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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 -
European Review For Medical and... Oct 2020Percutaneous cholecystostomy (PC) is used for the treatment of acute cholecystitis in patients with high surgical risk due to the severity of cholecystitis and/or the... (Review)
Review
OBJECTIVE
Percutaneous cholecystostomy (PC) is used for the treatment of acute cholecystitis in patients with high surgical risk due to the severity of cholecystitis and/or the underlying acute or chronic medical comorbidities. The evidence for this strategy is unclear.
MATERIALS AND METHODS
We searched PubMed and the Cochrane databases for English-language studies published from January 1979 through December 31, 2019, for randomized clinical trials (RCTs), meta-analyses, systematic reviews, and observational studies.
RESULTS
The two randomized studies that have compared PC with cholecystectomy (CCY) or conservative treatment have shown that the clinical outcomes did not differ significantly between the groups. Similar results have been found in the large majority of retrospective cohorts or single-center studies that have compared PC with CCY.
CONCLUSIONS
PC does not seem to offer any benefit compared with CCY in the treatment of acute cholecystitis in patients with high surgical risk due to the severity of cholecystitis and/or the underlying acute or chronic medical comorbidities. A large, prospective, randomized study that compares percutaneous PC and CCY in patients with high surgical risk and/or moderate to severe cholecystitis is warranted.
Topics: Cholecystectomy; Cholecystitis, Acute; Cholecystostomy; Humans; Meta-Analysis as Topic; Observational Studies as Topic; Randomized Controlled Trials as Topic; Systematic Reviews as Topic
PubMed: 33155228
DOI: 10.26355/eurrev_202010_23428 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Apr 2022Although laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis, its optimal timing is still controversial. In this study, our aim is to...
BACKGROUND
Although laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis, its optimal timing is still controversial. In this study, our aim is to determine the appropriate cholecystectomy time by comparing the results of emergency and elective cholecystectomy in patients presenting with recurrent acute cholecystitis.
METHODS
Between January 2019 and January 2022, the data of 434 patients who were scheduled for late cholecystectomy and were admitted to our hospital with recurrent cholecystitis attacks during the waiting period were retrospectively evaluated. Demo-graphic data of patients, stage according to Tokyo Guidelines 2018, duration of hospital stay before and after surgery, surgery dura-tion, open surgery rate, drain use, hollow organ injury, biliary tract injury, bleeding, wound infection, post-operative collection, and mortality rates were analyzed.
RESULTS
Emergency LC (group 1) was performed in 176 (40.5%) of 434 patients presenting with recurrent cholecystitis, and elec-tive LC (group 2) was performed in 258 (59.5%) patients. Pre-operative hospital stay was significantly longer in group 2, and mean surgery duration was significantly longer in group 1 (p=0.001 and p=0.035, respectively). Gastric or intestinal injury, biliary tract injury, wound infection, and mortality were not detected in either group. There was no significant difference between the groups in the rate of open surgery and postoperative collection rates (p>0.05).
CONCLUSION
In centers experienced in hepatobiliary surgery, LC can be safely performed in recurrent acute cholecystitis attacks, regardless of symptom duration and the number of attacks.
Topics: Cholecystectomy; Cholecystitis; Cholecystitis, Acute; Humans; Retrospective Studies; Wound Infection
PubMed: 35485525
DOI: 10.14744/tjtes.2022.81908 -
Ugeskrift For Laeger Oct 2017Acute cholecystitis (AC) is mainly caused by stones in the gall bladder. Although cholescintigraphy has the highest sensitivity (97%) and specificity (94%) for AC,... (Review)
Review
Acute cholecystitis (AC) is mainly caused by stones in the gall bladder. Although cholescintigraphy has the highest sensitivity (97%) and specificity (94%) for AC, ultrasound is the most commonly used technique in confirming the diagnosis. Laparoscopic cholecystectomy is the recom-mended treatment of choice; however, in high-risk patients percutaneous gall bladder drainage is an attractive alter-native approach to avoid lesions to the common bile duct. To avoid serious bleeding incidences, it is imperative to pause anticoagulation therapy prior to gall bladder drainage.
Topics: Cholecystectomy; Cholecystitis, Acute; Contraindications, Procedure; Drainage; Humans; Magnetic Resonance Imaging; Radiography, Interventional; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography; Ultrasonography, Interventional
PubMed: 29053098
DOI: No ID Found -
Irish Journal of Medical Science Feb 2022In response to the outbreak of COVID-19 in Ireland, the government implemented a nationwide stay-at-home order, with the closure of all non-essential businesses. During...
