First in-Human Gallbladder Cryoablation in a Patient with Acute Calculous Cholecystitis Initially Treated with a Cholecystostomy Tube

McGregor, Hugh; Woodhead, Gregory; Conrad, Miles; Tang, Andrew; Ruiz, David; Khan, Abdul Aleem; Hennemeyer, Charles

doi:10.1016/j.jvir.2018.12.011

Cited by 9 publications

(8 citation statements)

References 13 publications

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“…including endoscopic ultrasound-guided drainage and cryoablation are now being offered. [4][5][6][7] While guidelines have often characterized high-risk patients as those who are critically ill and/or elderly, few studies have examined the impact of frailty among patients undergoing laparoscopic cholecystectomy. 2,[8][9][10][11] Earlier version of the 2013 Tokyo guidelines focused on clinically related characteristics of cholecystitis.…”

Section: Introductionmentioning

confidence: 99%

Frailty Predicts Morbidity and Mortality After Laparoscopic Cholecystectomy for Acute Cholecystitis: An ACS-NSQIP Cohort Analysis

Fagenson

Powers

Zorbas

et al. 2021

Journal of Gastrointestinal Surgery

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Background Current guidelines recommend laparoscopic cholecystectomy be offered for patients with acute cholecystitis except those deemed as high risk. Few studies have examined the impact of frailty on outcomes for patients undergoing laparoscopic cholecystectomy. Therefore, the aim of this study was to determine the association of frailty with postoperative morbidity and mortality in patients undergoing laparoscopic cholecystectomy for acute cholecystitis. Methods Patients undergoing laparoscopic cholecystectomy for acute cholecystectomy were identified from 2005 to 2010 in the American College of Surgeons National Surgical Quality Improvement Project (NSQIP). The Modified Frailty Index (mFI) was used a surrogate for frailty, and patients were stratified as non-frail (mFI 0), low frailty (mFI 1-2), intermediate frailty (mFI 3-4) and high frailty (mFI ≥ 5). Univariable and multivariable analyses were performed. Receiver operator curves (ROC) and an area under the curve (AUC) were generated to determine accuracy of mFI in predicting postoperative morbidity and mortality. Results Of the 6898 patients undergoing laparoscopic cholecystectomy, 3245 (47%) patients were non-frail. There were 2913 (42%) patients with low-frailty, 649 (9%) patients with intermediate frailty, and 91 (2%) with high frailty. Clavien IV complications were higher for intermediate frail patients (OR 1.81, 95% CI 1.00-3.28, p = 0.050) and high-frail patients (OR 4.59, 95% CI 1.98-10.7, p < 0.001). Additionally, mortality was higher for patients with intermediate frailty (OR 4.69, 95% CI 1.37-16.0, p = 0.014) and high frailty (OR 12.2, 95% CI 2.67-55.5, p = 0.001). The mFI had excellent accuracy for mortality (AUC = 0.83) and Clavien IV complications (AUC = 0.73). Conclusion Frailty is associated with postoperative morbidity and mortality in patients undergoing laparoscopic cholecystectomy for acute cholecystitis.

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Section: Introductionmentioning

confidence: 99%

Frailty Predicts Morbidity and Mortality After Laparoscopic Cholecystectomy for Acute Cholecystitis: An ACS-NSQIP Cohort Analysis

Fagenson

Powers

Zorbas

et al. 2021

Journal of Gastrointestinal Surgery

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“…Early clinical data similarly have been promising, with reported technical success of 86% and clinical success of 100% in seven patients with a mean American Society of Anesthesiologists score of 3.67 and approximately 500 days of follow-up. 25,27 In this high-risk cohort, one infection treated with short-term catheter drainage and one hemorrhage in an advanced cirrhotic occurred. Imaging demonstrated gallbladder involution in 83% of cases (►Fig.…”

Section: Gallbladder Cryoablation: Preclinical and Early Clinical Studiesmentioning

confidence: 86%

“…2). [25][26][27] Despite this promising early evidence, further studies confirming cystic duct occlusion are required.…”

Section: Potential Advantages Of Gallbladder Cryoablationmentioning

confidence: 99%

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Gallbladder Cryoablation: Clinical and Technical Considerations

