
The median YKL-40 protein level was 798.66 pq/mL in the patient group and 392.45 pq/mL in the control group. A statistically significant difference in YKL-40 protein levels was found between the two groups. YKL-40 protein levels were significantly higher in patients diagnosed with acute cholecystitis than in healthy individuals (p < 0.001). A positive correlation was found between YKL-40 protein levels and ALT, AST, LDH, and GGT levels (r = 0.272, p = 0.015; r = 0.397, p < 0.001; r = 0.386, p < 0.001; and r = 0.264, p = 0.018; respectively).
CONCLUSION
When evaluated together with physical examination, radiological imaging and other laboratory parameters, we think that plasma YKL-40 levels can be used effectively in the diagnosis of acute cholecystitis.
Topics: Adult; Humans; Chitinase-3-Like Protein 1; Biomarkers; Hospitalization; Chronic Disease; Cholecystitis, Acute
PubMed: 36241524
DOI: 10.1016/j.asjsur.2022.09.073 -
HPB : the Official Journal of the... Sep 2014Gangrenous cholecystitis (GC) is often challenging to treat. The objectives of this study were to determine the accuracy of pre-operative diagnosis, to assess the rate...
BACKGROUND
Gangrenous cholecystitis (GC) is often challenging to treat. The objectives of this study were to determine the accuracy of pre-operative diagnosis, to assess the rate of post-cholecystectomy complications and to assess models to predict GC.
METHODS
A retrospective single-institution review identified patients undergoing a cholecystectomy. Logistic regression models were used to examine the association of variables with GC and to build risk-assessment models.
RESULTS
Of 5812 patients undergoing a cholecystectomy, 2219 had acute, 4837 chronic and 351 GC. Surgeons diagnosed GC pre-operatively in only 9% of cases. Patients with GC had more complications, including bile-duct injury, increased estimated blood loss (EBL) and more frequent open cholecystectomies. In unadjusted analyses, variables significantly associated with GC included: age >45 years, male gender, heart rate (HR) >90, white blood cell count (WBC) >13,000/mm(3), gallbladder wall thickening (GBWT) ≥ 4 mm, pericholecystic fluid (PCCF) and American Society of Anesthesiology (ASA) >2. In adjusted analyses, age, WBC, GBWT and HR, but not gender, PCCF or ASA remained statistically significant. A 5-point scoring system was created: 0 points gave a 2% probability of GC and 5 points a 63% probability.
CONCLUSION
Using models can improve a diagnosis of GC pre-operatively. A prediction of GC pre-operatively may allow surgeons to be better prepared for a difficult operation.
Topics: Adult; Baltimore; Cholecystectomy; Cholecystitis; Cholecystitis, Acute; Chronic Disease; Decision Support Techniques; Female; Gallbladder; Gangrene; Humans; Male; Middle Aged; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 24635779
DOI: 10.1111/hpb.12226 -
World Journal of Emergency Surgery :... 2019Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The... (Review)
Review
BACKGROUND
Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide.
AIM
The present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population.
MATERIAL AND METHODS
The 2016 WSES guidelines on ACC were used as baseline; six questions have been used to investigate the particularities in elderly population; the answers have been developed in terms of differences compared to the general population and to statements of the 2016 WSES Guidelines. The Consensus Conference discusses, voted, and modified the statements. International experts contributed in the elaboration of final statements and evaluation of the level of scientific evidences.
RESULTS
The quality of the studies available decreases when we approach ACC in elderly. Same admission laparoscopic cholecystectomy should be suggested for elderly people with ACC; frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist. The role of cholecystostomy is uncertain.
DISCUSSION AND CONCLUSIONS
The evaluation of pro and cons for surgery or for alternative treatments in elderly suffering of ACC is more complex than in young people; also, the oldest old age is not a contraindication for surgery; however, a larger use of frailty and surgical risk scores could contribute to reach the best clinical judgment by the surgeon. The present guidelines offer the opportunity to share with the scientific community a baseline for future researches and discussion.