PURPOSE
In response to the outbreak of COVID-19 in Ireland, the government implemented a nationwide stay-at-home order, with the closure of all non-essential businesses. During this period, there was a significant increase in supermarket expenditure. It has been shown that stress, anxiety and boredom are triggers for unhealthy eating habits. Fat consumption is a risk factor for both the development of gallstones and, additionally, the development of acute calculous cholecystitis. The aim of this study was to assess the incidence of acute calculous cholecystitis during the nationwide lockdown and compare it to the same period one year prior.
METHODS
A retrospective review of all emergency abdominal imaging performed during the first 5 weeks of the lockdown was completed using the hospital PACS (picture archiving and communication system). All cases of acute calculous cholecystitis were identified and compared with the same period 1 year prior.
RESULTS
Eighteen cases of acute calculous cholecystitis were identified from 24 March to 27 April 2020. Eleven cases were identified during the same period in 2019. This represented an increase of 63%. Non-COVID-19-related emergency presentations decreased during this period, and imaging of emergency presentations decreased by 24%. The rate of scans positive for acute cholecystitis more than doubled (p < 0.037).
CONCLUSION
A statistically significant increase in cases of acute calculous cholecystitis was observed during a nationwide lockdown during the COVID-19 pandemic. It is hypothesised that this is due to increased consumption of fatty foods during this period due to stress, anxiety and boredom.
Topics: COVID-19; Cholecystitis, Acute; Communicable Disease Control; Humans; Incidence; Pandemics; Retrospective Studies; SARS-CoV-2
PubMed: 33704626
DOI: 10.1007/s11845-021-02587-2 -
Israel Journal of Health Policy Research Aug 2020Elderly patients admitted because of acute cholecystitis are usually not operated during their initial admission and receive conservative treatment. To help formulate a... (Comparative Study)
Comparative Study
BACKGROUND
Elderly patients admitted because of acute cholecystitis are usually not operated during their initial admission and receive conservative treatment. To help formulate a new admission policy regarding elderly patients with acute cholecystitis we compared the demographic and clinical characteristics and outcome of patients > 65 with acute cholecystitis admitted to medical or surgical wards.
METHODS
This retrospective study included all patients > 65 years admitted for acute cholecystitis between January, 2009 and September, 2016. Data were retrieved from the electronic health records.
RESULTS
A total of 187 patients were detected, 54 (29%) in medical departments and 133 (71%) in surgical wards. The mean age (±SD) was 80 ± 7.5 and was higher among those in medical than surgical wards (84 ± 7 versus 79 ± 7, p < 0.05). Patients hospitalized in medical departments had more comorbidity, disability and mental impairment. However, there was no difference in mortality between the two groups, 1 (2%) and 6 (4%) respectively. Independent predictors for hospitalization in medical departments were chronic obstructive pulmonary disease (OR = 9.8, 95% C. I 1.6-59) and the Norton Scale score (NSS)(OR = 0.7, 95% C. I 0.7-0.8). Impaired mental condition was the only predictor for hospitalization > 1 week. The strongest predictor for having cholecystostomy was admission to the surgical department (OR = 14.7, 95% C. I 3.9-56.7). Linear regression showed a negative correlation between NSS and length of hospitalization (LOH; Beta = - 0.5).
CONCLUSION
Elderly patients with acute cholecystitis who require conservative management, especially those with severe functional and mental impairment can be safely hospitalized in medical departments. Outcome was not inferior in terms of mortality and LOH. These results have practical policy implications for the placement of elderly patients with acute cholecystitis in medical rather than surgical departments.
Topics: Aged; Aged, 80 and over; Cholecystitis, Acute; Cholecystostomy; Cohort Studies; Conservative Treatment; Female; Hospital Departments; Hospital Mortality; Hospitalization; Humans; Israel; Length of Stay; Male; Retrospective Studies
PubMed: 32741359
DOI: 10.1186/s13584-020-00383-4 -
Annals of the Royal College of Surgeons... Nov 2022Ultrasound has long been the radiological investigation of choice for right upper quadrant pain in the detection of gallstones and cholecystitis. However, previously...
INTRODUCTION
Ultrasound has long been the radiological investigation of choice for right upper quadrant pain in the detection of gallstones and cholecystitis. However, previously reported sensitivity, specificity and other diagnostic metrics have varied widely and the underlying patient numbers have been small. We present robust and exhaustive diagnostic metrics based on a large series of 795 patients.
METHODS
All laparoscopic cholecystectomies at Portsmouth Hospitals University were prospectively logged between 2017 and 2020. Ultrasound findings, Nassar operative difficulty and histopathological findings were all collected in addition to patient biometrics.
RESULTS
In our large patient series, the sensitivity of ultrasound for cholecystitis was lower than previously reported at 75.7% for acute cholecystitis, 34.6% for chronic cholecystitis and 42.7% overall. Moreover, we show that sensitivity degrades with the time between ultrasound and cholecystectomy, falling below 50% at 140 days. Finally, we show that ultrasound strongly predicts the Nassar difficulty grade of cholecystectomy and that its ability to do so is greatest when the interval between ultrasound and cholecystectomy is less than 27 days.
