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Gastrointestinal Endoscopy Clinics of... Apr 2013Acute cholecystitis is a commonly encountered medical emergency that is managed surgically with excellent results. Recent experiences with endoscopic cystic duct stent... (Review)
Review
Acute cholecystitis is a commonly encountered medical emergency that is managed surgically with excellent results. Recent experiences with endoscopic cystic duct stent placement and cholecystectomy using the NOTES (Natural Orifice Transluminal Endoscopic Surgery) approach have inspired endoscopists to identify other less invasive means for treating cholecystitis. The ability to access and drain obstructive bile ducts in real time using endoscopic ultrasound guidance has led to recent reports of successful gallbladder drainage using similar techniques. This article discusses the current state of the endoscopic management of acute and acalculous cholecystitis, and outlines a consensus approach to the management of these patients.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholecystitis, Acute; Drainage; Endosonography; Humans; Intubation; Ultrasonography, Interventional
PubMed: 23540969
DOI: 10.1016/j.giec.2012.12.010 -
Journal of Laparoendoscopic & Advanced... Jan 2021Laparoscopic cholecystectomy is the main treatment of acute cholecystitis. Although considered relatively safe, it carries 6%-9% risk of major complications and 0.1%-1%... (Meta-Analysis)
Meta-Analysis Review
Laparoscopic cholecystectomy is the main treatment of acute cholecystitis. Although considered relatively safe, it carries 6%-9% risk of major complications and 0.1%-1% risk of mortality. There is no consensus regarding the evaluation of the preoperative risks, and the management of patients with acute cholecystitis is usually guided by surgeon's personal preferences. We assessed the best method to identify patients with acute cholecystitis who are at high risk of complications and mortality. We performed a systematic review of studies that reported the preoperative prediction of outcomes in people with acute cholecystitis. We searched the Cochrane Library, MEDLINE, EMBASE, WHO ICTRP, ClinicalTrials.gov, and Science Citation Index Expanded until April 27, 2019. We performed a meta-analysis when possible. Six thousand eight hundred twenty-seven people were included in one or more analyses in 12 studies. Tokyo guidelines 2013 (TG13) predicted mortality (two studies; Grade 3 versus Grade 1: odds ratio [OR] 5.08, 95% confidence interval [CI] 2.79-9.26). Gender predicted conversion to open cholecystectomy (two studies; OR 1.59, 95% CI 1.06-2.39). None of the factors reported in at least two studies had significant predictive ability of major or minor complications. There is significant uncertainty in the ability of prognostic factors and risk prediction models in predicting outcomes in people with acute calculous cholecystitis. Based on studies of high risk of bias, TG13 Grade 3 severity may be associated with greater mortality than Grade 1. Early referral of such patients to high-volume specialist centers should be considered. Further well-designed prospective studies are necessary.
Topics: Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Clinical Decision Rules; Humans; Postoperative Complications; Prognosis; Risk Assessment; Risk Factors
PubMed: 32716737
DOI: 10.1089/lap.2020.0151 -
Medicina (Kaunas, Lithuania) Oct 2022Background and objectives: Acute cholecystitis causes acute abdominal pain and may necessitate emergency surgery or intensive antibiotic therapy and percutaneous... (Review)
Review
Background and objectives: Acute cholecystitis causes acute abdominal pain and may necessitate emergency surgery or intensive antibiotic therapy and percutaneous drainage, depending on the patient’s condition. The symptoms of acute cholecystitis in older patients may be atypical and difficult to diagnose, causing delayed treatment. Clarifying the risk factors for delayed diagnosis among older patients could lead to early diagnosis and treatment of acute cholecystitis. This study aimed to explore the risk factors for delayed diagnosis of acute cholecystitis among rural older patients. Material and Methods: This retrospective cohort study included patients aged over 65 years diagnosed with acute cholecystitis at a rural community hospital. The primary outcome was the time from symptom onset to acute cholecystitis diagnosis. We reviewed the electronic medical records of patients with acute cholecystitis and investigated whether they were diagnosed and treated for the condition at the time of symptom onset. Results: The average ages of the control and exposure groups were 77.71 years (standard deviation [SD] = 14.62) and 80.13 years (SD = 13.95), respectively. Additionally, 41.7% and 64.1% of the participants in the control and exposure groups, respectively, were men. The logistic regression model revealed that the serum albumin level was significantly related to a time to diagnosis > 3 days (odds ratio = 0.51; 95% confidence interval, 0.28−0.94). Conclusion: Low serum albumin levels are related to delayed diagnosis of cholecystitis and male sex. The presence of abdominal pain and a high body mass index (BMI) may be related to early cholecystitis diagnosis. Clinicians should be concerned about the delay in cholecystitis diagnosis in older female patients with poor nutritional conditions, including low serum albumin levels, a low BMI, vague symptoms, and no abdominal pain.
