Outcomes of Percutaneous Cholecystostomy for Acute Cholecystitis

Pang, Khang Wen; Tan, Chun Han Nigel; Loh, Stanley; Chang, Kin Yong Stephen; Ganpathi, Iyer Shridhar; Madhavan, Krishnakumar; Kow, Wei Chieh Alfred

doi:10.1007/s00268-016-3585-z

Cited by 49 publications

(49 citation statements)

References 22 publications

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“…26 In addition, several recent studies have suggested not only the traditional role of PC as bridging therapy, but also its potential role as definitive therapy for AC. [22][23][24][25][26] These suggestions are based on the relatively low recurrence rates of AC after PC without subsequent cholecystectomy in the aforementioned studies (ranging from 9.2% to 23.5%), which is comparable with those values in the present study (elderly group 19.3%, non-elderly group 20%). Given the relatively low mortality and low recurrence rates of AC after PC, this technique appears useful as a definitive first-line treatment without subsequent cholecystectomy in elderly AC patients with various comorbidities.…”

Section: Discussionsupporting

confidence: 90%

“…A systematic review in 2009 reported that the mortality rate after PC (overall 15.4%, procedure‐associated 3.6%) was significantly higher than that after cholecystectomy (4.5%) in AC patients aged ≥65 years . However, recent reports have shown relatively low mortality rates after PC (0–8.5%), which is consistent with the findings in the present study (overall 3.6% [6/166], procedure‐associated 0%) . A recent review from Canada indicated that the reduction in the mortality rate after PC with time might be attributed to improvements in equipment and technique, operator use, increased imaging quality, better supportive care, and improved patient selection .…”

Section: Discussionsupporting

confidence: 89%

“…A recent review from Canada indicated that the reduction in the mortality rate after PC with time might be attributed to improvements in equipment and technique, operator use, increased imaging quality, better supportive care, and improved patient selection . In addition, several recent studies have suggested not only the traditional role of PC as bridging therapy, but also its potential role as definitive therapy for AC . These suggestions are based on the relatively low recurrence rates of AC after PC without subsequent cholecystectomy in the aforementioned studies (ranging from 9.2% to 23.5%), which is comparable with those values in the present study (elderly group 19.3%, non‐elderly group 20%).…”

Section: Discussionmentioning

confidence: 66%

“…21 However, recent reports have shown relatively low mortality rates after PC (0-8.5%), which is consistent with the findings in the present study (overall 3.6% [6/166], procedureassociated 0%). [22][23][24][25] A recent review from Canada indicated that the reduction in the mortality rate after PC with time might be attributed to improvements in equipment and technique, operator use, increased imaging quality, better supportive care, and improved patient selection. 26 In addition, several recent studies have suggested not only the traditional role of PC as bridging therapy, but also its potential role as definitive therapy for AC.…”

Section: Discussionmentioning

confidence: 99%

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Clinical characteristics and short‐term outcomes in patients with acute cholecystitis over aged >80 years

Akasu

Kinoshita

Imai

et al. 2018

Geriatrics Gerontology Int

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Aim We investigated the clinical characteristics and short‐term outcomes in acute cholecystitis (AC) patients aged ≥80 years. We therefore sought to determine the ideal treatment for elderly patients with AC. Methods We retrospectively evaluated 253 patients with AC. The patients were divided into two groups according to their age: elderly group (n = 77, aged ≥80 years) and non‐elderly group (n = 176, aged <80 years). We compared the clinical characteristics, in‐hospital mortality and recurrence of cholecystitis within 6 months between the two groups. The predictive factors for in‐hospital mortality were also assessed. Results The elderly group had more severe comorbidities (P = 0.0055), higher severity grade of AC (P = 0.00071) and higher in‐hospital mortality (P = 0.029) than the non‐elderly group. The multivariate analysis showed that the serum creatinine level (hazard ratio 12.43; P = 0.002) was independently associated with the in‐hospital mortality. The elderly group (20.8%) underwent subsequent cholecystectomy less frequently than the non‐elderly group (63.2%; P < 0.0001). The recurrence rate of AC was comparable between the two groups (P = 0.89). The proportion of patients in the elderly group who received percutaneous drainage in the latter period (64.3%) was significantly higher than in the former period (33.3%; P = 0.015). Conclusions More attention should be paid to AC patients with chronic renal disease after treatment. Percutaneous drainage might serve as a definitive treatment without subsequent cholecystectomy in elderly AC patients with various comorbidities. Geriatr Gerontol Int 2019; 19: 208–212.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

