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Samanta A, Sarma MS. "Post-Kasai Portoenterostomy Cholangitis: What Have We Learnt So Far?". J Clin Exp Hepatol 2025; 15:102471. [PMID: 39816454 PMCID: PMC11730534 DOI: 10.1016/j.jceh.2024.102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 11/30/2024] [Indexed: 01/12/2025] Open
Abstract
Post-Kasai portoenterostomy (KPE) cholangitis is one of the most common complications that has a negative impact on liver function and native liver survival. Early diagnosis and judicious empiric antimicrobial management are, therefore, important to prevent further liver damage and decompensation. However, there is no consensus regarding the standard definition of post-KPE cholangitis, and established guidelines on evaluation and management are also lacking. Metagenomic next-generation sequencing, a new molecular diagnostic technique, has the potential for detecting broader spectrum of pathogens, especially in blood culture-negative patients. Antibiotic prophylaxis to prevent cholangitis has been widely used, but questions over the choice of antibiotics, route of administration, and optimal duration remain unsettled. The available evidence on the efficacy of antibiotic prophylaxis in preventing cholangitis has shown conflicting results. This review offers a summary of the current research on advances in diagnostic approaches, including molecular techniques, and therapeutic challenges in managing intractable cholangitis.
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Affiliation(s)
- Arghya Samanta
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Moinak S. Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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Sanavio M, Camus M, Nammour JP, Godmer A, Meynard JL, Chaput U, Becq A. Clinical use of per ERCP bile aspiration in patients with cholangitis: The aspibile study. Clin Res Hepatol Gastroenterol 2025; 49:102599. [PMID: 40273980 DOI: 10.1016/j.clinre.2025.102599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 04/09/2025] [Accepted: 04/22/2025] [Indexed: 04/26/2025]
Abstract
BACKGROUND AND STUDY AIMS Bile aspiration during endoscopic retrograde cholangiopancreatography (ERCP) for cholangitis is not systematic and data on its clinical relevance remain limited. The aim of this study was to evaluate the clinical contribution of biliary aspiration in the setting of cholangitis. METHODS Consecutive patients with ERCP performed for cholangitis were included. The primary outcome was the rate of adaptation of antibiotic therapy to biliary aspirations. Secondary outcomes were length of hospitalization, mortality, cholangitis recurrence at 30 days, duration of antibiotic therapy, antibiotic change, agreement between antibiotic therapy and biliary aspiration. RESULTS A total of 140 patients were included, 103 (73.6 %) had blood cultures before ERCP. The rate of empiric and adjusted antibiotics effectively targeting bacteria found in bile was 82.1 % and 85.4 %, respectively. The mean length of hospital stay was 15.7 days, cholangitis recurrence rate was 3.2 % and the mortality rate was 5.5 %. The mean duration of antibiotic therapy was 11.3 days with an antibiotic modification rate of 45 %. CONCLUSIONS Bile aspiration during ERCP for acute cholangitis is a valuable complement to blood culture providing a higher diagnostic yield and enabling targeted antibiotic therapy. The rate of antibiotics effectively targeting bacteria found in bile is higher than 80 %.
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Affiliation(s)
- Mathilde Sanavio
- Sorbonne University, Center for Digestive Endoscopy, Saint Antoine Hospital, APHP, Paris, France
| | - Marine Camus
- Sorbonne University, Center for Digestive Endoscopy, Saint Antoine Hospital, APHP, Paris, France
| | - Jean Paul Nammour
- Paris-Est Creteil University, Gastroenterology Department, Henri Mondor Hospital, APHP, Creteil, France
| | - Alexandre Godmer
- U1135, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), Sorbonne University, AP-HP.Sorbonne University, Microbiology department, Saint Antoine Hospital, APHP, Paris, France
| | - Jean Luc Meynard
- Sorbonne University, Infectious disease department, Saint Antoine Hospital, APHP, Paris, France
| | - Ulriikka Chaput
- Sorbonne University, Center for Digestive Endoscopy, Saint Antoine Hospital, APHP, Paris, France
| | - Aymeric Becq
- Paris-Est Creteil University, Gastroenterology Department, Henri Mondor Hospital, APHP, Creteil, France.
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Hao Z, Lu Y, Hao Y, Luo Y, Wu K, Zhu C, Shi P, Zhu F, Lin Y, Zeng X. Fungal mycobiome dysbiosis in choledocholithiasis concurrent with cholangitis. J Gastroenterol 2025; 60:340-355. [PMID: 39604579 DOI: 10.1007/s00535-024-02183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 11/11/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND The gut mycobiome might have an important influence on the pathogenesis of choledocholithiasis concurrent with cholangitis (CC). The aim of this study was to characterize the fungal mycobiome profiles, explore the correlation and equilibrium of gut interkingdom network among bacteria-fungi-metabolites triangle in CCs. METHODS In a retrospective case-control study, we recruited patients with CC (n = 25) and healthy controls (HCs) (n = 25) respectively to analyze the gut fungal dysbiosis. Metagenomic sequencing was employed to characterize the gut mycobiome profiles, and liquid chromatography/mass spectrometry (LC/MS) analysis was used to quantify the metabolites composition. RESULTS The Shannon index displayed a reduction in fungal α-diversity in CCs compared to HCs (p = 0.041), and the overall fungal composition differed significantly between two groups. The dominant 7 fungi species with the remarkable altered abundance were identified (LDA score > 3.0, p < 0.05), including CC-enriched Aspergillus_niger and CC-depleted fungi Saccharomyces_boulardii. In addition, the correlations between CC-related fungi and clinical variables in CCs were analyzed. Moreover, the increased abundance ratio of Basidiomycota-to-Ascomycota and a dense linkage of bacteria-fungi interkingdom network in CCs were demonstrated. Finally, we identified 30 markedly altered metabolites in CCs (VIP > 1.0 and p < 0.05), including low level of acetate and butyrate, and the deeper understanding on the complexity of bacteria-fungi-metabolites triangle involving bile inflammation was verified. CONCLUSION Our investigation demonstrated a distinct gut fungal dysbiosis in CCs and proposed that, beyond bacteria, the more attention should be paid to significantly potential influence of fungi and bacteria-fungi-metabolites triangle interkingdom interactions on pathogenesis of CC.
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Affiliation(s)
- Zhiyuan Hao
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
- Department of Pathology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai, 200003, China
| | - Yiting Lu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
- Department of Pathology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai, 200003, China
| | - Yarong Hao
- Department of Gastroenterology, Shanghai Changzheng Hospital, Navy Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
- Department of Pathology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai, 200003, China
| | - Yuanyuan Luo
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
- Department of Pathology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai, 200003, China
| | - Kaiming Wu
- Department of Gastroenterology, Shanghai Changzheng Hospital, Navy Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
- Department of Pathology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai, 200003, China
| | - Changpeng Zhu
- Department of Gastroenterology, Shanghai Changzheng Hospital, Navy Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
- Department of Pathology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai, 200003, China
| | - Peimei Shi
- Department of Gastroenterology, Shanghai Changzheng Hospital, Navy Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
- Department of Pathology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai, 200003, China
| | - Feng Zhu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
- Department of Pathology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai, 200003, China
| | - Yong Lin
- Department of Gastroenterology, Shanghai Changzheng Hospital, Navy Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
- Department of Pathology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai, 200003, China.
| | - Xin Zeng
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China.
- Department of Pathology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai, 200003, China.