Topics: Humans; Male; Female; Aged; Retrospective Studies; Delayed Diagnosis; Cholecystitis, Acute; Cholecystitis; Risk Factors; Anti-Bacterial Agents; Serum Albumin; Pain; Treatment Outcome
PubMed: 36295553
DOI: 10.3390/medicina58101392 -
ANZ Journal of Surgery Jul 2021
Topics: Cecal Diseases; Cholecystitis, Acute; Humans; Intestinal Obstruction; Intestinal Volvulus
PubMed: 33405363
DOI: 10.1111/ans.16550 -
Journal of Neurological Surgery. Part... Sep 2022Spinal cord injury (SCI) is a significant medical condition associated with various secondary complications, including cholelithiasis. Cholelithiasis can cause...
BACKGROUND
Spinal cord injury (SCI) is a significant medical condition associated with various secondary complications, including cholelithiasis. Cholelithiasis can cause biliary duct obstruction and result in acute cholecystitis. The development of acute cholecystitis in SCI patients has been well studied in the Taiwanese population, showing an increased risk of acute cholecystitis in patients with SCI. The development of cholecystitis has not been well studied in the United States.
MATERIALS AND METHODS
A retrospective review was performed on 3,939 propensity score-matched patients aged 18 to 85 years who had SCI/surgery from 2000 to 2019. Patients were divided based on the development of postoperative complications, specifically cholecystitis with cholecystectomy.
RESULTS
SCI consisted of quadriplegia (42%), paraplegia (53%), unspecified lesion of cervical spinal cord (3%), and thoracic spinal cord (2%). All groups were comparable regarding age, gender, body mass index, smoking status, and Charlson comorbidity Index. The incidence of acute cholecystitis with subsequent cholecystectomy among patients with SCI was 43.0 per 10,000 person-years (95% confidence interval: 41.51-44.49). Median follow-up was 36 months. The development of cholecystitis was comparable among females (54.5%) and males (45.5%), and among African Americans (52.5%) and Caucasians (47.5%).
CONCLUSION
There is an association between SCI and development of acute cholecystitis among U.S.
PATIENTS
As SCI patients do not present with the classic signs of biliary colic, risk assessment for the development of acute cholecystitis will guide patient management and allow neurosurgeons to weigh the risks and benefits of prophylactic treatment for gallbladder complications.
Topics: Cholecystitis; Cholecystitis, Acute; Cholelithiasis; Female; Humans; Male; Paraplegia; Retrospective Studies; Spinal Cord Injuries; United States
PubMed: 35644137
DOI: 10.1055/s-0041-1740617 -
JAAPA : Official Journal of the... Nov 2011
Topics: Cholecystitis, Acute; Humans
PubMed: 22111186
DOI: 10.1097/01720610-201111000-00013 -
Surgical Endoscopy Feb 2017In medical practice, the tendency to remove an inflamed gallbladder is deeply rooted. Cholecystectomy, however, is associated with relatively high complication rates,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In medical practice, the tendency to remove an inflamed gallbladder is deeply rooted. Cholecystectomy, however, is associated with relatively high complication rates, and therefore the decision whether or not to perform surgery should be well considered. For some patients, the surgical risk-benefit profile may favour conservative treatment. The objective of this study was to examine the short- and long-term outcome of conservative treatment of patients with acute calculous cholecystitis.
