Current role of percutaneous transhepatic gallbladder aspiration: from palliative to curative management for acute cholecystitis

Komatsu, Shohei; Tsuchida, Shinobu; Tsukamoto, Tadashi; Wakahara, Tomoyuki; Ashitani, Hiroshi; Ueno, Naohiko; Toyokawa, Akihiro; Watanabe, Akihiko; Sugahara, Atsushi; Mukai, Hidekazu

doi:10.1002/jhbp.394

Cited by 21 publications

(25 citation statements)

References 30 publications

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“…There are several possibilities for this reason as follows: (1) based on our experience and previous literature, there might be the possibility that the PTGBA group included mild or moderate grade cholecystitis; (2) lavage of gallbladder using saline was more effective than simple drainage; and (3) rapid decompression of gallbladder contents by aspiration causes the release of impacted stone at the neck and even cystic duct (going back in gallbladder). Interestingly, the latest large cohort study in a high volume center where expertise of PTGBA is present, revealed that 263 (95.6%) of 275 high risk patients (aged ≥80 years and/or with American Society of Anesthesiologists score III to IV and/or performance status 3 to 4) showed recovery after PTGBA . These data suggest that 75% and 96.2% clinical success in 3 and 7 days, respectively is reasonable in the PTGBA group.…”

Section: Discussionmentioning

confidence: 99%

“…Although PTGBD is still first‐line therapy of decompression of enlarged gallbladder, recently, there have been several suboptimal alternatives to PTGBD. Percutaneous transhepatic gallbladder aspiration (PTGBA) using a 19‐gauge or 22‐gauge aspiration needle is a simple decompression method . Another alternative is endoscopic transpapillary gallbladder decompression by means of endoscopic retrograde cholangiopancreatography (ERCP) technique including endoscopic naso‐gallbladder drainage (ENGBD) and gallbladder stenting (EGBS) in acute cholecystitis.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous and endoscopic gallbladder drainage for acute cholecystitis: international multicenter comparative study using propensity score‐matched analysis

Itoi

Takada

Hwang

et al. 2017

J Hepato Biliary Pancreat

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Background Tokyo Guideline 2013 (TG13) proposed three drainage techniques for the treatment of acute cholecystitis. We evaluated the clinical efficacy and adverse events between percutaneous transhepatic intervention (PTGBI) including percutaneous transhepatic gallbladder drainage (PTGBD) and percutaneous transhepatic gallbladder aspiration (PTGBA) and endoscopic transpapillary gallbladder drainage (EGBD). Methods A cohort study was performed using propensity score matching to reduce treatment selection bias. This involved the analysis of collected data for 1,764 patients who underwent PTGBI and EGBD. Results Propensity score matching extracted 330 pairs of patients. The difference in the clinical success rate within 3 days between PTGBI and EGBD were 62.5% and 69.8%, respectively (P = 0.085). The differences in the suboptimal clinical success rates within 7 days between PTGBI and EGBD were 87.6% and 89.2% (P = 0.579). The differences in the complication rate between PTGBI and EGBD were 4.8% and 8.2% (P = 0.083). The differences in the complication rate among PTGBD, PTGBA and EGBD were 5.6%, 1.6% and 8.2% (P = 0.11). Median required days of PTGBD (3.0 days) was significantly longer than those of PTGBA and EGBD (1.5 and 2.0 days, respectively) (P = 0.001). Conclusion The current study showed the PTGBI showed similar clinical efficacy compared with EGBD without significant discrepancy of complication rate for the treatment of acute cholecystitis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Percutaneous and endoscopic gallbladder drainage for acute cholecystitis: international multicenter comparative study using propensity score‐matched analysis

Itoi

Takada

Hwang

et al. 2017

J Hepato Biliary Pancreat

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“…Although PTGBA without catheter placement appears to be a simple and easy decompression method, aspiration could be unsuccessful because of replacement of bile with dense biliary sludge or pus (RCT) , (OS) . Therefore, PTGBA should not be recommended as a standard procedure for all patients with AC.…”