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Calinescu AM, Wildhaber BE. Post-Kasai cholangitis evaluation and management strategies: Review of the literature with insights from the Swiss Biliary Atresia Registry. Semin Pediatr Surg 2024; 33:151471. [PMID: 39862689 DOI: 10.1016/j.sempedsurg.2025.151471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 01/07/2025] [Indexed: 01/27/2025]
Abstract
Cholangitis, defined as the inflammation of the bile ducts, is the most frequent complication after Kasai hepatoportoenterostomy in patients with biliary atresia (BA). This review seeks to provide a comprehensive synthesis of current knowledge on diagnosing and managing BA-associated cholangitis while identifying gaps in the existing literature. A scoping literature review was conducted to gather global insights into the definition, evaluation, and management of post-Kasai cholangitis, illustrated through data from the Swiss Biliary Atresia Registry (SBAR). In the literature many different decision algorithms exist for BA-associated cholangitis underlining the clear need for standardizing diagnostic criteria. As an illustration, in 2015 the Swiss center introduced structured guidelines to diagnose BA-associated cholangitis. Upon retrospective analysis of SBAR data (2010-2022) we noted significant differences in disease management before and after implementation: The number of multiple diagnosed cholangitis episodes was reduced and we observed a reduced transplantation rate. Building on this, the Biliary Atresia and Related Diseases consensus has developed key diagnostic and management guidelines with objective criteria that have yet to undergo prospective validation. Indeed, prospective multicenter assessment is clearly needed to enhance acceptance and improve outcomes. Further, rigorous evaluation of prophylactic and therapeutic interventions, including antibiotics and immunomodulatory treatments, seems essential, with randomized trials required to establish their effectiveness and explore microbiota modulation in cholangitis management. The BA-community should strive to establish and adopt a widely accepted protocol for the diagnosis, management and prevention of BA-associated cholangitis. The implementation of such protocols is expected to significantly improve clinical outcomes for these patients.
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Affiliation(s)
- Ana M Calinescu
- Swiss Pediatric Liver Center, Geneva University Hospitals, Geneva, Switzerland; Division of Child and Adolescent Surgery, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
| | - Barbara E Wildhaber
- Swiss Pediatric Liver Center, Geneva University Hospitals, Geneva, Switzerland; Division of Child and Adolescent Surgery, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Kurauchi N, Mori Y, Nakamura Y, Tokumura H. Gallbladder and common bile duct. Asian J Endosc Surg 2024; 17:e13369. [PMID: 39278638 DOI: 10.1111/ases.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 09/18/2024]
Affiliation(s)
- Nobuaki Kurauchi
- Department of Surgery, Kutchan-Kosei General Hospital, Hokkaido, Japan
| | - Yasuhisa Mori
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Yoshiharu Nakamura
- Department of Surgery, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
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Lv TR, Wang JK, Li FY, Hu HJ. The effectiveness of combined extrahepatic bile duct resection in radically resected cases with intrahepatic cholangiocarcinoma: a SEER-based retrospective cohort study and an external validation. Int J Surg 2024; 110:5342-5354. [PMID: 38788199 PMCID: PMC11392128 DOI: 10.1097/js9.0000000000001661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of the combined extrahepatic bile duct resection (EHBDR) in cases with intrahepatic cholangiocarcinoma (IHCC) in terms of clinicopathological features and long-term survival. METHODS Radically resected cases with IHCC from 2000 to 2020 were identified from Surveillance, Epidemiology, and End Results (SEER) database. Comparative analyses were performed between resected IHCC patients who received EHBDR and those without EHBDR. Moreover, an external validation was further performed based on a single-center cohort. RESULTS A total of 1521 radically resected cases with IHCC (EHBDR: 189) were identified from the SEER database. Comparable age, sex, race, marital status, liver cirrhosis, differentiation status, and adjuvant chemotherapy were acquired between the two groups. EHBDR was associated with a higher incidence of adequate lymphadenectomy ( P <0.001). The incidence of cases with T3-4 or N+ disease was significantly higher in EHBDR group ( P <0.001). Adjuvant radiotherapy was more frequently performed in cases with EHBDR ( P <0.001). EHBDR failed to bring any survival benefit and was associated with a worse prognosis even after matching. Similar findings have also been revealed in the external validation cohort ( n =522, EHBDR: 117). EHBDR was associated with more extended resections, more aggressive tumor biological features, and worse prognosis. In the matched validation cohort, EHBDR was still associated with a higher incidence of early recurrence. CONCLUSION EHBDR was an indicator of the advanced stage and failed to bring any survival benefit. It is the tumor stage that really determines the prognosis. More in-depth analyses focusing on different situations of EHBDR with more detailed clinical data are required.
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Affiliation(s)
- Tian-Run Lv
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun-Ke Wang
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fu-Yu Li
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hai-Jie Hu
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Vs VR, Sureka B, Yadav T, Varshney VK, Sharma N, Chaudhary R, Rodha MS, Banerjee M, Elhence P, Khera PS. Gallbladder perforation: Diagnostic accuracy of new CT difficulty score in predicting complicated laparoscopic cholecystectomy. Emerg Radiol 2024; 31:455-466. [PMID: 38780718 DOI: 10.1007/s10140-024-02245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To formulate and evaluate the diagnostic performance and utility of a new CT difficulty score in predicting difficult laparoscopic surgery in cases of gallbladder (GB) perforation. METHODS This prospective single centre study included a total of 48 diagnosed cases of GB perforation on CT between December 2021 and June 2023, out of which 24 patients were operated. A new 6-point CT difficulty scoring system was devised to predict difficult laparoscopic approach, based on patterns of inflammation around the perforated GB that were found to be surgically relevant. The pre-operative imaging findings on CT were studied in detail and correlation coefficients of various imaging findings were calculated to predict difficult surgery. RESULTS On CECT, the type of perforation, according to the revised Niemeier's classification could be exactly delineated in all 48 patients. A CT difficulty score of ≥ 3 was found to a good predictor difficult laparoscopic approach, with statistical significance (p = 0.001), sensitivity of 94.44%, specificity of 83.33%, PPV of 94.44% and NPV of 83.33%. Inflammatory changes around duodenum showed maximum correlation coefficient of 0.744 (p = 0.0001), around colon showed a correlation coefficient of 0.657 (p = 0.0005), and in the omentum had a correlation coefficient of 0.5 (p = 0.013)). Inter-observer agreement was also calculated for various findings and it was found to have moderate to strong agreement (κ value 0.5-1.0). CONCLUSION The CT difficulty scoring system can be an effective tool in predicting difficult laparoscopic surgery in cases of GB perforation in an emergency setting which can help in decision making and improved patient outcome.
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Affiliation(s)
- Vijaya Ram Vs
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS) Jodhpur, Rajasthan, 342005, India
| | - Binit Sureka
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS) Jodhpur, Rajasthan, 342005, India.
| | - Taruna Yadav
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS) Jodhpur, Rajasthan, 342005, India
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Naveen Sharma
- Department of General Surgery, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Ramkaran Chaudhary
- Department of General Surgery, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Mahaveer Singh Rodha
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Poonam Elhence
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Pushpinder Singh Khera
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS) Jodhpur, Rajasthan, 342005, India
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Martin WT, Snyder KB, Stewart K, Sarwar Z, Starr WC, Grady A, Ball J, Raines AR, Cross A. Bridging the Gap: Comparison of Outpatient Clinic and Emergency Department Patients Undergoing Cholecystectomy. J Surg Res 2024; 300:183-190. [PMID: 38823268 DOI: 10.1016/j.jss.2024.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/19/2024] [Accepted: 04/28/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Literature shows failure of the outpatient clinic (OC) pathway after emergency department (ED) ultrasound diagnosis of symptomatic cholelithiasis (SC). We hypothesized SC to be more prevalent on final surgical pathology (FSP) in patients who successfully completed OC pathway. METHODS This retrospective single-institution chart review compared OC and ED patients with right upper quadrant (RUQ) pain and cholelithiasis whom underwent cholecystectomy. Clinical evaluation was considered positive if RUQ pain >4 h, or + Murphy's sign. Ultrasound was positive if two of these three were present: sonographic Murphy's, wall thickness > 4 mm, or pericholecystic fluid. Results were compared with FSP. RESULTS Six hundred-seven patients underwent cholecystectomy, 299 OC and 308 ED. OC was more likely to SC (23% versus 4.6%) (P < 0.0001) and ED acute cholecystitis (39.3% versus 4.7%). Chronic cholecystitis was the most common FSP in both OC (72%) and ED (56%) populations, of these, 73% of OC denied pain >4 h versus only 10% of ED (P < 0.001). Median time from evaluation to cholecystectomy was 14 d versus 14 h in the OC and ED respectively (P < 0.0001). CONCLUSIONS While chronic cholecystitis was the most common FSP in both OC and ED, the majority of OC reported RUQ pain <4 h delineating these presentations. Duration of pain should be utilized as algorithm triage. We recommend patients with pain episode <4 h should complete OC algorithm with expedited cholecystectomy within 14 d.