CONCLUSIONS
We present robust diagnostic metrics for ultrasound in the diagnosis of cholecystitis. These should caution the clinician that ultrasound may miss a quarter of cases of acute cholecystitis and over half of all cases of cholecystitis. Conversely, the finding of a thickened gallbladder wall on ultrasound can predict a 'difficult cholecystectomy' and highlight the need for appropriate expertise and resources. Both this prediction and the diagnostic sensitivity are best if the ultrasound is done less than 27 days before cholecystectomy.
Topics: Humans; Cholecystitis; Cholecystectomy; Cholecystitis, Acute; Cholecystectomy, Laparoscopic; Gallstones; Retrospective Studies
PubMed: 35175883
DOI: 10.1308/rcsann.2021.0322 -
Journal of Gastrointestinal Surgery :... Jul 2022To determine effects on admission, treatment, and outcome for acute cholecystitis during the course of the COVID-19 pandemic in 2020 and 2021.
Access to Surgery and Quality of Care for Acute Cholecystitis During the COVID-19 Pandemic in 2020 and 2021 - an Analysis of 12,545 Patients from a German-Wide Hospital Network.
PURPOSE
To determine effects on admission, treatment, and outcome for acute cholecystitis during the course of the COVID-19 pandemic in 2020 and 2021.
METHODS
Retrospective analysis of claims data from 74 German hospitals. Study periods were defined from March 5, 2020 (start of first wave) to June 20, 2021 (end of third wave) and compared to corresponding control periods (March 2018 to February 2020). All in-patients with acute cholecystitis were included. Distribution of cases, type of surgery, comorbidities, surgical outcome, and length of stay of all cases with acute cholecystitis and cholecystectomy were compared. In addition, we analyzed the type of treatment (non-surgical, cholecystostomy, or cholecystectomy) for all cases with main diagnosis of acute cholecystitis.
RESULTS
We could not demonstrate differences in daily admissions over the course of the pandemic (11.2-12.7 patients vs. 11.9-12.6 patients for control periods). Proportion of patients with non-surgical treatment was low and not increased (11.7-17.3% vs. 14.5-18.4%). Cholecystostomy was rare throughout all periods (0-0.5% of all patients). We did not observe an increase in open surgery (proportion of open cholecystectomies 3.4-5.5%). Mortality was generally low (1.5-1.9%) with no differences between periods. Median length of stay was 4 days throughout all periods.
CONCLUSION
The numerous restrictions during the COVID-19 pandemic did not result in an increase of admissions or surgery for acute cholecystitis. Laparoscopic cholecystectomy has been safely applied during the pandemic. Our results may assure the ability to maintain high quality of surgical care even in times of disruptions to the health care system.
Topics: COVID-19; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Cholecystostomy; Hospitals; Humans; Pandemics; Retrospective Studies; Treatment Outcome
PubMed: 35445322
DOI: 10.1007/s11605-022-05318-9 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Dec 2022Acute cholecystitis (AC) is an acute inflammatory disease of gallbladder and it is one of the most common causes of acute abdominal pain. Determining the severity of AC...
BACKGROUND
Acute cholecystitis (AC) is an acute inflammatory disease of gallbladder and it is one of the most common causes of acute abdominal pain. Determining the severity of AC at hospital admission is extremely important to choose the most effective treatment method and predict vital prognosis. The aim of this study was to investigate the effectiveness of immature granulocyte percentage (IG%) in grading AC severity.
METHODS
This retrospective study was carried out on 528 patients hospitalized due to AC diagnosis. Demographic data, white blood cell (WBC) count, neutrophil lymphocyte ratio (NLR), IG%, C-reactive protein (CRP) levels, and imaging results of patients were recorded. Furthermore, patients' length of hospital stay was determined. Tokyo Guidelines were used to grade AC severity. According to this grading, patients were classified into three groups as grade 1 (mild), grade 2 (moderate), and grade 3 (severe) AC. Differences among groups were analyzed statistically.
RESULTS
There were 386 patients (73.1%) in the mild AC group, 102 patients (19.3%) in the moderate AC group, and 40 patients (7.6%) in the severe AC group. WBC, NLR, CRP and IG% were significant parameters in discriminating mild AC from moderate and severe AC. However, only IG% was a significant parameter in discriminating moderate AC from severe AC. Moreover, the power of IG% to discriminate between patients with mild and moderate AC and those with severe AC was dramatically higher than the other parameters.
CONCLUSION
Increased IG% is seen as an effective and reliable predictor in the early determination of AC severity.
Topics: Humans; Retrospective Studies; Granulocytes; Cholecystitis, Acute; Biomarkers; Neutrophils
PubMed: 36453788
DOI: 10.14744/tjtes.2021.86322