Outcomes of endoscopic retrograde cholangiopancreatography-guided gallbladder drainage compared to percutaneous cholecystostomy in acute cholecystitis

Ali, Hassam; Shamoon, Sheena; Bolick, Nicole Leigh; Manickam, Swethaa; Sattar, Usama; Poola, Shiva; Mudireddy, Prashant

doi:10.14701/ahbps.22-065

Cited by 5 publications

(5 citation statements)

References 28 publications

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“…Our study determined that the length of hospital stay as well as the cost incurred were higher for patients undergoing percutaneous drainage. Various other studies have concluded similar ndings [32,33].…”

Section: Discussionsupporting

confidence: 78%

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Title: Evaluating Nasobiliary and Stent Drainage in Acute Cholecystitis and Cholangitis: Insights from a National Inpatient Survey

Poudel,

Adhikari,

Poudel

et al. 2024

Preprint

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Background: Acute cholecystitis is typically managed with cholecystectomy. However, in patients with underlying co-morbidities who are not suitable for surgery, drainage procedures are recommended. Traditionally, these procedures have been performed percutaneously, but endoscopic techniques have gained popularity in recent years due to their physiological approach and lower complication rates. Aims: This study aims to compare endoscopic modalities of drainage (nasobiliary and internal drainage with stenting) in patients with acute cholecystitis and acute cholangitis. We also compared percutaneous drainage with endoscopic retrograde drainage procedures. Methods: We analyzed the National Inpatient Sample (NIS) database (2016-2020) to compare outcomes of acute cholecystitis and cholangitis patients undergoing endoscopic nasobiliary drainage and stent placement. Differences in outcomes between percutaneous and various endoscopic drainages were highlighted. Statistical significance was assessed using χ² and t-tests for categorical and continuous data respectively, with P<0.05 considered significant. Multivariate analyses were performed to assess study outcomes and adverse events for each procedure. Results: Patients subjected to nasobiliary drainage exhibited a higher mean age compared to those undergoing internal drainage (68.56 +/- 1.84 years vs 64.62 +/- 0.39 years, p-value < 0.05). Both groups shared similar demographic parameters and comorbidities. Internal drainage with stenting correlated with elevated incidences of acute pancreatitis (14.68% vs 13.04%, p-value <0.05) and intestinal perforation (4.24% vs 2.17%, p-value <0.05) compared to nasobiliary drainage. Conversely, nasobiliary drainage was associated with increased occurrences of bleeding (2.17% vs 0.98%, p-value < 0.05) and ileus (10.87% vs 5.22%, p-value < 0.05). Additionally, internal drainage with stenting exhibited a higher rate of subsequent cholecystectomy compared to nasobiliary drainage (3.20% vs 2.17%, p-value < 0.05). Percutaneous drainage predominated among older individuals (70.36 +/- 0.16 years vs 64.15 +/-0.35, p-value < 0.05). The adjusted odds ratio for mortality for percutaneous drainage versus endoscopic drainage was (5.15 +/- 0.88 vs 0.2 +/- 0.03, p-value < 0.05). Those undergoing endoscopic drainage demonstrated a substantially higher rate of subsequent cholecystectomy (26.50% vs 0.24%, p-value < 0.05). Conclusion: Patients undergoing nasobiliary or internal drainage with stent shared similar demographic characteristics and comorbidities. Internal drainage with stenting correlated with a heightened risk of acute pancreatitis and intestinal perforation, whereas bleeding and ileus were more prevalent with nasobiliary drainage. Moreover, internal drainage with stent was associated with a higher incidence of subsequent cholecystectomy.

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Section: Discussionsupporting

confidence: 78%

“…Patients with co-morbidity burden were more likely to undergo percutaneous drainage rather than endoscopic drainage. Another NIS database study comparing ERCP with percutaneous drainage had similar ndings [32].…”

Section: Discussionmentioning

confidence: 79%

Title: Evaluating Nasobiliary and Stent Drainage in Acute Cholecystitis and Cholangitis: Insights from a National Inpatient Survey

Poudel,

Adhikari,

Poudel

et al. 2024

Preprint

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“…Each hospitalization was assigned a propensity score using a multivariable logistic regression, which included individual‐ (age, sex, race, and comorbidities) and hospital‐level (location, teaching status, and bed size) variables. Cases and controls were matched based on the propensity scores in a 1:1 manner within 0.01 standard deviation of the calculated score, as in prior literature 5,6 . The covariate balance was then visualized using a two‐way plot shown in Figures S1a (before the match) and S1b (after the match).…”

Section: Methodsmentioning

confidence: 99%

“…Cases and controls were matched based on the propensity scores in a 1:1 manner within 0.01 standard deviation of the calculated score, as in prior literature. 5 , 6 The covariate balance was then visualized using a two‐way plot shown in Figures S1a (before the match) and S1b (after the match). A two‐sample Wilcoxon rank‐sum (Mann–Whitney) test was used for continuous variables, and outcomes were reported with interquartile ranges (IQRs).…”

Section: Methodsmentioning

confidence: 99%

Renal replacement therapy prior to liver transplant and inpatient mortality in patients without advanced kidney disease: A nationwide study