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Affiliation(s)
- W Taylor Martin
- Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma.
| | - Katherine B Snyder
- Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Kenneth Stewart
- Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Zoona Sarwar
- Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma
| | - William C Starr
- The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Anna Grady
- The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Jonathan Ball
- The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Alexander R Raines
- Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Alisa Cross
- Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma
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Madadi‐Sanjani O, Calinescu AM, Rock N, McLin VA, Uecker M, Kuebler JF, Petersen C, Wildhaber BE. Retrospective analysis of the standardized BARD criteria for acute cholangitis in biliary atresia patients. JPGN REPORTS 2024; 5:309-316. [PMID: 39149194 PMCID: PMC11322016 DOI: 10.1002/jpr3.12071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/28/2023] [Accepted: 02/29/2024] [Indexed: 08/17/2024]
Abstract
Objectives In 2022, the Biliary Atresia and Related Diseases (BARD) community reached a consensus for the definition of suspected and confirmed cholangitis for biliary atresia (BA) patients after hepatoportoenterostomy (HPE). This study assessed the new standardized BARD definition in a retrospective, multicenter cohort study. Methods We included BA cases managed between 2010 and 2020 at the Hannover Medical School and Geneva University Hospitals' Swiss Pediatric Liver Center. The standardized BARD cholangitis definition assesses four clinical items and four imaging/laboratory items to define cholangitis. The definition was retrospectively applied to all BA cases having presented, according to their physician, cholangitis within the first year after the HPE. The diagnosis defined by the standardized BARD definition was compared with the final clinical diagnosis made by physicians. The Spearman's correlation coefficient was used to test for correlation between diagnoses made by standardized and clinical appreciation. Results Of 185 consecutive BA patients, 59 (32%) had at least one episode of cholangitis within the first year after HPE. The correlation between the clinician's impression and the standardized BARD definition was very strong (r = 0.8). Confirmed cholangitis definition coincided with the clinician's impression (2.5 [±0.7]/4 clinical items, 2.6 [±0.5]/4 imaging/laboratory items). For suspected cholangitis, the threshold for diagnosis was lower within the standardized BARD definition (1.1 [±0.3]/4 clinical items, 2.2 [±0.8]/4 laboratory/imaging items). Conclusions This first retrospective application of the standardized BARD cholangitis definition reveals a very strong correlation with the physician's assessment before standardization. A prospective study is needed to further refine the standardized definition for cholangitis in BA patients.
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Affiliation(s)
| | - Ana M. Calinescu
- Swiss Pediatric Liver CenterGeneva University HospitalsGenevaSwitzerland
- Department of Pediatrics, Gynecology, and Obstetrics, Division of Child and Adolescent SurgeryGeneva University HospitalsGenevaSwitzerland
- Department of Pediatrics, Gynecology and ObstetricsUniversity of GenevaGenevaSwitzerland
| | - Nathalie Rock
- Swiss Pediatric Liver CenterGeneva University HospitalsGenevaSwitzerland
- Department of Pediatrics, Gynecology and ObstetricsUniversity of GenevaGenevaSwitzerland
- Department of Pediatrics, Gynecology, and Obstetrics, Gastroenterology, Hepatology and Nutrition Unit, Division of Pediatric SpecialtiesGeneva University HospitalsGenevaSwitzerland
| | - Valerie A. McLin
- Swiss Pediatric Liver CenterGeneva University HospitalsGenevaSwitzerland
- Department of Pediatrics, Gynecology and ObstetricsUniversity of GenevaGenevaSwitzerland
- Department of Pediatrics, Gynecology, and Obstetrics, Gastroenterology, Hepatology and Nutrition Unit, Division of Pediatric SpecialtiesGeneva University HospitalsGenevaSwitzerland
| | - Marie Uecker
- Department of Pediatric SurgeryHannover Medical SchoolHannoverGermany
| | | | - Claus Petersen
- Department of Pediatric SurgeryHannover Medical SchoolHannoverGermany
| | - Barbara E. Wildhaber
- Swiss Pediatric Liver CenterGeneva University HospitalsGenevaSwitzerland
- Department of Pediatrics, Gynecology, and Obstetrics, Division of Child and Adolescent SurgeryGeneva University HospitalsGenevaSwitzerland
- Department of Pediatrics, Gynecology and ObstetricsUniversity of GenevaGenevaSwitzerland
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Matsumi A, Kato H, Ogawa T, Ueki T, Wato M, Fujii M, Toyokawa T, Harada R, Ishihara Y, Takatani M, Tsugeno H, Yunoki N, Tomoda T, Mitsuhashi T, Otsuka M. Risk factors and treatment strategies for cholecystitis after metallic stent placement for malignant biliary obstruction: a multicenter retrospective study. Gastrointest Endosc 2024; 100:76-84. [PMID: 38490459 DOI: 10.1016/j.gie.2024.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND AND AIMS Cholecystitis can occur after self-expandable metallic stent (SEMS) placement for malignant biliary obstruction (MBO), but the best treatment option for cholecystitis has not been determined. Here, we aimed to identify the risk factors of cholecystitis after SEMS placement and determine the best treatment option. METHODS Incidence, treatments, and predictive factors of cholecystitis were retrospectively evaluated in 1084 patients with distal MBO (DMBO) and 353 patients with hilar MBO (HMBO) who underwent SEMS placement at 12 institutions from January 2012 to March 2021. RESULTS Cholecystitis occurred in 7.5% of patients with DMBO and 5.9% of patients with HMBO. The recurrence rate was significantly lower (P = .043) and the recurrence-free period significantly longer (P = .039) in endoscopic procedures than in percutaneous procedures for cholecystitis treatment. EUS-guided gallbladder drainage (EUS-GBD) was better in terms of technical success, procedure time, and recurrence-free period than endoscopic transpapillary gallbladder drainage. Obstruction across the cystic duct orifice by tumor (P = .015) and by stent (P = .037) were independent risk factors for cholecystitis in DMBO. Cases with multiple SEMS placements (odds ratio [OR], 11; 95% confidence interval [CI], 0.68-190; P = .091) and with gallbladder stones (OR, 2.3; 95% CI ,0.92-5.6; P = .075) had a higher risk for cholecystitis in HMBO. CONCLUSIONS The incidences of cholecystitis after SEMS placement for DMBO and HMBO were similar. EUS-GBD is the optimal treatment option for patients with cholecystitis after SEMS placement for MBO.
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Affiliation(s)
- Akihiro Matsumi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Taiji Ogawa
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Toru Ueki
- Department of Gastroenterology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masaki Wato
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
| | - Masakuni Fujii
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Tatsuya Toyokawa
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Ryo Harada
- Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Yuki Ishihara
- Department of Gastroenterology, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Masahiro Takatani
- Department of Internal Medicine, Tsuyama Central Hospital, Tsuyama, Japan
| | - Hirofumi Tsugeno
- Department of Internal Medicine, Sumitomo Besshi Hospital, Niihama, Japan
| | - Naoko Yunoki
- Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
| | - Takeshi Tomoda
- Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
| | | | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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11
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Sohail A, Shehadah A, Chaudhary A, Naseem K, Iqbal A, Khan A, Singh S. Impact of index admission cholecystectomy vs interval cholecystectomy on readmission rate in acute cholangitis: National Readmission Database survey. World J Gastrointest Endosc 2024; 16:350-360. [PMID: 38946855 PMCID: PMC11212518 DOI: 10.4253/wjge.v16.i6.350] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Elective cholecystectomy (CCY) is recommended for patients with gallstone-related acute cholangitis (AC) following endoscopic decompression to prevent recurrent biliary events. However, the optimal timing and implications of CCY remain unclear. AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database (NRD). METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020. Our primary outcome was all-cause 30-d readmission rates, and secondary outcomes included in-hospital mortality, length of stay (LOS), and hospitalization cost. RESULTS Among the 124964 gallstone-related AC hospitalizations, only 14.67% underwent the same admission CCY. The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group (5.56% vs 11.50%). Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attributable to surgery. Although the most common reason for readmission was sepsis in both groups, the second most common reason was AC in the interval CCY group. CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission. These readmissions can potentially be prevented by performing same-admission CCY in appropriate patients, which may reduce subsequent hospitalization costs secondary to readmissions.