Topics: Aged; Aged, 80 and over; Cholecystitis, Acute; Cholecystostomy; Female; Geriatrics; Guidelines as Topic; Humans; Male
PubMed: 30867674
DOI: 10.1186/s13017-019-0224-7 -
Neurology India 2019Although acute cholecystitis after stroke is rare, an immediate diagnosis and treatment is required.
BACKGROUND
Although acute cholecystitis after stroke is rare, an immediate diagnosis and treatment is required.
MATERIAL AND METHODS
In the past five years, we observed six patients with acute cholecystitis during the initial hospitalization for stroke.
RESULTS
Three patients had cardiac embolism, two had subarachnoid hemorrhage, and one had intra-cerebral hemorrhage. Four had calculous cholecystitis and two had acalculous cholecystitis. One of the patients with acalculous cholecystitis had hemorrhagic cholecystitis. The most commonly presented symptom was fever (50%), whereas only one patient (17%) had abdominal pain. Three patients (50%) were completely asymptomatic.
CONCLUSIONS
Acute cholecystitis and stroke are closely associated, and anti-thromboembolic drugs may cause hemorrhagic cholecystitis. Stroke patients tend to have atherosclerotic risk factors resulting in ischemic injury of the gallbladder. Furthermore, severe hemiparesis, a fasting state, dehydration, or bacteremia, which are occasionally exhibited by stroke patients, are known risk factors for acalculous cholecystitis. Stroke patients, especially patients with aphasia and consciousness disturbance, require immediate abdominal examination, if acute cholecystitis is suspected.
Topics: Acute Disease; Aged; Cholecystitis, Acute; Female; Hospitalization; Humans; Male; Middle Aged; Paresis; Risk Factors; Stroke
PubMed: 31085856
DOI: 10.4103/0028-3886.258055 -
BJS Open May 2022This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.
BACKGROUND
This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.
METHODS
CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality.
RESULTS
This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121).
CONCLUSION
CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic.
Topics: COVID-19; Cholecystectomy; Cholecystitis, Acute; Humans; Pandemics; SARS-CoV-2
PubMed: 35511954
DOI: 10.1093/bjsopen/zrac052 -
Medicina (Kaunas, Lithuania) Apr 2023: Acute cholecystitis (AC) is a common surgical emergency. Recent evidence suggests that serum procalcitonin (PCT) is superior to leukocytosis and serum C-reactive... (Review)
Review
: Acute cholecystitis (AC) is a common surgical emergency. Recent evidence suggests that serum procalcitonin (PCT) is superior to leukocytosis and serum C-reactive protein in the diagnosis and severity stratification of acute infections. This review evaluates the role of PCT in AC diagnosis, severity stratification, and management. : PubMed, Embase, and Scopus were searched from inception till 21 August 2022 for studies reporting the role of PCT in AC. A qualitative analysis of the existing literature was conducted. : Five articles, including 688 patients, were included. PCT ≤ 0.52 ng/mL had fair discriminative ability (Area under the curve (AUC) 0.721, < 0.001) to differentiate Grade 1 from Grade 2-3 AC, and PCT > 0.8 ng/mL had good discriminatory ability to differentiate Grade 3 from 1-2 AC (AUC 0.813, < 0.001). PCT cut-off ≥ 1.50 ng/mL predicted difficult laparoscopic cholecystectomy (sensitivity 91.3%, specificity 76.8%). The incidence of open conversion was higher with PCT ≥ 1 ng/mL (32.4% vs. 14.6%, = 0.013). A PCT value of >0.09 ng/mL could predict major complications (defined as open conversion, mechanical ventilation, and death). : Current evidence is plagued by the heterogeneity of small sample studies. Though PCT has some role in assessing severity and predicting difficult cholecystectomy, and postoperative complications in AC patients, more evidence is necessary to validate its use.