Ali,

Moond,

Lawson

et al. 2024

JGH Open

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Background and AimThe utility of renal replacement therapy (RRT) before liver transplant (LT) in patients without end‐stage renal disease (ESRD) or advanced chronic kidney disease (CKD‐IV/V) is debatable and lacks data support. We aimed to evaluate the impact of RRT on patients undergoing LT.MethodsWe used the National Readmission Database (2016–2019) to identify all index hospitalizations undergoing RRT before LT (cases). A matched comparison cohort of similar hospitalizations without RRT before LT was identified (controls) after 1:1 propensity score matching for age, gender, and available comorbidities.ResultsWe matched 364 cases (RRT before LT) to 364 controls (LT without prior RRT). There was no statistical difference in all‐cause inpatient mortality (4.9% vs 3.6% P = 0.4). A significantly greater proportion of cases were associated with ICU admission (40.7% vs 17.0%, P < 0.001) and RRT requirement post LT (100% vs 17%, P < 0.001). There was no difference in 30‐ (hazard ratio [HR] 1.1, 0.4–2.6), 60‐ (HR 0.9, 0.4–1.8), or 90‐day (HR 0.8, 0.4–1.6) inpatient mortality between the groups. Also, 180‐day survival estimates were comparable (P = 0.5). The results were similar in patients with no chronic kidney disease (CKD) and CKD‐III.ConclusionRRT prior to LT, in patients without advanced CKD or ESRD, was associated with greater instances of ICU stay and need for future RRT. Also, 30‐, 60‐, and 90‐day inpatient mortality rates were similar, and 180‐day survival estimates were comparable.

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“…Matched observations had a caliper width of 0.01 for the caliper matching variable (propensity scores). Cases and controls were matched 1:1 on age, sex, and Elixhauser comorbidities, including cardiac comorbidities (heart failure and valvular dysfunction), hypertension, diabetes, and cirrhosis (compensated and decompensated), as previously reported[ 16 , 17 ]. The covariate balance was visualized using the two-way plot shown in Figure 1 .…”

Section: Methodsmentioning

confidence: 99%

Impact of metabolic dysfunction-associated steatotic liver disease on COVID-19 hospitalizations: A propensity-matched analysis of the United States

Sohail,

Ali,

Patel

et al. 2024

World J Virol

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BACKGROUND Metabolic dysfunction-associated steatotic liver disease (MASLD), formally known as nonalcoholic fatty liver disease, is the most common chronic liver disease in the United States. Patients with MASLD have been reported to be at a higher risk of developing severe coronavirus disease 2019 (COVID-19) and death. However, most studies are single-center studies, and nationwide data in the United States is lacking. AIM To study the influence of MASLD on COVID-19 hospitalizations during the initial phase of the pandemic. METHODS We retrospectively analyzed the 2020 National Inpatient Sample (NIS) database to identify primary COVID-19 hospitalizations based on an underlying diagnosis of MASLD. A matched comparison cohort of COVID-19 hospitalizations without MASLD was identified from NIS after 1: N propensity score matching based on gender, race, and comorbidities, including hypertension, heart failure, diabetes, and cirrhosis. The primary outcomes included inpatient mortality, length of stay, and hospitalization costs. Secondary outcomes included the prevalence of systemic complications. RESULTS A total of 2210 hospitalizations with MASLD were matched to 2210 hospitalizations without MASLD, with a good comorbidity balance. Overall, there was a higher prevalence of severe disease with more intensive care unit admissions (9.5% vs 7.2%, P = 0.007), mechanical ventilation (7.2% vs 5.7%, P = 0.03), and septic shock (5.2% vs 2.7%, P <0.001) in the MASLD cohort than in the non-MASLD cohort. However, there was no difference in mortality (8.6% vs 10%, P = 0.49), length of stay (5 d vs 5 d, P = 0.25), and hospitalization costs (42081.5 $ vs 38614$, P = 0.15) between the MASLD and non-MASLD cohorts. CONCLUSION The presence of MAFLD with or without liver cirrhosis was not associated with increased mortality in COVID-19 hospitalizations; however, there was an increased incidence of severe COVID-19 infection. This data (2020) predates the availability of COVID-19 vaccines, and many MASLD patients have since been vaccinated. It will be interesting to see if these trends are present in the subsequent years of the pandemic.

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Outcomes of endoscopic retrograde cholangiopancreatography-guided gallbladder drainage compared to percutaneous cholecystostomy in acute cholecystitis

Cited by 5 publications

References 28 publications

Title: Evaluating Nasobiliary and Stent Drainage in Acute Cholecystitis and Cholangitis: Insights from a National Inpatient Survey

Title: Evaluating Nasobiliary and Stent Drainage in Acute Cholecystitis and Cholangitis: Insights from a National Inpatient Survey

Renal replacement therapy prior to liver transplant and inpatient mortality in patients without advanced kidney disease: A nationwide study

Impact of metabolic dysfunction-associated steatotic liver disease on COVID-19 hospitalizations: A propensity-matched analysis of the United States

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