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JAMA Mar 2022Gallbladder disease affects approximately 20 million people in the US. Acute cholecystitis is diagnosed in approximately 200 000 people in the US each year. (Review)
Review
IMPORTANCE
Gallbladder disease affects approximately 20 million people in the US. Acute cholecystitis is diagnosed in approximately 200 000 people in the US each year.
OBSERVATIONS
Gallstone-associated cystic duct obstruction is responsible for 90% to 95% of the cases of acute cholecystitis. Approximately 5% to 10% of patients with acute cholecystitis have acalculous cholecystitis, defined as acute inflammation of the gallbladder without gallstones, typically in the setting of severe critical illness. The typical presentation of acute cholecystitis consists of acute right upper quadrant pain, fever, and nausea that may be associated with eating and physical examination findings of right upper quadrant tenderness. Ultrasonography of the right upper quadrant has a sensitivity of approximately 81% and a specificity of approximately 83% for the diagnosis of acute cholecystitis. When an ultrasound result does not provide a definitive diagnosis, hepatobiliary scintigraphy (a nuclear medicine study that includes the intravenous injection of a radiotracer excreted in the bile) is the gold standard diagnostic test. Following diagnosis, early (performed within 1-3 days) vs late (performed after 3 days) laparoscopic cholecystectomy is associated with improved patient outcomes, including fewer composite postoperative complications (11.8% for early vs 34.4% for late), a shorter length of hospital stay (5.4 days vs 10.0 days), and lower hospital costs. During pregnancy, early laparoscopic cholecystectomy, compared with delayed operative management, is associated with a lower risk of maternal-fetal complications (1.6% for early vs 18.4% for delayed) and is recommended during all trimesters. In people older than 65 years of age, laparoscopic cholecystectomy is associated with lower mortality at 2-year follow-up (15.2%) compared with nonoperative management (29.3%). A percutaneous cholecystostomy tube, in which a drainage catheter is placed in the gallbladder lumen under image guidance, is an effective therapy for patients with an exceptionally high perioperative risk. However, percutaneous cholecystostomy tube placement in a randomized trial was associated with higher rates of postprocedural complications (65%) compared with laparoscopic cholecystectomy (12%). For patients with acalculous acute cholecystitis, percutaneous cholecystostomy tube should be reserved for patients who are severely ill at the time of diagnosis; all others should undergo a laparoscopic cholecystectomy.
CONCLUSIONS AND RELEVANCE
Acute cholecystitis, typically due to gallstone obstruction of the cystic duct, affects approximately 200 000 people in the US annually. In most patient populations, laparoscopic cholecystectomy, performed within 3 days of diagnosis, is the first-line therapy for acute cholecystitis.
Topics: Anti-Bacterial Agents; Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Cholelithiasis; Female; Gallbladder; Humans; Pregnancy; Pregnancy Complications; Risk Factors
PubMed: 35258527
DOI: 10.1001/jama.2022.2350 -
The Korean Journal of Gastroenterology... May 2018Acute cholecystitis is a common serious complication of gallstones. The reported mortality of acute cholecystitis is approximately 3%, but the rate increases with age or... (Review)
Review
Acute cholecystitis is a common serious complication of gallstones. The reported mortality of acute cholecystitis is approximately 3%, but the rate increases with age or comorbidity of the patient. If appropriate treatment is delayed, complications can develop as a consequence with a grave prognosis. The current standard of care in acute cholecystitis is an early laparoscopic cholecystectomy with the appropriate administration of fluid, electrolyte, and antibiotics. On the other hand, the severity of the disease and patient's operational risk must be considered. In those with high operational risks, gall bladder drainage can be performed as an alternative. Currently percutaneous and endoscopic drainage are available and show clinical success in most cases. After recovering from acute cholecystitis, the patients who have undergone drainage should be considered for cholecystectomy as a definitive treatment. However, in elderly patients or patients with significant comorbidity, operational risks may still be high, making cholecystectomy inappropriate. In these patients, gallstone removal using the percutaneous tract or endoscopy may be considered.