METHODS
A systematic search of MEDLINE, Embase and Cochrane Library databases was performed. Prospective studies reporting on the success rate of conservative treatment (i.e. non-invasive treatment) of acute cholecystitis during index admission were included, as well as prospective and retrospective studies reporting on the recurrence rate of gallstone-related disease during long-term follow-up (i.e. ≥12 months) after initial non-surgical management. Study selection was undertaken independently by two reviewers using predefined criteria. The risk of bias was assessed. The pooled success and mortality rate during index admission and the pooled recurrence rate of gallstone-related disease during long-term follow-up were calculated using a random-effects model.
RESULTS
A total of 1841 patients were included in 10 randomized controlled trials and 14 non-randomized studies. Conservative treatment during index admission was successful in 87 % of patients with acute calculous cholecystitis and in 96 % of patients with mild disease. In the long term, 22 % of the patients developed recurrent gallstone-related disease. Pooled analysis showed a success rate of 86 % (95 % CI 0.8-0.9), a mortality rate of 0.5 % (95 % CI 0.001-0.009) and a recurrence rate of 20 % (95 % CI 0.1-0.3).
DISCUSSION
Conservative treatment of acute calculous cholecystitis during index admission seems feasible and safe, especially in patients with mild disease. During long-term follow-up, less than a quarter of the patients appear to develop recurrent gallstone-related disease, although this outcome is based on limited data.
Topics: Cholecystectomy; Cholecystitis, Acute; Conservative Treatment; Humans; Models, Statistical; Recurrence; Treatment Outcome
PubMed: 27317033
DOI: 10.1007/s00464-016-5011-x -
Clinical Gastroenterology and... May 2023Endoscopic gallbladder drainage is a feasible and efficacious alternative to percutaneous drainage in the management of acute cholecystitis for high-risk surgical... (Review)
Review
DESCRIPTION
Endoscopic gallbladder drainage is a feasible and efficacious alternative to percutaneous drainage in the management of acute cholecystitis for high-risk surgical candidates. Endoscopic ultrasound-guided gallbladder drainage and per-oral cholecystoscopy is facilitated by the use of lumen-apposing metal stents. Endoscopic ultrasound-guided gallbladder drainage should be performed by those expert in advanced therapeutic endoscopic ultrasound. Multidisciplinary collaboration between interventional radiology and surgery is paramount in the care of these patients. Choosing the optimal drainage method is dependent on individual patient characteristics.
METHODS
This commentary was drawn from a review of the literature to provide practical advice. Because this was not a systematic review, we did not perform any formal rating of the quality of evidence or strength of the presented considerations. This expert commentary was commissioned and approved by the American Gastroenterological Association (AGA) Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer-review by the Clinical Practice Updates Committee and external peer-review through standard procedures of Clinical Gastroenterology and Hepatology.
Topics: Humans; Gallbladder; Cholecystitis, Acute; Endosonography; Drainage; Endoscopy; Stents; Treatment Outcome
PubMed: 36967319
DOI: 10.1016/j.cgh.2022.12.039 -
Medicina Clinica Sep 2021
Topics: Acalculous Cholecystitis; Acute Disease; Cholecystitis, Acute; Humans; Q Fever
PubMed: 32896368
DOI: 10.1016/j.medcli.2020.06.036 -
Gastroenterology Oct 2023
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Cholecystitis, Acute; Embolization, Therapeutic
PubMed: 36965741
DOI: 10.1053/j.gastro.2023.03.217