McGregor

2022

Digestive Disease Interventions

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As many as 500,000 cholecystectomies are performed per year in the United States. Frail patients are at higher risk from cholecystectomy, with reported postoperative complication and mortality rates as high as 31 and 5% in patients older than 75 years. Percutaneous cholecystostomy drainage is commonly employed in high-risk patients with cholecystitis, with over 12,000 cases performed annually. Cholecystostomy, however, is not a definitive treatment, with up to 30% of patients having a recurrent episode of cholecystitis within 4 months after tube removal. Gallbladder cryoablation has emerged as a minimally invasive procedure that achieves transmural gallbladder wall necrosis in a single session resulting in gallbladder fibrosis and involution. Early clinical data have been promising, with reported technical success of 86% and clinical success of 100% at up to 500 days of follow-up. Several challenges and unknowns remain, however, including optimal patient selection and procedural technique, the potential need for adjunct procedures to occlude the cystic duct, the implications of the immunostimulatory effects of cryoablation, and the impact of the presence of gallstones on outcomes. This article reviews the rationale behind gallbladder cryoablation, updates early clinical outcomes, and discusses the challenges that remain for the adoption of the technique for the treatment of benign gallbladder disease.

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“…Recent advances have introduced additional options for patients who undergo cholecystostomy including cholecystoscopy with subsequent cholecystolithotomy to remove gallstones, and even electrohydraulic or laser cholecystolithotripsy for stones that are too large to be removed through the sheath [19,20]. Gallbladder cryoablation, which has recently been reported to achieve occlusion of the cystic duct and involution of the gallbladder, rendering the patient functionally acholecystic, represents another potential option for these patients [21].…”

Section: Treatment and Prognosismentioning

confidence: 99%

Acute Hemorrhagic Cholecystitis with Large Hemoperitoneum: Treatment with Microcoil Embolization and Subsequent Cholecystectomy

et al. 2021

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Hemorrhagic cholecystitis is a potentially deadly and difficult to recognize entity. It is associated with cystic artery pseudoaneurysm and is usually seen in the setting of acute calculous cholecystitis. We report two cases of hemorrhagic cholecystitis with arteriographic findings of cystic artery pseudoaneurysms that were successfully embolized using microcoils, facilitating subsequent cholecystectomy. Both cases had unusual presentations of gallbladder rupture with hemoperitoneum, the latter of which was atypical occurring in the absence of gallstones. We believe when hemorrhagic cholecystitis is suspected, a two-step therapeutic approach should be employed with embolization of the bleeding cystic artery followed by cholecystectomy. A comprehensive literature review and discussion of hemorrhagic cholecystitis will be provided. CASE REPORT Case Report 1: Calculous hemorrhagic cholecystitis (typical)A 74-year-old white male with a history of atrial fibrillation on coumadin was referred from an outside hospital with a 5-day history of abdominal pain, nausea, and vomiting, followed by 2 days of severe right upper quadrant pain. He experienced no hematemesis or melena. His physical examination was significant for abdominal tenderness, particularly in the right upper quadrant and epigastric region. A hepatic panel revealed markedly elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin. The patient's coagulation studies were only mildly elevated. Of greater clinical concern, however, laboratory values showed a significant drop in hemoglobin at 6.4 g/dL (normal: 14-17.4 g/dL) compared to 12.3 g/dL at the outside hospital.A CT of the abdomen and pelvis performed at the outside hospital revealed right upper quadrant hematoma and hemoperitoneum around the liver and spleen. In addition, a 1cm gallstone was impacted at the gallbladder neck with suggestion of erosion of the gallbladder wall. An ultrasound CASE REPORT

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First in-Human Gallbladder Cryoablation in a Patient with Acute Calculous Cholecystitis Initially Treated with a Cholecystostomy Tube

Cited by 9 publications

References 13 publications

Frailty Predicts Morbidity and Mortality After Laparoscopic Cholecystectomy for Acute Cholecystitis: An ACS-NSQIP Cohort Analysis

Frailty Predicts Morbidity and Mortality After Laparoscopic Cholecystectomy for Acute Cholecystitis: An ACS-NSQIP Cohort Analysis

Gallbladder Cryoablation: Clinical and Technical Considerations

Acute Hemorrhagic Cholecystitis with Large Hemoperitoneum: Treatment with Microcoil Embolization and Subsequent Cholecystectomy

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