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Affiliation(s)
- Abdullah Sohail
- Department of Internal Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa, IA 52242, United States
| | - Ahmed Shehadah
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, United States
| | - Ammad Chaudhary
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, United States
| | - Khadija Naseem
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195-0001, United States
| | - Amna Iqbal
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, United States
| | - Ahmad Khan
- Department of Gastroenterology and Hepatology, Case Western Reserve University Hospital, Cleveland, OH 44106, United States
| | - Shailendra Singh
- Division of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, WV 26505, United States
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12
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Wilson SJ, Thavanathan R, Cheng W, Stuart J, Kim DJ, Glen P, Duigenan S, Shorr R, Woo MY, Perry JJ. Test Characteristics of Emergency Medicine-Performed Point-of-Care Ultrasound for the Diagnosis of Acute Cholecystitis: A Systematic Review and Meta-analysis. Ann Emerg Med 2024; 83:235-246. [PMID: 37855790 DOI: 10.1016/j.annemergmed.2023.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/17/2023] [Accepted: 09/12/2023] [Indexed: 10/20/2023]
Abstract
Acute cholecystitis accounts for up to 9% of hospital admissions for acute abdominal pain, and best practice entails early surgical management. Ultrasound is the standard modality used to confirm diagnosis. Our objective was to perform a systematic review and meta-analysis to determine the diagnostic accuracy of emergency physician-performed point-of-care ultrasound for the diagnosis of acute cholecystitis when compared with a reference standard of final diagnosis (informed by available surgical pathology, discharge diagnosis, and radiology-performed ultrasound). We completed a systematic review and meta-analysis, registered in PROSPERO, in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched 7 databases as well as gray literature in the form of select conference abstracts from inception to February 8, 2023. Two independent reviewers completed study selection, data extraction, and risk of bias (QUADAS-2) assessment. Disagreements were resolved by consensus with a third reviewer. Data were extracted from eligible studies to create 2 × 2 tables for diagnostic accuracy meta-analysis. Hierarchical Summary Receiver Operating Characteristic models were constructed. Of 1855 titles/abstracts, 40 were selected for full-text review. Ten studies (n=2356) were included. Emergency physician-performed point-of-care ultrasound with final diagnosis as the reference standard (7 studies, n=1,772) had a pooled sensitivity of 70.9% (95% confidence interval [CI] 62.3 to 78.2), specificity of 94.4% (95% CI 88.2 to 97.5), positive likelihood ratio of 12.7 (5.8 to 27.5), and negative likelihood ratio of 0.31 (0.23 to 0.41) for the diagnosis of acute cholecystitis. Emergency physician-performed point-of-care ultrasound has high specificity and moderate sensitivity for the diagnosis of acute cholecystitis in patients with clinical suspicion. This review supports the use of emergency physician-performed point-of-care ultrasound to rule in a diagnosis of acute cholecystitis in the emergency department, which may help expedite definitive management.
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Affiliation(s)
- Samuel J Wilson
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Rajiv Thavanathan
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Wei Cheng
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Joanna Stuart
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniel J Kim
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter Glen
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shauna Duigenan
- Department of Radiology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Risa Shorr
- Health Sciences Library, The Ottawa Hospital, Ottawa, ON, Canada
| | - Michael Y Woo
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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13
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Lee S, Qasim A, Alemam A, Khaja M, Dev A. Extended-Spectrum Beta-Lactamase Escherichia coli-Associated Acute Cholangitis: Uncommon Patient Characteristics and Clinical Implications. Cureus 2024; 16:e54533. [PMID: 38516487 PMCID: PMC10956482 DOI: 10.7759/cureus.54533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Acute cholangitis is a potentially life-threatening condition caused by an infection of the biliary tract resulting from biliary obstruction. This case report highlights an unusual presentation of acute cholangitis in an elderly patient characterized by the presence of extended-spectrum beta-lactamase-producing Escherichia coli. We aim to emphasize the significance of recognizing diverse clinical manifestations in the elderly population to enhance timely diagnosis and appropriate management. The case highlights the importance of better understanding patient risk factors for potential causative organisms and their susceptibility to selecting proper antibiotics and improving clinical outcomes.
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Affiliation(s)
- Somin Lee
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Abeer Qasim
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Ahmed Alemam
- Gastroenterology, BronxCare Health System, Bronx, USA
| | | | - Anil Dev
- Gastroenterology, BronxCare Health System, Bronx, USA
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14
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Ortenzi M, Corallino D, Botteri E, Balla A, Arezzo A, Sartori A, Reddavid R, Montori G, Guerrieri M, Williams S, Podda M. Safety of laparoscopic cholecystectomy performed by trainee surgeons with different cholangiographic techniques (SCOTCH): a prospective non-randomized trial on the impact of fluorescent cholangiography during laparoscopic cholecystectomy performed by trainees. Surg Endosc 2024; 38:1045-1058. [PMID: 38135732 DOI: 10.1007/s00464-023-10613-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
AIMS The identification of the anatomical components of the Calot's Triangle during laparoscopic cholecystectomy (LC) might be challenging and its difficulty may increase when a surgical trainee (ST) is in charge, ultimately allegedly affecting also the incidence of common bile duct injuries (CBDIs). There are various methods to help reach the critical view of safety (CVS): intraoperative cholangiogram (IOC), critical view of safety in white light (CVS-WL) and near-infrared fluorescent cholangiography (NIRF-C). The primary objective was to compare the use of these techniques to obtain the CVS during elective LC performed by ST. METHODS This was a multicentre prospective observational study (Clinicalstrials.gov Registration number: NCT04863482). The impact of three different visualization techniques (IOC, CVS-WL, NIRF-C) on LC was analyzed. Operative time and time to achieve the CVS were considered. All the participating surgeons were also required to fill in three questionnaires at the end of the operation focusing on anatomical identification of the general task and their satisfaction. RESULTS Twenty-nine centers participated for a total of 338 patients: 260 CVS-WL, 10 IOC and 68 NIRF-C groups. The groups did not differ in the baseline characteristics. CVS was considered achieved in all the included case. Rates were statistically higher in the NIR-C group for common hepatic and common bile duct visualization (p = 0.046; p < 0.005, respectively). There were no statistically significant differences in operative time (p = 0.089) nor in the time to achieve the CVS (p = 0.626). Three biliary duct injuries were reported: 2 in the CVS-WL and 1 in the NIR-C. Surgical workload scores were statistically lower in every domain in the NIR-C group. Subjective satisfaction was higher in the NIR-C group. There were no other statistically significant differences. CONCLUSIONS These data showed that using NIRF-C did not prolong operative time but positively influenced the surgeon's satisfaction of the performance of LC.
