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Annals of Surgery Sep 2023To evaluate the safety and efficacy of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS).
OBJECTIVE
To evaluate the safety and efficacy of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS).
BACKGROUND
For patients with acute cholecystitis who are poor surgical candidates, EUS-GBD using a LAMS is an important treatment alternative to percutaneous gallbladder drainage.
METHODS
We conducted a regulatory-compliant, prospective multicenter trial at 7 tertiary referral centers in the United States of America and Belgium. Thirty consecutive patients with mild or moderate acute cholecystitis who were not candidates for cholecystectomy were enrolled between September 2019 and August 2021. Eligible patients had a LAMS placed transmurally with 30 to 60-day indwell if removal was clinically indicated, and 30-day follow-up post-LAMS removal. Endpoints included days until acute cholecystitis resolution, reintervention rate, acute cholecystitis recurrence rate, and procedure-related adverse events (AEs).
RESULTS
Technical success was 93.3% (28/30) for LAMS placement and 100% for LAMS removal in 19 patients for whom removal was attempted. Five (16.7%) patients required reintervention. Mean time to acute cholecystitis resolution was 1.6±1.5 days. Acute cholecystitis symptoms recurred in 10.0% (3/30) after LAMS removal. Five (16.7%) patients died from unrelated causes. Procedure-related AEs were reported to the FDA in 30.0% (9/30) of patients, including one fatal event 21 days after LAMS removal; however, no AEs were causally related to the LAMS.
CONCLUSIONS
For selected patients with acute cholecystitis who are at elevated surgical risk, EUS-GBD with LAMS is an alternative to percutaneous gallbladder drainage. It has high technical and clinical success, with low recurrence and an acceptable AE rate. Clinicaltrials.gov, Number: NCT03767881.
Topics: Humans; Gallbladder; Prospective Studies; Treatment Outcome; Cholecystitis, Acute; Endosonography; Drainage; Stents; Ultrasonography, Interventional
PubMed: 36537290
DOI: 10.1097/SLA.0000000000005784 -
The Journal of Surgical Research Feb 2020Seasonal variation in the occurrence of medical illnesses reflects the effect of the environment, provides insight into pathogenesis, and can assist health care...
BACKGROUND
Seasonal variation in the occurrence of medical illnesses reflects the effect of the environment, provides insight into pathogenesis, and can assist health care administrators in allocating resources accordingly. Seasonal variation has been reported in various infectious and surgical diseases, but has been rarely studied in acute cholecystitis. Our objective was to study seasonal variation in acute cholecystitis at our institution.
METHODS
We performed a retrospective analysis of patients who underwent cholecystectomy for acute cholecystitis from January 1988 to December 2018. Chi-square goodness-of-fit test was used to analyze seasonality of acute cholecystitis adjusting for variation in number of days between seasons. The number of days for seasons were taken as 92, 92, 91, and 90.25 for spring, summer, fall, and winter, respectively.
RESULTS
Overall, 3924 patients underwent cholecystectomy for acute cholecystitis during the study period. The frequency of cholecystectomies performed varied between months (minimum February n = 259, maximum July n = 372, P < 0.001) and seasons (minimum winter n = 789, maximum summer n = 1101 P < 0.001). Age and gender distribution across months and seasons was similar (P > 0.05).
CONCLUSIONS
Our findings confirm seasonal variation in occurrence of acute cholecystitis with summer season witnessing the most and the winter season encountering the least patients with acute cholecystitis. Validation of our findings through prospectively collected data at national level is the way forward.