Topics: Anti-Bacterial Agents; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Drainage; Electrolytes; Gallbladder; Humans
PubMed: 29791985
DOI: 10.4166/kjg.2018.71.5.264 -
BMJ Clinical Evidence Aug 2014Of people admitted to hospital for biliary tract disease, 20% have acute cholecystitis. Up to the age of 50 years, acute calculous cholecystitis is three times more... (Review)
Review
INTRODUCTION
Of people admitted to hospital for biliary tract disease, 20% have acute cholecystitis. Up to the age of 50 years, acute calculous cholecystitis is three times more common in women than in men, and about one and a half times more common in women than in men thereafter. About 95% of people with acute cholecystitis have gallstones. Optimal therapy for acute cholecystitis, based on timing and severity of presentation, remains controversial.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute cholecystitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 18 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: early cholecystectomy, laparoscopic cholecystectomy, observation alone, open cholecystectomy, and percutaneous cholecystostomy.
Topics: Cholecystectomy; Cholecystitis, Acute; Gallstones; Humans
PubMed: 25144428
DOI: No ID Found -
JAMA Apr 2022
Topics: Acute Disease; Cholecystitis; Cholecystitis, Acute; Humans
PubMed: 35258523
DOI: 10.1001/jama.2022.2969 -
Cirugia Y Cirujanos 2021Acute calculous cholecystitis (AC) is one of the most frequent surgical emergencies in our field. Laparoscopic cholecystectomy is considered the treatment of choice,... (Observational Study)
Observational Study
BACKGROUND
Acute calculous cholecystitis (AC) is one of the most frequent surgical emergencies in our field. Laparoscopic cholecystectomy is considered the treatment of choice, although not sufficiently widespread.
OBJECTIVE
To analyze the application of the Tokyo Guidelines in the management of AC and to determine the influence of the degree of severity on management and prognosis.
METHOD
Prospective, observational study of patients with a primary diagnosis of AC between 2010 and 2015.. Exclusion criteria: AC recurrence; AC as a secondary diagnosis; acalculous cholecystitis; concurrent biliary pathology. Severity was classified according Tokyo 2013 Guidelines.
RESULTS
998 patients were included: 338 (33.9%) mild AC, 567 (56.8%) moderate AC, and 93 (9.3%) severe AC. A total of 582 (58.3%) patients were operated on. Postoperative complications Dindo-Clavien grade ≥ II 12.6%: mild AC 3.6%; moderate AC 12.2%; severe AC 49.0% (p < 0.001). Overall mortality 2%: mild AC 0%; moderate AC 0.5%; severe AC 18.0% (p < 0.001).
CONCLUSION
Urgent laparoscopic cholecystectomy remains the treatment of choice for mild and moderate AC. In patients with severe AC, the risks and benefits of surgery should be assessed, given the high degree of complications and associated mortality.
Topics: Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Humans; Length of Stay; Prospective Studies; Retrospective Studies; Tokyo; Treatment Outcome
PubMed: 33498065
DOI: 10.24875/CIRU.19001616 -
JAMA Jul 2022
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Journal of Hepato-biliary-pancreatic... Feb 2022Acute cholecystitis is a progressive inflammation of the gallbladder usually caused by gallstones obstructing the cystic duct. Congestion and edema are evident symptoms... (Review)
Review
Acute cholecystitis is a progressive inflammation of the gallbladder usually caused by gallstones obstructing the cystic duct. Congestion and edema are evident symptoms during the first 2-4 days, also known as the phase of edematous cholecystitis. Necrotizing cholecystitis, a phase characterized by bleeding and necrosis, is seen at 3-5 days. From 7-10 days, the disease progresses to its purulent phase, also known as suppurative cholecystitis. If the disease is still left untreated at this point, it progresses to subacute cholecystitis and it eventually becomes chronic cholecystitis. Possible complications that affect the management of cholecystitis include perforation of the gallbladder (bile peritonitis) during the hemorrhagic and necrosis phase, and peri-gallbladder abscess and internal biliary fistula during the purulent phase.