Topics: Humans; Procalcitonin; ROC Curve; C-Reactive Protein; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Biomarkers; Retrospective Studies
PubMed: 37109763
DOI: 10.3390/medicina59040805 -
Acute Cholecystitis Management During the COVID-19 Pandemic - A Systematic Review and Meta-analysis.Polski Przeglad Chirurgiczny Jan 2022<br><b>Aim:</b> The aim of this study is to evaluate the prevalence of acute cholecystitis (AC) and review its possible management options during the... (Meta-Analysis)
Meta-Analysis
<br><b>Aim:</b> The aim of this study is to evaluate the prevalence of acute cholecystitis (AC) and review its possible management options during the COVID-19 pandemic.</br> <br><b>Methods:</b> The present systematic review and meta-analysis was done in accordance with the PRISMA guideline. In August 2021, two independent reviewers reviewed a number of articles with the aim of finding studies on the management of acute cholecystitis during the COVID-19 pandemic. Articles were searched in the Cochrane, Embassies, and Medline libraries. Using the Stata statistical software 14, the estimated pooled rates were calculated. Funnel plot and I2 indices were applied for evaluating the heterogeneity between the studies.</br> <br><b>Results:</b> An overall of 8 studies consisting of 654 patients suspected for AC were included. The prevalence of COVID-19 among our included patients was 82% (95% CI: 79-84%, I2: 99.2%). Regarding the type of management, 35% (95% CI: 26-45%, I2: 46.9%) of patients undergone cholecystectomy, 47% (95% CI: 43-51%, I2: 54.4%) were managed by non-surgical methods, and 19% (95% CI: 14-23%, I2: 68.1%) of patients were treated by percutaneous cholecystostomy. The prevalence of grade 2 and 3 among our patients was 44 and 15%, respectively.</br> <br><b>Conclusions:</b> Considering the fact that due to the current pandemic, the number of patients referring with higher grades is assumed to be increased, early cholecystectomy remains the best management option for AC patients. However, LC seems not to be the most favorable option since it is associated with a relatively higher risk of contamination with COVID-19. PC can also be considered as a temporary and safe method in high-risk patients which might enable us to protect both patients and healthcare providers.</br>.
Topics: COVID-19; Cholecystectomy; Cholecystitis, Acute; Cholecystostomy; Humans; Pandemics
PubMed: 36047359
DOI: 10.5604/01.3001.0015.7099 -
Digestive Surgery 2017In the era of advanced surgical techniques and improved perioperative care, the willingness to perform emergency operations in elderly patients continues to increase.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In the era of advanced surgical techniques and improved perioperative care, the willingness to perform emergency operations in elderly patients continues to increase. This systematic review aimed at assessing the clinical outcomes of early cholecystectomy in elderly patients with acute cholecystitis.
METHODS
Medline, Embase, and Cochrane Library databases were systematically searched for studies reporting on early cholecystectomy for acute cholecystitis in patients aged ≥70 years. The conversion rate, perioperative morbidity, and mortality were calculated using a random-effects model.
RESULTS
Eight articles fell within the scope of this study. In total, 592 patients were identified. The mean age was 81 years. Early cholecystectomy was performed laparoscopically in 316 patients (53%) and open in 276 patients (47%). The procedure was associated with a conversion rate of 23% (95% CI 18.6-28.3), a perioperative morbidity of 24% (95% CI 20.5-27.5), and a mortality of 3.5% (95% CI 2.3-5.4).
CONCLUSION
Early cholecystectomy seems to be a feasible treatment in elderly patients with acute cholecystitis. To reduce morbidity, patients who may benefit from surgery ought to be selected carefully. Future prospective studies should compare early cholecystectomy with alternative treatments to select the treatment that is most appropriate for elderly patients.
Topics: Aged; Aged, 80 and over; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Conversion to Open Surgery; Humans; Length of Stay; Postoperative Complications; Time Factors; Treatment Outcome
PubMed: 28095385
DOI: 10.1159/000455241 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Nov 2022Gallbladder diseases are an important health concern affecting approximately 20% of the population in developed countries. Acute cholecystitis is the most common...
