Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy?

Garcés-Albir, Marina; Martin-Gorgojo, Victor; Perdomo, R.; Molina-Rodríguez, José Luis; Muñoz-Forner, Elena; Dorcaratto, Dimitri; Sabater, Luís

doi:10.1007/s11605-019-04424-5

Cited by 19 publications

(27 citation statements)

References 22 publications

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“…The literature search identified 19 case-matched control or comparative studies and one randomised control trial, which were included for analysis [ 14 – 33 ]. Figure 1 shows the PRISMA flowchart for the literature search.…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of mortality was demonstrated by 17 studies [ 14 – 23 , 25 – 27 , 29 – 31 , 33 ]. The utilisation of percutaneous cholecystostomy was associated with a significant increase in mortality (POR = 4.85; 95% CI: 1.02–7.30; p = 0.0001) ( Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Overall morbidity was studied in 13 studies [ 14 – 18 , 20 , 23 – 25 , 29 – 31 , 33 ]. There was no significant difference in overall morbidity between percutaneous cholecystostomy and emergency cholecystectomy (POR = 0.92; 95% CI: 0.45–1.98; p = 0.83).…”

Section: Resultsmentioning

confidence: 99%

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Outcomes of percutaneous cholecystostomy in elderly patients: a systematic review and meta-analysis

Markopoulos¹,

Mulita²,

Kehagias³

et al. 2021

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Introduction Percutaneous cholecystostomy (PC) represents a management option to control sepsis in patients with acute cholecystitis, who are unable to tolerate surgery. Aim This review aimed to evaluate the outcomes of elderly patients treated with PC and compare it with emergent cholecystectomy. Material and methods An electronic search of the Embase, Medline Web of Science, and Cochrane databases was performed. Percutaneous cholecystostomy was used as the reference group, and weighted mean differences (WMD) were calculated for the effect of PC on continuous variables, and pooled odds ratios (POR) were calculated for discrete variables. Results There were 20 trials included in this review. Utilisation of PC was associated with significantly increased mortality (POR = 4.85; 95% CI: 1.02–7.30; p = 0.0001) and increased re-admission rates (POR = 2.95; 95% CI: 2.21–3.87; p < 0.0001). Conclusions This pooled analysis established that patients treated with PC appear to have increased mortality and readmission rates relative to those managed with cholecystectomy.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Outcomes of percutaneous cholecystostomy in elderly patients: a systematic review and meta-analysis

Markopoulos¹,

Mulita²,

Kehagias³

et al. 2021

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“…As the population of Europe ages (it is estimated that some 30% will be over the age of 65 by 2050), it is important that societies such as ESTES explore clear pathways and guidance for the optimum care of the elderly patient requiring emergency surgery [23][24][25]. Observations from this snapshot audit (treated in detail elsewhere, REF) that morbidity, postoperative length of stay and the requirement for discharge to a rehabilitation facility are more common in our elderly patients will inform future study on frailty, predictors of morbidity, and optimization of this patient population [26,27].…”

Section: Discussionmentioning

confidence: 99%

Patterns of prevalence and contemporary clinical management strategies in complicated acute biliary calculous disease: an ESTES ‘snapshot audit’ of practice

Bass

Gillis

Cao

et al. 2020

Eur J Trauma Emerg Surg

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Background Acute complications of biliary calculi are common, morbid, and complex to manage. Variability exists in the techniques utilized to treat these conditions at an individual surgeon and unit level. Aim To identify, through an international prospective nonrandomized cohort study, the epidemiology and areas of practice variability in management of acute complicated calculous biliary disease (ACCBD) and to correlate them against reported outcomes. Methods A preplanned analysis of the European Society of Trauma and Emergency Surgery (ESTES) 2018 Complicated Biliary Calculous Disease audit was performed. Patients undergoing emergency hospital admission with ACCBD between 1 October 2018 and 31 October 2018 were included. All eligible patients with acute complicated biliary calculous disease were recorded contemporaneously using a standardized predetermined protocol and a secure online database and followed-up through to 60 days from their admission. Endpoints A two-stage data collection strategy collecting patient demographics, details of operative, endoscopic and radiologic intervention, and outcome metrics. Outcome measures included mortality, surgical morbidity, ICU stay, timing of operative intervention, and length of hospital stay. Results Three hundred thirty-eight patients were included, with a mean age of 65 years and 54% were female. Diagnosis at admission were: cholecystitis (45.6%), biliary pancreatitis (21%), choledocholithiasis with and without cholangitis (13.9% and 18%). Index admission cholecystectomy was performed in just 50% of cases, and 28% had an ERCP performed. Morbidity and mortality were low. Conclusion This first ESTES snapshot audit, a purely descriptive collaborative study, gives rich ‘real world’ insights into local variability in surgical practice as compared to international guidelines, and how this may impact upon outcomes. These granular data will serve to improve overall patient care as well as being hypothesis generating and inform areas needing future prospective study.

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“… 68 Two large retrospective studies also found that PC was associated with higher mortality and did not offer any advantage over emergent cholecystectomy in acute cholecystitis. 69 70 Hence, they suggested that PC should not be routinely used. Other indications include acute cholangitis, gallbladder mucocele, or biliary obstruction and biliary interventions (stenting or stone removal) when ERCP or PTBD is not possible or has failed.…”

Section: Methodsmentioning

confidence: 99%

Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures

Madhusudhan

Valakkada

Keshava

2021

Indian J Radiol Imaging

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Percutaneous biliary interventions are among the commonly performed nonvascular radiological interventions. Most common of these interventions is the percutaneous transhepatic biliary drainage for malignant biliary obstruction. Other biliary procedures performed include percutaneous cholecystostomy, biliary stenting, drainage for bile leaks, and various procedures like balloon dilatation, stenting, and large-bore catheter drainage for bilioenteric or post-transplant anastomotic strictures. Although these procedures are being performed for ages, no standard guidelines have been formulated. This article attempts at preparing guidelines for performing various percutaneous image-guided biliary procedures along with discussion on the published evidence in this field.

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Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy?

Cited by 19 publications

References 22 publications

Outcomes of percutaneous cholecystostomy in elderly patients: a systematic review and meta-analysis

Outcomes of percutaneous cholecystostomy in elderly patients: a systematic review and meta-analysis

Patterns of prevalence and contemporary clinical management strategies in complicated acute biliary calculous disease: an ESTES ‘snapshot audit’ of practice

Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures

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