COVID-19 and Acute Cholecystitis Management: A Systematic Review of Current Literature

Abstract

IntroductionSince the beginning of the COVID-19 pandemic, many patients with clinically acute presentations have been approached differently. The fear of viral transmission along with the short period of study made patients delay their hospital visits and doctors reassess the approach of certain acute situations. This study aimed to assess the changes in the management of patients with acute cholecystitis before and during COVID-19.MethodsA systematic review of the literature using PubMed (MEDLINE), Scopus, and ScienceDirect databases was performed until 01 September 2021. Totally, two kinds of studies were included, those assessing the management of acute cholecystitis during COVID-19 and those comparing the periods before and during the pandemic. The outcomes recorded include management approaches, complications, and mean length of stay.ResultsA number of 15 eligible articles were included in the study. During the pandemic, six studies revealed a shift toward conservative management of acute cholecystitis and five of them reported that conservative management was opted in 73% of the patients. On the contrary, data from all studies revealed that the surgical approach was preferred in only 29.2% of patients. Furthermore, when comparing the periods before vs. during COVID-19, the conservative approach was reported in 36.3 and 43.2% before vs. during COVID-19, respectively, whereas surgical intervention was performed in 62.5% of patients before COVID-19 and 55.3% during the pandemic. The length of stay was delayed when a non-surgical approach was selected in most studies. Complications, mainly classified by the Clavien-Dindo scale, were higher in the pandemic period.ConclusionA tendency toward more conservative approaches was observed in most studies, reversing the previously used surgical approach in most cases of acute cholecystitis. In most of the examined cases during the COVID-19 pandemic, antibiotic treatment and percutaneous cholecystostomy were much more considered and even preferred.

Multidisciplinary management of acute cholecystitis during the COVID-19 pandemic

“…In Period II, the PTGBD rate was significantly higher, successful conservative therapy showed a significantly lower rate, and there was no significant change in the surgery rate. A systematic review yielded comparable findings; however, the study reported that while the PTGBD rate was higher during the COVID period, there was also a higher rate of conservative therapy and a decrease in the rate of surgical treatment 11 . A recent article from July 2023 found similar results by examining data from US Academic Centers (comparing 15–15 months pre-pandemic and pandemic periods) 12 .…”

Analysis of management tactics of patients with acute noncalculous cholecystitis in combination with coronavirus disease

“…Морфологічно розрізняють катаральні, флегмонозні та гангренозні форми. Існують ускладнені форми, які включають в себе: водянку, емпієму жовчного міхура, біліарні панкреатити, холангіти, перивезикальні абсцеси, інфільтрати, абсцеси печінки, перфорації жовчного міхура та жовчні перитоніти [9]. Згідно з Токійським гайдлайном 2018 р. розрізнять три ступені важкості гострого холециститу.…”

Acute cholecystitis during the COVID-19 pandemic: is percutaneous cholecystostomy a good alternative for treatment?

“…During the COVID-19 pandemic, medical organizations such as the Society of American Gastrointestinal and Endoscopic Surgeons and the European Association for Endoscopic Surgery have suggested that an alternative approach to surgery, i.e., antibiotic therapy, PC, and watch-wait, should be preferred in as cases where possible (3). The onset of the pandemic was difficult in many aspects.…”