Section: Percutaneous Transhepatic Gallbladder Drainagementioning

confidence: 99%

“…Since then, TG13 stated that PTGBD should be recommended as the first alternative to cholecystectomy in such patients . However, some studies have evaluated the usefulness of percutaneous transhepatic gallbladder aspiration (PTGBA) without catheter placement as a simple decompression method . Another alternative procedure is endoscopic gallbladder drainage, which can be performed using either a transpapillary or transmural approach.…”

Section: Introductionmentioning

confidence: 99%

Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

Mori

Itoi

Baron

et al. 2017

J Hepato Biliary Pancreat

254

196

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Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high‐risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high‐risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound‐guided gallbladder drainage can be considered in high‐volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso‐gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound‐guided gallbladder drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

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“…In our study, we found procedure-related complications in elderly patients with AC were only 7.16%, comparable to those of previous reports. [20] Although urgent cholecystectomy (within 72 hours from symptom onset) has been proposed as a de nitive treatment for symptomatic gallbladder disease, [21] routine cholecystectomy in an emergency setting can be challenging. Rather, gallbladder puncture is a better choice for surgeons with less experience.…”

Section: Discussionmentioning

confidence: 99%

APACHE IV system helps to determine cholecystostomy role in elderly patients with acute cholecystitis

Hua¹,

Guo²,

Yao³

et al. 2020

Preprint

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Background Cholecystostomy offers an alternative method for patients unfit to undergo immediate cholecystectomy. Nevertheless, the role of cholecystostomy in the clinical management of high-risk surgical patients remains unclear. One of the main problems concerning the therapeutic effect in critically ill patients with acute cholecystitis is the lack of validated, well-established scoring systems to stratify the severity of patient disease states. APACHE IV scoring system was useful to estimate the hospital mortality for high-risk patients. We try to evaluate the performance of the APACHE IV scoring system in patients over 65 years of age with acute cholecystitis and the therapeutic effect of percutaneous cholecystostomy. Methods 597 patients over 65 years of age with acute cholecystitis between January 2011 and December 2018 were retrospectively analyzed with the APACHE IV scores. Results Among the 597 patients, 52 successfully underwent cholecystectomy (2 died, 3.85%), 65 underwent percutaneous cholecystostomy (1 died, 1.54%), and 480 received conservative therapy (27 died, 5.63%). The fitness of the APACHE IV score prediction is good with the area under the ROC curve of 0.894. The APACHE IV models were well-calibrated (with the Hosmer-Lemeshow statistic). Using the method of binary regression analysis, for the patients whose estimated mortality rate was more than 10%, cholecystostomy was an important factor for prognosis (P = 0.048). The estimated mortality of PC patients before and after operation was compared, which indicated that the estimated mortality after puncture was significantly decreased, either in the whole patient group (P = 0.004) or in the group with an estimated mortality greater than 10% (P = 0.008). Conclusion The APACHE IV scoring system showed that cholecystostomy was a safe and effective treatment for elderly high-risk patients with acute cholecystitis.

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Current role of percutaneous transhepatic gallbladder aspiration: from palliative to curative management for acute cholecystitis

Abstract: Percutaneous transhepatic gallbladder aspiration can be a useful alternative for most patients with AC, including those at high risk. Elective cholecystectomy can be performed safely regardless of the timing of PTGBA or surgery.

Cited by 21 publications

References 30 publications

Percutaneous and endoscopic gallbladder drainage for acute cholecystitis: international multicenter comparative study using propensity score‐matched analysis

Percutaneous and endoscopic gallbladder drainage for acute cholecystitis: international multicenter comparative study using propensity score‐matched analysis

Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

APACHE IV system helps to determine cholecystostomy role in elderly patients with acute cholecystitis

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