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Clinical characteristics and short‐term outcomes in patients with acute cholecystitis over aged >80 years

Akasu

Kinoshita

Imai

et al. 2018

Geriatrics Gerontology Int

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“…Only one retrospective study reported long-term mortality of 71 patients with a median follow-up of 37 months and an overall mortality rate of 32% during that time period, 24 which is consistent with our overall 2-year survival rate of 35% in the cholecystostomy group and 41% in the no cholecystostomy group. The poor long-term survival data reflect the underlying severity of comorbid illness.…”

Section: Discussionsupporting

confidence: 87%

Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis

Dimou

Adhikari

Mehta

et al. 2017

Journal of the American College of Surgeons

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Background The Tokyo guidelines recommend initial cholecystostomy tube drainage, antibiotics, and delayed cholecystectomy in patients with grade III cholecystitis. Study Design We used Medicare data (1996–2010) to identify patients ≥66 years admitted with grade III acute cholecystitis. We evaluated adherence to the Tokyo guidelines and compared mortality, readmission, and complication rates with and without cholecystostomy tube placement in a propensity-matched (1:3) cohort of patients with grade III cholecystitis. Results 8,818 patients were admitted with grade III cholecystitis; 565 patients (6.4%) had a cholecystostomy tube placed. Cholecystostomy tube placement increased from 3.9% to 9.7% over the study period. Compared to 1,689 propensity-matched controls, patients with cholecystostomy tube placement had higher 30-day (HR 1.26, 95% CI 1.05–1.50), 90-day (HR 1.26, 95% CI 1.08–1.46) and 2-year mortality (HR 1.19, 95% CI 1.04–1.36) and were less likely to undergo cholecystectomy in the 2-years after initial hospitalization (33.4% vs. 64.4%, HR 0.26, 95% CI 0.21–0.31). Readmissions were also higher at 30 days (HR 2.93, 95% CI 2.12–4.05), 90 days (HR 3.48, 95% CI 2.60–4.64), and 2 years (HR 3.08, 95% CI 2.87–4.90). Conclusions Since introduction of the Tokyo Guidelines (2007), use of cholecystostomy tubes in patients with grade III cholecystitis has increased, but the majority of patients do not get cholecystostomy tube drainage as first line therapy. Cholecystostomy tube placement was associated with lower rates of definitive treatment with cholecystectomy, higher mortality and higher readmission rates. These data suggest a need for further evaluation and refinement of the Tokyo guidelines.

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Percutaneous cholecystostomy for severe (Tokyo 2013 stage III) acute cholecystitis

Polistina¹,

Mazzucco²,

Coco³

et al. 2018

Eur J Trauma Emerg Surg

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Outcomes of Percutaneous Cholecystostomy for Acute Cholecystitis

Abstract: PC is effective and relatively safe in high-risk patients with AC. However, patients with higher ALP or AMI during index admission have higher risk of recurrence and might benefit from definitive cholecystectomy.

Cited by 49 publications

References 22 publications

Clinical characteristics and short‐term outcomes in patients with acute cholecystitis over aged >80 years

Clinical characteristics and short‐term outcomes in patients with acute cholecystitis over aged >80 years

Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis

Percutaneous cholecystostomy for severe (Tokyo 2013 stage III) acute cholecystitis

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