BACKGROUND
Gallbladder diseases are an important health concern affecting approximately 20% of the population in developed countries. Acute cholecystitis is the most common complication of gallstones. The aim of our study is to determine the use of Nesfatin-1, which is an easily applicable and fast resulting and is thought to have an association with inflammatory events, in the diagnosis and grading of acute cholecystitis.
METHODS
Patients who admitted and were hospitalized and treated with the acute cholecystitis diagnosis in İstanbul Training and Research Hospital between July 1, 2020, and December 1, 2020, were included in the study. The patients were divided in threemain groups as mild, moderate, and severe according to Tokyo Guidelines 2018 based on their routine blood tests and imaging results. All patients who are included in the study were tested for their blood leukocyte, neutrophil, lymphocyte, Nesfatin-1 levels, and neutrophil/lymphocyte ratios within the first 24 h of their hospitalization.
RESULTS
With at least 15 patients in each group, 61 volunteers in total were included in the study as healthy volunteers, mild, moderate, and severe cholecystitis. The average age of the participants were 58.11±19.76 years. About 47.54% of the participants were female and 52.46% weremale. In the study, Nesfatin-1 levels in the patient groups were found to be lower than the control group. In the subgroup analyzes, Nesfatin-1 values in the middle patient group were found to be significantly lower than the control group; however, there was no statistically significant relationship between the severity of the disease and Nesfatin-1.
CONCLUSION
Nesfatin-1 may guide the clinician for the diagnosis of the disease; however, no significant relationship was found between Nesfatin-1 and the severity or stage of the disease.
Topics: Humans; Female; Adult; Middle Aged; Aged; Male; Prognosis; Cholecystitis, Acute; Gallstones; Lymphocytes; Neutrophils
PubMed: 36282155
DOI: 10.14744/tjtes.2021.05694 -
World Journal of Surgery Nov 2018The use of ultrasound (US) outside the radiology department has increased the last decades, but large studies assessing the quality of bedside US are still lacking. This... (Observational Study)
Observational Study
BACKGROUND
The use of ultrasound (US) outside the radiology department has increased the last decades, but large studies assessing the quality of bedside US are still lacking. This study evaluates surgeon-performed US (SPUS) and radiologist-performed US (RPUS) with respect to biliary disease and appendicitis.
METHODS
Between October 2011 and November 2012, 300 adult patients, with a referral for an abdominal US, were prospectively enrolled in the study and examined by a radiologist as well as a surgeon. The surgeons had undergone a 4-week-long US education. US findings of the surgeon and of the radiologist were compared to final diagnosis, set by an independent external observer going through each patient's chart.
RESULTS
Among 183 patients with suspected biliary disease, 74 had gallstones and 21 had acute cholecystitis. SPUS and RPUS diagnosed gallstones with a sensitivity of 87.1 versus 97.3%. Specificity was 96.0 versus 98.9%, and the accuracy 92.3 versus 98.2%. The sensitivity, specificity and accuracy for acute cholecystitis by SPUS and RPUS were: 60.0 versus 80.0%, 98.6 versus 97.8% and 93.9 versus 95.6%, respectively. Among 58 patients with suspected appendicitis, 15 had the disease. The sensitivity, specificity and accuracy for appendicitis by SPUS and RPUS were: 53.3 versus 73.3%, 89.7 versus 93.3% and 77.3 versus 86.7%, respectively.
CONCLUSION
SPUS is reliable in diagnosing gallstones. Diagnosing cholecystitis and appendicitis with US is more challenging for both surgeons and radiologists.
TRIAL REGISTRATION NUMBER
The study was registered at clinicaltrials.gov. Registration number: NCT02469935.
Topics: Adult; Aged; Aged, 80 and over; Appendicitis; Cholecystitis, Acute; Female; Gallstones; Humans; Male; Middle Aged; Prospective Studies; Radiologists; Sensitivity and Specificity; Surgeons; Ultrasonography; Young Adult
PubMed: 29882098
DOI: 10.1007/s00268-018-4673-z