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Affiliation(s)
- Monica Ortenzi
- Department of General and Emergency Surgery, Università Politecnica delle Marche, Ancona, Italy.
| | - Diletta Corallino
- Department of General Surgery and Surgical Specialties, Sapienza University of Rome, Rome, Italy
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili di Brescia PO Montichiari, Montichiari, Brescia, Italy
| | - Andrea Balla
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Alberto Arezzo
- Department of General Surgery, Ospedale Di Montebelluna, Montebelluna, Treviso, Italy
| | - Alberto Sartori
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | | | | | - Mario Guerrieri
- Department of General and Emergency Surgery, Università Politecnica delle Marche, Ancona, Italy
| | | | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
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15
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Berenson A, Doran M, Strollo B, Burton J, Townsend M, Babin J, Millien J, Brown R, Fuhrman G. An Analysis of Outcomes and Management Strategies for Patients With Cholecystostomy Tubes. Am Surg 2023; 89:4424-4430. [PMID: 35852865 DOI: 10.1177/00031348221109459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Percutaneous cholecystostomy tube (PCT) drainage is an effective management strategy for acute cholecystitis in patients medically unfit for surgery. However, little is known about the fate of patients managed by PCT. We conducted this study to determine tube management outcomes for patients with acute cholecystitis managed by PCT. METHODS The electronic record was queried to identify patients with acute cholecystitis managed by PCT from 2012-2020. Patients were divided into three groups for analysis: 1) ultimately managed by cholecystectomy, 2) eventual confirmation of distal flow of bile from the gallbladder and tube removal, and 3) tubes left in place without further management. RESULTS A total of 179 patients with acute cholecystitis treated by PCT were included. Sixty-six patients never fully recovered from the medical insult associated with their diagnosis of acute cholecystitis and had their tubes left in situ. Sixty-four of these 66 patients (97%) died during follow-up. The remaining 113 patients recovered from their illness and presented to clinic for evaluation for tube removal and/or cholecystectomy. When distal biliary flow was confirmed, tube removal was favored (n = 70). When cystic duct outflow occlusion persisted, cholecystectomy was planned for patients who became acceptable surgical candidates (n = 43). For patients managed by cholecystectomy, 8 were approached open and 35 laparoscopically, with 12 of 35 (34.3%) converted to open and 23 (65.7%) completed laparoscopically. CONCLUSION Our study favors PCT removal for patients who recover from their acute illness when distal bile flow from the gallbladder is confirmed. We reserve cholecystectomy for patients who recover from their illness and demonstrate persistent cystic duct outflow obstruction.
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Affiliation(s)
- Adam Berenson
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Marisa Doran
- Ochsner Clinical School,The University of Queensland Faculty of Medicine, New Orleans, LA, USA
| | - Brian Strollo
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
- Ochsner Clinical School,The University of Queensland Faculty of Medicine, New Orleans, LA, USA
| | - Jeff Burton
- Ochsner Health Center for Outcomes and Health Services Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Michael Townsend
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Jonathan Babin
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Jeffanne Millien
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
- Ochsner Clinical School,The University of Queensland Faculty of Medicine, New Orleans, LA, USA
| | - Russell Brown
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - George Fuhrman
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
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16
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Hazan D, Leibovitz E, Jazmawi M, Shimonov M. Does percutaneous cholecystostomy affect prognosis of patients with acute cholecystitis that are unresponsive to conservative treatment? Saudi J Gastroenterol 2023; 29:376-380. [PMID: 37417190 PMCID: PMC10754375 DOI: 10.4103/sjg.sjg_87_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 07/08/2023] Open
Abstract
Background Percutaneous cholecystostomy (PC) can be used as bridging or definitive therapy in some cases of acute cholecystitis. We aimed to compare hospital stay and survival of patients that underwent PC insertion because of acute calculus cholecystitis (ACC) compared to those who did not. Methods This is a retrospective study in which patients with gangrenous cholecystitis and perforation were excluded. Regression models were used to evaluate the influence of PC on mortality and hospital stay. Results Six hundred and eighty-three patients were admitted because of ACC, and 50 patients were referred to PC. Indication for PC insertion were high disease severity index (DSI, 8 pts) and failure of conservative treatment with total disease duration >7 days (42 pts). Those who underwent PC were older (76.0 ± 12.4 vs. 60.8 ± 19.2, P < 0.001); PC was associated with longer hospital stay (12.8 vs. 6.5 days) and higher one-year mortality (20% vs. 4.9%, P < 0.001). Among patients with non-severe disease severity index (DSI), PC was associated with longer length of hospital stay and higher one-year mortality compared to patients treated conservatively (9.9 ± 0.6 vs. 6.0 ± 0.2 days, and 16.7% vs. 4.0%, respectively, P < 0.001 for both). For patients with severe DSI, PC was associated with similar length of hospital stay and one-year mortality compared to similar patients treated conservatively (16.1 ± 8.1 vs. 18.4 ± 4.0 days, and 37.5% vs. 22.6%, respectively, P = 0.802 and P = 0.389, respectively). Conclusions In patients with mild-moderate DSI unresponsive to conservative treatment, PC may be associated with deteriorated prognosis compared to conservative treatment. The decision to insert PC in patients unresponsive to conservative therapy even with disease duration >7 days must be re-evaluated.
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Affiliation(s)
- Danny Hazan
- Surgery A, Edith Wolfson Medical Center, Holon, Israel
| | - Eyal Leibovitz
- Internal Medicine “A”, Yoseftal, Hospital, Eilat, Israel
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17
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Park TY, Do JH, Oh HC, Choi YS, Lee SE, Kang H, Hong SA. Relationship between the Tokyo Guidelines and Pathological Severity in Acute Cholecystitis. J Pers Med 2023; 13:1335. [PMID: 37763103 PMCID: PMC10533096 DOI: 10.3390/jpm13091335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Background: It is not well understood whether the severity of acute cholecystitis (AC) correlates with the extent of gallbladder (GB) inflammation or laboratory findings. This study aimed to assess whether the severity of AC, in accordance with the Tokyo Guidelines (TGs), is consistent with the extent of GB inflammation on histopathological and laboratory findings, including microbiological isolation in blood and bile. Methods: The medical records of patients who underwent cholecystectomy for AC between January 2017 and May 2020 were reviewed. Demographic data, laboratory findings, the microbiologic culture of blood and bile, the extent of GB inflammation, and stone composition were compared in accordance with the TGs. Results: A total of 217 patients were divided into three groups of increasing severity-Grade I (n = 146), Grade II (n = 51), and Grade III (n = 20)-in accordance with the TGs. The Grade III group contained significantly older patients compared with the Grade I or Grade II groups (Grade I, 56.9 ± 13.9; Grade II, 64.3 ± 15.4; Grade III, 69.9 ± 9.9; p-value < 0.001). Patients in the Grade III group showed significantly higher levels of CRP, WBC, creatinine, and bilirubin and lower levels of platelets and albumin compared with the Grade I or Grade II group. As the grade of severity increased, the rate of microbiological isolation in blood (Grade I, 0% [0/146]; Grade II, 2.0% [1/51]; Grade III, 20% [4/20]; p-value < 0.001) and bile (Grade I, 19.9% [29/146]; Grade II, 33.3% [17/51]; Grade III, 70% [14/20]; p-value < 0.001) also increased significantly. However, there were no significant differences in the extent of GB inflammation between grades. Conclusions: AC severity, as stated by the TGs, does not correlate with the extent of GB inflammation on histopathological and laboratory findings. However, microbiological isolation in blood and bile was increased proportionally to the grade of the TGs.
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Affiliation(s)
- Tae Young Park
- Division of Gastroenterology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong 14353, Republic of Korea
| | - Jae Hyuk Do
- Division of Gastroenterology, Chung-Ang University Hospital, Seoul 06973, Republic of Korea
| | - Hyoung-Chul Oh
- Division of Gastroenterology, Chung-Ang University Hospital, Seoul 06973, Republic of Korea
| | - Yoo Shin Choi
- Department of Surgery, Chung-Ang University Hospital, Seoul 06973, Republic of Korea
| | - Seung Eun Lee
- Department of Surgery, Chung-Ang University Hospital, Seoul 06973, Republic of Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul 06973, Republic of Korea
| | - Soon Auck Hong
- Department of Pathology, Chung-Ang University Hospital, Seoul 06973, Republic of Korea;
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18
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Nve E, Badia JM, Amillo-Zaragüeta M, Juvany M, Mourelo-Fariña M, Jorba R. Early Management of Severe Biliary Infection in the Era of the Tokyo Guidelines. J Clin Med 2023; 12:4711. [PMID: 37510826 PMCID: PMC10380792 DOI: 10.3390/jcm12144711] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/28/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Sepsis of biliary origin is increasing worldwide and has become one of the leading causes of emergency department admissions. The presence of multi-resistant bacteria (MRB) is increasing, and mortality rates may reach 20%. This review focuses on the changes induced by the Tokyo guidelines and new concepts related to the early treatment of severe biliary disease. If cholecystitis or cholangitis is suspected, ultrasound is the imaging test of choice. Appropriate empirical antibiotic treatment should be initiated promptly, and selection should be performed while bearing in mind the severity and risk factors for MRB. In acute cholecystitis, laparoscopic cholecystectomy is the main therapeutic intervention. In patients not suitable for surgery, percutaneous cholecystostomy is a valid alternative for controlling the infection. Treatment of severe acute cholangitis is based on endoscopic or transhepatic bile duct drainage and antibiotic therapy. Endoscopic ultrasound and other new endoscopic techniques have been added to the arsenal as novel alternatives in high-risk patients. However, biliary infections remain serious conditions that can lead to sepsis and death. The introduction of internationally accepted guidelines, based on clinical presentation, laboratory tests, and imaging, provides a framework for their rapid diagnosis and treatment. Prompt assessment of patient severity, timely initiation of antimicrobials, and early control of the source of infection are essential to reduce morbidity and mortality rates.