Topics: Cholecystitis; Cholecystitis, Acute; Gallbladder; Gallstones; Humans; Japan
PubMed: 33570821
DOI: 10.1002/jhbp.912 -
Digestive Diseases (Basel, Switzerland) 2022Acute acalculous cholecystitis (AAC) is characterized by acute necrotizing inflammation with no calculi and is diagnosed based on imaging, intraoperative, and... (Review)
Review
BACKGROUND
Acute acalculous cholecystitis (AAC) is characterized by acute necrotizing inflammation with no calculi and is diagnosed based on imaging, intraoperative, and pathological examinations.
KEY MESSAGE
Although AAC has been studied clinically for a long time, it remains difficult to diagnose and treat. The pathogenesis of AAC is still not fully understood, and it is often regarded as a relatively independent clinical disease that is different from acute calculous cholecystitis (ACC). Pathological studies suggest that AAC is the manifestation of a critical systemic disease, while ACC is a local disease of the gallbladder.
SUMMARY
Concerning the pathogenesis, diagnosis, and treatment of AAC, we reviewed the research progress of AAC, which will enhance the understanding of the early diagnosis and treatment of AAC.
Topics: Acalculous Cholecystitis; Acute Disease; Cholecystitis, Acute; Humans
PubMed: 34657038
DOI: 10.1159/000520025 -
Journal of Hepato-biliary-pancreatic... 2007This article discusses the definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis. Acute cholangitis and cholecystitis mostly originate...
This article discusses the definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis. Acute cholangitis and cholecystitis mostly originate from stones in the bile ducts and gallbladder. Acute cholecystitis also has other causes, such as ischemia; chemicals that enter biliary secretions; motility disorders associated with drugs; infections with microorganisms, protozoa, and parasites; collagen disease; and allergic reactions. Acute acalculous cholecystitis is associated with a recent operation, trauma, burns, multisystem organ failure, and parenteral nutrition. Factors associated with the onset of cholelithiasis include obesity, age, and drugs such as oral contraceptives. The reported mortality of less than 10% for acute cholecystitis gives an impression that it is not a fatal disease, except for the elderly and/or patients with acalculous disease. However, there are reports of high mortality for cholangitis, although the mortality differs greatly depending on the year of the report and the severity of the disease. Even reports published in and after the 1980s indicate high mortality, ranging from 10% to 30% in the patients, with multiorgan failure as a major cause of death. Because many of the reports on acute cholecystitis and cholangitis use different standards, comparisons are difficult. Variations in treatment and risk factors influencing the mortality rates indicate the necessity for standardized diagnostic, treatment, and severity assessment criteria.
Topics: Abdominal Pain; Cholangitis; Cholecystitis, Acute; Cholecystolithiasis; Female; Humans; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Recurrence; Tokyo
PubMed: 17252293
DOI: 10.1007/s00534-006-1152-y -
The Surgical Clinics of North America Apr 2014Acute cholecystitis is defined as inflammation of the gallbladder and is usually caused by obstruction of the cystic duct. Cholescintigraphy is the most sensitive... (Review)
Review
Acute cholecystitis is defined as inflammation of the gallbladder and is usually caused by obstruction of the cystic duct. Cholescintigraphy is the most sensitive imaging modality for cholecystitis. The gold standard treatment of acute cholecystitis is laparoscopic cholecystectomy. Operating early in the disease course decreases overall hospital stay and avoids increased complications, conversion to open procedures, and mortality. Cholecystitis during pregnancy is a challenging problem for surgeons. Operative intervention is generally safe for both mother and fetus, given the improved morbidity of the laparoscopic approach compared with open, although increased caution should be exercised in women with gallstone pancreatitis.
Topics: Abdominal Pain; Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis; Cholecystitis, Acute; Chronic Disease; Diagnostic Imaging; Humans; Risk Factors; Time-to-Treatment
PubMed: 24679431
DOI: 10.1016/j.suc.2014.01.005