Topics: Adult; Age Distribution; Cholecystectomy; Cholecystitis, Acute; Female; Humans; Male; Middle Aged; Pakistan; Retrospective Studies; Seasons; Sex Distribution; Time Factors; Young Adult
PubMed: 31562989
DOI: 10.1016/j.jss.2019.08.025 -
Nihon Shokakibyo Gakkai Zasshi = the... 2017A 78-year-old man with chief complaints of cough and lower limb numbness was admitted to our hospital. Serum myeloperoxidase-antineutrophil cytoplasmic antibody titer... (Review)
Review
A 78-year-old man with chief complaints of cough and lower limb numbness was admitted to our hospital. Serum myeloperoxidase-antineutrophil cytoplasmic antibody titer (MPO-ANCA) was elevated (48.8U/ml), and a diagnosis of microscopic polyangiitis (MPA) was made. After admission, the patient developed a fever and right upper quadrant pain. Ultrasonography and computed tomography revealed an acute cholecystitis of unknown cause, and laparoscopic cholecystectomy was performed. Histopathological examination of the resected gallbladder revealed necrotizing vasculitis along with the infiltration of eosinophils, lymphocytes, and plasma cells around the small arteries in the muscular layer of the gallbladder, which are characteristics of MPA.
Topics: Aged; Cholecystitis, Acute; Humans; Male; Microscopic Polyangiitis
PubMed: 29213028
DOI: 10.11405/nisshoshi.114.2167 -
Journal of Hepato-biliary-pancreatic... Feb 2021Acute cholecystitis (AC) is a severe complication after cardiovascular surgery (CS). The purpose of this study was to delineate the clinical picture of AC after CS to...
BACKGROUND
Acute cholecystitis (AC) is a severe complication after cardiovascular surgery (CS). The purpose of this study was to delineate the clinical picture of AC after CS to propose an optimal treatment strategy.
METHODS
We retrospectively reviewed the records of 88 patients who underwent cholecystectomy for grade II or III AC between 2008 and 2019 (AC after CS: Group CS, n = 37; AC without CS: Group non-CS, n = 51).
RESULTS
The proportion of grade III AC in Group CS was significantly higher than that in Group non-CS (73% vs 41%, P = .005). Furthermore, the incidences of acalculous (81% vs 39%) and gangrenous (86% vs 59%) AC were significantly higher in Group CS (P < .05 for both). In Group CS, 11 patients had had percutaneous drainage preceding surgery, for whom cholecystectomy within 3 days was eventually necessary because their general condition was exacerbated. The incidence of a positive culture from the gallbladder bile and blood samples of Group CS were significantly higher (P < .05 for both); multidrug-resistant bacteria were detected at an especially high rate. However, the morbidity rate was comparable, and zero mortality was achieved in both groups.
CONCLUSIONS
Timely surgical intervention without hesitation is recommended for AC after CS.
Topics: Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Drainage; Humans; Retrospective Studies; Treatment Outcome
PubMed: 33259684
DOI: 10.1002/jhbp.872 -
Digestive Endoscopy : Official Journal... Jan 2015With the evolution of the linear echoendoscope and the improved ability to direct a needle within the field of interest, the therapeutic potential of endoscopic... (Review)
Review
With the evolution of the linear echoendoscope and the improved ability to direct a needle within the field of interest, the therapeutic potential of endoscopic ultrasonography (EUS) has greatly expanded. Endoscopic ultrasonography-guided transmural gallbladder drainage (EUS-GBD) may be the next frontier for therapeutic EUS. Since EUS-GBD was first described in 2007, recent reports have suggested it as an alternative to external gallbladder drainage for acute cholecystitis. EUS-GBD includes EUS-guided transmural nasogallbladder drainage, EUS-guided gallbladder aspiration, and EUS-guided transmural gallbladder stenting. Indications for the EUS-GBD technique as currently practiced, including equipment, technical details, complications, and efficacy are herein reviewed.
Topics: Cholecystitis, Acute; Drainage; Endosonography; Gallbladder; Humans; Surgery, Computer-Assisted
PubMed: 25284030
DOI: 10.1111/den.12386 -
Journal of Gastroenterology and... Dec 2009
Topics: Anti-Bacterial Agents; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Cholecystostomy; Evidence-Based Medicine; Guideline Adherence; Humans; Length of Stay; Patient Selection; Practice Guidelines as Topic; Severity of Illness Index; Treatment Outcome
PubMed: 20002938
DOI: 10.1111/j.1440-1746.2009.06043.x -
Gastrointestinal Endoscopy Mar 2024
Topics: Humans; Gallbladder; Cholecystitis, Acute; Endosonography; Drainage; Abdomen; Treatment Outcome; Stents
PubMed: 38368044
DOI: 10.1016/j.gie.2023.11.037 -
ANZ Journal of Surgery Sep 2020Acute cholecystitis (AC) is a surgical condition that is usually managed by emergency surgery. The presence of common bile duct stones (CBDS) in this setting mandates... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute cholecystitis (AC) is a surgical condition that is usually managed by emergency surgery. The presence of common bile duct stones (CBDS) in this setting mandates definitive treatment to avoid complications such as cholangitis. The incidence of CBDS in the setting of AC is poorly defined.