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Affiliation(s)
- Esther Nve
- Department of Surgery, Hospital Universitari Mútua de Terrassa, 08221 Barcelona, Spain;
- School of Medicine, Universitat Rovira i Virgili, 43003 Tarragona, Spain;
| | - Josep M. Badia
- Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain; (M.A.-Z.); (M.J.)
| | - Mireia Amillo-Zaragüeta
- Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain; (M.A.-Z.); (M.J.)
| | - Montserrat Juvany
- Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain; (M.A.-Z.); (M.J.)
| | - Mónica Mourelo-Fariña
- Intensive Care Unit, Complexo Hospitalario Universitario A Coruña, 15006 A Coruña, Spain;
| | - Rosa Jorba
- School of Medicine, Universitat Rovira i Virgili, 43003 Tarragona, Spain;
- Department of Surgery, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
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19
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Kesim Ç, Özen Ö. Ultrasound-guided percutaneous cholecystostomy as bridging or definitive treatment in patients with acute cholecystitis grade II or III. Heliyon 2023; 9:e15601. [PMID: 37153409 PMCID: PMC10160755 DOI: 10.1016/j.heliyon.2023.e15601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
Background We aimed to investigate the extent to which ultrasound (US)-guided percutaneous cholecystostomy (PC) is used as a bridging or definitive therapy for grade II and III acute cholecystitis and whether this treatment causes significant changes in C-reactive protein (CRP) and direct bilirubin (DB) levels in the first 72 h and the first three weeks. Methods We included 145 consecutive patients who underwent PC over 17 years. No patient had cirrhosis. PC was performed in the interventional radiology department under US guidance. Results US-guided PC was the definitive treatment for more than half of the patients (51.7%) and decreased DB levels significantly more than CRP levels. Conclusion No statistically significant correlation between those whose CRP and DB levels normalized within three weeks and those who did not and required a second invasive procedure. Nevertheless, the bridging treatment group was significantly older than the definitive treatment group.
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Affiliation(s)
- Çağrı Kesim
- Başkent University, Konya Hospital, Department of Radiology, Interventional Radiology Section, Turkey
- Corresponding author.
| | - Özgür Özen
- Başkent University, Ankara Hospital, Department of Radiology, Interventional Radiology Section, Turkey
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20
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Simeonova M, Daneman N, Lam PW, Elligsen M. Addition of anaerobic coverage for treatment of biliary tract infections: a propensity score-matched cohort study. JAC Antimicrob Resist 2023; 5:dlac141. [PMID: 36694848 PMCID: PMC9866233 DOI: 10.1093/jacamr/dlac141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/19/2022] [Indexed: 01/22/2023] Open
Abstract
Objectives To evaluate whether additional antibiotics that target anaerobes, including Bacteroides spp., are associated with improved clinical outcomes in patients with biliary tract infections (BTIs). Methods This was a retrospective propensity score-matched cohort of adults aged ≥18 years with BTIs, admitted to hospital between 1 April 2015 and 30 March 2021. Eligible patients treated with antibiotics that provided coverage of anaerobes were compared with those treated with comparable regimens without anaerobic coverage. The primary outcome was a composite of mortality within 30 days or relapse within 90 days of source control or completion of antibiotics. Secondary outcomes included length of stay (LOS), duration of antibiotic therapy and adverse drug reactions. ORs were calculated using a weighted generalized linear regression model with propensity-score matching. Results Among 398 patients included, 209 were treated without anaerobic coverage and 189 with anaerobic coverage. After propensity-score matching, there was no significant difference in primary outcome between propensity-matched patients who received additional anaerobic coverage and those who did not [adjusted OR (aOR) 1.23; 95% CI 0.69-2.22)]. Those with anti-anaerobic coverage had longer LOS (aOR 4.85; 95% CI 1.68-13.98) and longer duration of antibiotic treatment (aOR 4.14; 95% CI 2.61-6.57) than those who did not receive additional anaerobic therapy, but not more adverse drug reactions (aOR 1.01; 95% CI 0.97-1.05). Conclusions Omitting anti-anaerobic antibiotics may be a safe antimicrobial stewardship intervention. However, a randomized controlled trial may be warranted to definitively conclude whether additional anaerobic coverage in BTI treatment is necessary.
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Affiliation(s)
- Marina Simeonova
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Canada,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Nick Daneman
- Division of Infectious Diseases, University of Toronto, Toronto, Canada,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, E-237, Toronto M4N 3M5, Ontario, Canada
| | - Philip W Lam
- Division of Infectious Diseases, University of Toronto, Toronto, Canada
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The gallbladder: what's new in 2022? ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:2-28. [PMID: 35348807 DOI: 10.1007/s00261-022-03429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/21/2023]
Abstract
This review focuses mainly on the imaging diagnosis, treatment, and complications of acute cholecystitis which is the most common benign disease of the gallbladder. The American College of Radiology appropriateness criteria for the imaging evaluation of patients with right upper quadrant pain and the Tokyo Guidelines for evaluating patients with acute cholecystitis and acute cholangitis are presented. The recent articles for using US, CT, MR, and HIDA in the evaluation of patients with suspected acute cholecystitis are reviewed in detail. The clinical management and postoperative complications are described. Because gallbladder polyps and adenomyomatosis can mimic gallbladder malignancies and acute cholecystitis, their imaging findings and management are presented. Finally, due the recent literature reporting better results with CT than US in the diagnosis of acute cholecystitis, a suggested approach for imaging patients with right upper quadrant pain and possible acute cholecystitis is presented in an addendum.
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22
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Li K, Jiang S, Fu H, Hao Y, Tian S, Zhou F. Risk Factors and Prognosis of Carbapenem-Resistant Organism Colonization and Infection in Acute Cholangitis. Infect Drug Resist 2022; 15:7777-7787. [PMID: 36597450 PMCID: PMC9805710 DOI: 10.2147/idr.s398581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022] Open
Abstract
Background To identify the risk factors and prognosis of carbapenem-resistant organisms (CRO) in patients with acute cholangitis. Methods This retrospective observational study was conducted to explore the risk factors and prognosis of CRO infection in 503 acute cholangitis patients diagnosed between July 2013 and January 2022 at the First Affiliated Hospital of Chongqing Medical University, who were divided into a CRO group and non-CRO group based on the presence or absence of CRO. Univariate, multivariate analyses, and the proportional hazards model were used to compare the risk factors and prognosis of CRO suffering in patients with acute cholangitis. Results We identified 35 patients colonized with CRO from 503 acute cholangitis patients. In the multivariate analysis, tumor (OR=7.09, 95% CI=1.11-45.30, P=0.038) and chronic kidney disease (OR=8.70, 95% CI=2.11-35.88, P=0.003) were ascertained as the risk factors of the occurrence on CRO infection under the background of acute cholangitis. CRO infection was identified as an independent risk factor for acute cholangitis patient death (HR=5.147, 95% CI=1.475-17.595, P=0.01) by Cox proportional-hazards regression. Conclusion Tumor and chronic kidney disease may be risk factors for CRO infection. Patients diagnosed with acute cholangitis further infected with CRO had a poor prognosis and a more severe mortality. Active screening for CRO is expected to facilitate early prevention, diagnosis, and treatment of high-risk patients.
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Affiliation(s)
- Kaili Li
- Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Sanle Jiang
- Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Hongxue Fu
- Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yingting Hao
- Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Shijing Tian
- Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China,Correspondence: Shijing Tian; Fachun Zhou, Emergency Department, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong Qu, 17th Floor, Building 1, Chongqing, People’s Republic of China, Tel +86 023-89011756, Email ; ;
| | - Fachun Zhou
- Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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Evaluation of early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis: a prospective, randomized study. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:139-144. [PMID: 36601493 PMCID: PMC9763484 DOI: 10.7602/jmis.2022.25.4.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
Purpose Uncertainty exists about whether early laparoscopic cholecystectomy (LC) is an appropriate surgical treatment for acute calculous cholecystitis. This study aimed to compare early vs. late LC for acute calculous cholecystitis regarding intraoperative difficulty and postoperative outcomes. Methods This was a prospective randomized study carried out between December 2015 and June 2017; 60 patients with acute calculous cholecystitis were divided into two groups (early and delayed groups), each comprising 30 patients. Thirty patients treated with LC within 3 to 5 days of arrival at the hospital were assigned to the early group. The other 30 patients were placed in the delayed group, first treated conservatively, and followed by LC 3 to 6 weeks later. Results The conversion rates in both groups were 6.7% and 0%, respectively (p = 0.143). The operating time was 56.67 ± 11.70 minutes in the early group and 75.67 ± 20.52 minutes in the delayed group (p = 0.001), and both groups observed equal levels of postoperative complications. Early LC patients, on the other hand, required much fewer postoperative hospital stay (3.40 ± 1.99 vs. 6.27 ± 2.90 days, p = 0.006). Conclusion Considering shorter operative time and hospital stay without significant increase of open conversion rates, early LC might have benefits over late LC.
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Çeliktürk E, Salt Ö, Sayhan MB, Dıbırdık İ. A novel biomarker in acute cholecystitis: YKL-40. Asian J Surg 2022; 46:1564-1570. [PMID: 36241524 DOI: 10.1016/j.asjsur.2022.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/25/2022] [Accepted: 09/19/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The lack of a specific biomarker that can be used in the diagnosis of acute cholecystitis, a common cause of admission to the emergency department, delays physician efforts to diagnose and treat these patients. Therefore, the aim of this study was to measure plasma YKL-40 levels and investigate their diagnostic value in patients with acute cholecystitis (AC). METHODS This study was carried out between February 2020 and September 2020 in the adult emergency department of a tertiary university hospital. Permission was obtained from the Ethics Committee of Scientific Research on 03/02/2020 with Decision No. 03/16. The study included 80 patients who were diagnosed with acute cholecystitis and 80 healthy volunteers without known chronic diseases. RESULTS The median YKL-40 protein level was 798.66 pq/mL in the patient group and 392.45 pq/mL in the control group. A statistically significant difference in YKL-40 protein levels was found between the two groups. YKL-40 protein levels were significantly higher in patients diagnosed with acute cholecystitis than in healthy individuals (p < 0.001). A positive correlation was found between YKL-40 protein levels and ALT, AST, LDH, and GGT levels (r = 0.272, p = 0.015; r = 0.397, p < 0.001; r = 0.386, p < 0.001; and r = 0.264, p = 0.018; respectively). CONCLUSION When evaluated together with physical examination, radiological imaging and other laboratory parameters, we think that plasma YKL-40 levels can be used effectively in the diagnosis of acute cholecystitis.
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Developing a Simple Score for Diagnosis of Acute Cholecystitis at the Emergency Department. Diagnostics (Basel) 2022; 12:diagnostics12092246. [PMID: 36140646 PMCID: PMC9497808 DOI: 10.3390/diagnostics12092246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 12/07/2022] Open
Abstract
We aim to develop a diagnostic score for acute cholecystitis that integrates symptoms, physical examinations, and laboratory data to help clinicians for timely detection and early treatment of this disease. We retrospectively collected data from our database from 2010 to 2020. Patients with acute abdominal pain who underwent an ultrasound or computed tomography (CT) scan at the emergency department (ED) were included. Cases were identified by pathological, CT, or ultrasound reports. Non-cases were those who did not fulfill any of these criteria. Multivariable regression analysis was conducted to identify predictors of acute cholecystitis. The model included 244 patients suspected of acute cholecystitis. Eighty-six patients (35.2%) were acute cholecystitis confirmed cases. Five final predictors remained within the reduced logistic model: age < 60, nausea and/or vomiting, right upper quadrant pain, positive Murphy’s sign, and AST ≥ two times upper limit of normal. A practical score diagnostic performance was AuROC 0.74 (95% CI, 0.67−0.81). Patients were categorized with a high probability of acute cholecystitis at score points of 9−12 with a positive likelihood ratio of 3.79 (95% CI, 1.68−8.94). ED Chole Score from these five predictors may aid in diagnosing acute cholecystitis at ED. Patients with an ED Chole Score >8 should be further investigated.
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Kihara Y, Yokomizo H. The clinical features of late postoperative cholangitis following pancreaticoduodenectomy brought on by conditions other than cancer recurrence: a single-center retrospective study. BMC Surg 2022; 22:301. [PMID: 35932000 PMCID: PMC9356454 DOI: 10.1186/s12893-022-01752-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/01/2022] [Indexed: 12/07/2022] Open
Abstract
Background Postoperative cholangitis is a late complication of pancreaticoduodenectomy (PD). This study aimed to elucidate the pathogenesis of post-PD cholangitis (PPDC) and explore its optimal treatment. Methods We retrospectively analyzed 210 patients who underwent PD at our institute between 2009 and 2018. Patients who underwent follow-up for less than 1 year or had cholangitis caused by cancer recurrence were excluded from the analysis. Diagnostic criteria for cholangitis and its severity were determined based on the classification of acute cholangitis provided by the 2018 Tokyo Guidelines (TG18). Results PPDC occurred in 19 (11%) of the 176 included patients. Of these 19 patients, nine experienced more than one episode of cholangitis (total episodes, 36). For 14 patients (74%), the first episode of PPDC occurred within two years after surgery. Based on the TG18, 21 episodes were mild and 15 episodes were moderate; none were severe. Blood culture test results were positive for 16 of 24 episodes. Most patients were hospitalized and treated with intravenous antibiotics (median, seven days). The blood test values improved promptly after treatment was started. Four patients with recurrent cholangitis underwent endoscopic examination, and three of them had anastomotic stenosis of the hepaticojejunostomy. The univariate and multivariate analyses did not indicate any significant predictive factors for PPDC development. Conclusion Mild and moderate PPDC occurred and improved with short-term antimicrobial treatment. Temporary reflux into the intrahepatic bile ducts may have been the cause of PPDC while anastomotic stenosis may be involved in recurrent cases.
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Affiliation(s)
- Yasuhiro Kihara
- Division of General Surgery, Japanese Red Cross Kumamoto Hospital, Nagamineminami 2-1-1, Higashiku, Kumamoto, Kumamoto, 861-8520, Japan.
| | - Hiroshi Yokomizo
- Division of General Surgery, Japanese Red Cross Kumamoto Hospital, Nagamineminami 2-1-1, Higashiku, Kumamoto, Kumamoto, 861-8520, Japan
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Donohue SJ, Reinke CE, Evans SL, Jordan MM, Warren YE, Hetherington T, Kowalkowski M, May AK, Matthews BD, Ross SW. Laparoscopy is associated with decreased all-cause mortality in patients undergoing emergency general surgery procedures in a regional health system. Surg Endosc 2022; 36:3822-3832. [PMID: 34477959 DOI: 10.1007/s00464-021-08699-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/24/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the use of laparoscopic surgery for common emergency general surgery (EGS) procedures within an integrated Acute Care Surgery (ACS) network. We hypothesized that laparoscopy would be associated with improved outcomes. METHODS Our integrated health care system's EGS registry created from AAST EGS ICD-9 codes was queried from January 2013 to October 2015. Procedures were grouped as laparoscopic or open. Standard descriptive and univariate tests were performed, and a multivariable logistic regression controlling for open status, age, BMI, Charlson Comorbidity Index (CCI), trauma tier, and resuscitation diagnosis was performed. Laparoscopic procedures converted to open were identified and analyzed using concurrent procedure billing codes across episodes of care. RESULTS Of 60,604 EGS patients identified over the 33-month period, 7280 (12.0%) had an operation and 6914 (11.4%) included AAST-defined EGS procedures. There were 4813 (69.6%) surgeries performed laparoscopically. Patients undergoing a laparoscopic procedure tended to be younger (45.7 ± 18.0 years vs. 57.2 ± 17.6, p < 0.001) with similar BMI (29.7 ± 9.0 kg/m2 vs. 28.8 ± 8.3, p < 0.001). Patients in the laparoscopic group had lower mean CCI score (1.6 ± 2.3 vs. 3.4 ± 3.2, p ≤ 0.0001). On multivariable analysis, open surgery had the highest association with inpatient mortality (OR 8.67, 4.23-17.75, p < 0.0001) and at all time points (30-, 90-day, 1-, 3-year). At all time points, conversion to open was found to be a statistically significant protective factor. CONCLUSION Use of laparoscopy in EGS is common and associated with a decreased risk of all-cause mortality at all time points compared to open procedures. Conversion to open was protective at all time points compared to open procedures.