METHODS
A systematic English literature search was conducted in PubMed, MEDLINE and Embase to determine the incidence of CBDS in patients presenting with AC. Outlier studies identified by funnel plot analysis were excluded and the incidence of CBDS was identified. The mean CBD diameter and liver function test values of patients with AC and CBDS were calculated.
RESULTS
Data were extracted from 19 studies representing a total 4057 patients with AC. Routine biliary imaging was not performed in all studies. The pooled incidence of CBDS was 13.7% (95% confidence interval 11.8-15.9). The incidence of unsuspected retained CBDS was 1.1%. Histologically confirmed cases of AC had a similar rate of CBDS compared to those diagnosed clinically. The mean CBD diameter of patients with AC and CBDS was 7.2 mm compared to 5.8 mm without. Liver function test values in the presence of CBDS were more likely to be deranged, with gamma-glutamyltransferase the most sensitive and specific marker for CBDS in the setting of AC.
CONCLUSION
CBDS is present in a significant proportion of patients presenting with AC. Routine biliary imaging is advised in all patients presenting with AC where possible.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholecystitis, Acute; Choledocholithiasis; Common Bile Duct; Humans; Incidence; Retrospective Studies
PubMed: 31743951
DOI: 10.1111/ans.15565 -
Surgery Jul 2022
Topics: Cholecystitis; Cholecystitis, Acute; Gallbladder Diseases; Humans
PubMed: 35090736
DOI: 10.1016/j.surg.2021.12.027 -
Langenbeck's Archives of Surgery Aug 2019In the Danish national guidelines from 2006 on the treatment of acute cholecystitis, early laparoscopic operation within 5 days after the debut of symptoms was...
PURPOSE
In the Danish national guidelines from 2006 on the treatment of acute cholecystitis, early laparoscopic operation within 5 days after the debut of symptoms was recommended. The aim of this study was to analyze the outcome in patients with acute cholecystitis subjected to cholecystectomy in Denmark in the five-year period hereafter.
METHODS
All patients undergoing cholecystectomy in the period 2006-2010 were registered in the Danish Cholecystectomy Database, from which outcome data were collected. The effect of potential risk factors such as age, gender, BMI, American Society of Anesthesiologists (ASA) score, previous pancreatitis, previous abdominal surgery, year of operation, surgical approach, and surgeon experience was analyzed.
RESULTS
Of 33,853 patients registered with a cholecystectomy, 4667 (14%) were operated for acute cholecystitis. In 95% of the patients, laparoscopic cholecystectomy was intended and in 5% primary open access was chosen. The frequency of conversion from laparoscopic to open surgery was 18%. High age and ASA score, operation in the early years of the period, and open or converted procedure all increased the risk of hospital stay to > 3 days or readmission. High age and ASA score, converted or open operation, and previous pancreatitis increased the risk of additional procedures. Postoperative mortality was 1.2%, and significant risk factors for postoperative death were age, low BMI, high ASA score, early year of operation, and open procedures.
CONCLUSIONS
Acute cholecystectomy was safely managed laparoscopically in most patients after the introduction of national guidelines, with an increasing rate of laparoscopically completed procedures during the study period.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cholangiography; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Clinical Competence; Cohort Studies; Conversion to Open Surgery; Databases, Factual; Denmark; Female; Humans; Length of Stay; Male; Middle Aged; Retrospective Studies; Risk Factors; Treatment Outcome; Young Adult
PubMed: 31297607
DOI: 10.1007/s00423-019-01802-0