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Affiliation(s)
- Sean J Donohue
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caroline E Reinke
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Susan L Evans
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Mary M Jordan
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Yancey E Warren
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Timothy Hetherington
- Carolinas Medical Center, Center for Outcomes Research and Evaluation, Charlotte, NC, USA
| | - Marc Kowalkowski
- Carolinas Medical Center, Center for Outcomes Research and Evaluation, Charlotte, NC, USA
| | - Addison K May
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Brent D Matthews
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Samuel W Ross
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
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FIRAT N, OZDEMIR K, MANTOGLU B, MUHTAROGLU A, ELMAS B, YAZAR H, ALTINTOPRAK F. The place of thiol/disulfide homeostasis parameters in acute gallstone cholecystitis diagnosis. Chirurgia (Bucur) 2022; 35. [DOI: 10.23736/s0394-9508.21.05267-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2025]
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Bejarano González N, Romaguera Monzonís A, Rebasa Cladera P, García Monforte N, Labró Ciurans M, Badia Closa J, Criado Paredes E, García Borobia FJ. Is percutaneous cholecystostomy safe and effective in acute cholecystitis? Analysis of adverse effects associated with the technique. Cir Esp 2022; 100:281-287. [PMID: 35487433 DOI: 10.1016/j.cireng.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/08/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The main objective of our study is to assess the safety and efficacy of percutaneous cholecystostomy for the treatment of acute cholecystitis, determining the incidence of adverse effects in patients undergoing this procedure. MATERIAL AND METHOD Observational study with consecutive inclusion of all patients diagnosed with acute cholecystitis for 10 years. The main variable studied was morbidity (adverse effects) collected prospectively. Minimum one-year follow-up of patients undergoing percutaneous cholecystostomy. RESULTS Of 1223 patients admitted for acute cholecystitis, 66 patients required percutaneous cholecystostomy. 21% of these have presented some adverse effect, with a total of 22 adverse effects. Only 5 of these effects, presented by 5 patients (7.6%), could have been attributed to the gallbladder drainage itself. The mortality associated with the technique is 1.5%. After cholecystostomy, one third of the patients (22 patients) have undergone cholecystectomy. Urgent surgery was performed due to failure of percutaneous treatment in 2 patients, and delayed in another 2 patients due to recurrence of the inflammatory process. The rest of the cholecystectomized patients underwent scheduled surgery, and the procedure could be performed laparoscopically in 16 patients (72.7%). CONCLUSION We consider percutaneous cholecystostomy as a safe and effective technique because it is associated with a low incidence of morbidity and mortality, and it should be considered as a bridge or definitive alternative in those patients who do not receive urgent cholecystectomy after failure of conservative antibiotic treatment.
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Affiliation(s)
- Natalia Bejarano González
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain.
| | - Andreu Romaguera Monzonís
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Pere Rebasa Cladera
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Neus García Monforte
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Meritxell Labró Ciurans
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain; Servicio de Cirugía General y del Aparato Digestivo, Althaia Xarxa Assistencial Universitària, Manresa, Barcelona, Spain
| | - Jesús Badia Closa
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Eva Criado Paredes
- Unidad de Radiología Vascular Intervencionista, Servicio de Radiología, UDIAT Centro Diagnóstico, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Francisco Javier García Borobia
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
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Lv TR, Liu F, Hu HJ, Regmi P, Ma WJ, Yang Q, Jin YW, Li FY. The role of extra-hepatic bile duct resection in the surgical management of gallbladder carcinoma. A first meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:482-491. [PMID: 34955314 DOI: 10.1016/j.ejso.2021.11.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 10/06/2021] [Accepted: 11/26/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To systematically evaluate the clinicopathological and prognostic value of extra-hepatic bile duct resection (EHBDR) in the surgical management of patients with gallbladder carcinoma (GBC), especially in non-jaundiced patients. METHODS PubMed, EMBASE and the Cochrane Library were searched up to March 1st 2021 for comparative studies between bile duct resected and non-resected groups. RevMan5.3 and Stata 13.0 software were used for the statistical analyses. RESULTS EHBDR did not correlate with a better overall survival (OS) (P = 0.17) or disease-free survival (P = 0.27). No survival benefit was also observed in patients with T2N1 (P = 0.4), T3N0 (P = 0.14) disease and node-positive patients (P = 0.75), rather, EHBDR was even harmful for patients with T2N0 (P = 0.01) and node-negative disease (P = 0.02). Significantly higher incidences of recurrent disease (P = 0.0007), postoperative complications (P < 0.00001) and positive margins (P = 0.02) were detected in the bile duct-resected group. The duration of postoperative hospital stay between the two groups was comparable (P = 0.58). Selection bias was also detected in our analysis that a significantly higher proportion of advanced lesions with T3-4 or III-IV disease was observed in the bile duct-resected group (P < 0.00001). EHBDR only contributed to a greater lymph yield (P = 0.01). CONCLUSION EHBDR has no survival advantage for patients with GBC, especially for those with non-jaundiced disease. Considering the unfairness of comparing OS between jaundiced patients receiving EHBDR with non-jaundiced patients without EHBDR, we could only conclude that routine EHBDR in non-jaundiced patients is not recommended and future well-designed studies with more specific subgroup analyses are required for further validation.
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Affiliation(s)
- Tian-Run Lv
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fei Liu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Parbatraj Regmi
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Qing Yang
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yan-Wen Jin
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Martin WT, Stewart K, Sarwar Z, Kennedy R, Quang C, Albrecht R, Cross A. Clinical diagnosis of cholecystitis in emergency department patients with cholelithiasis is indication for cholecystectomy: A comparison of clinical, ultrasound, and pathologic diagnosis. Am J Surg 2022; 224:80-84. [DOI: 10.1016/j.amjsurg.2022.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 12/07/2022]
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Calinescu AM, Madadi-Sanjani O, Mack C, Schreiber RA, Superina R, Kelly D, Petersen C, Wildhaber BE. Cholangitis Definition and Treatment after Kasai Hepatoportoenterostomy for Biliary Atresia: A Delphi Process and International Expert Panel. J Clin Med 2022; 11:jcm11030494. [PMID: 35159946 PMCID: PMC8836553 DOI: 10.3390/jcm11030494] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/14/2022] [Indexed: 12/17/2022] Open
Abstract
(1) Background: Acute cholangitis during the first year after Kasai hepatoportoenterostomy (HPE) has a negative impact on patient and native liver survival. There are no consistent guidelines for the definition, treatment, and prophylaxis of cholangitis after HPE. The aim of this study was to develop definition, treatment, and prophylaxis guidelines to allow for expeditious management and for standardization in reporting. (2) Methods: the Delphi method, an extensive literature review, iterative rounds of surveys, and expert panel discussions were used to establish definition, treatment, and prophylaxis guidelines for cholangitis in the first year after HPE. (3) Results: Eight elements (pooled into two groups: clinical and laboratory/imaging) were identified to define cholangitis after HPE. The final proposed definitions for suspected and confirmed cholangitis are a combination of one element, respectively, two elements from each group; furthermore, the finding of a positive blood culture was added to the definition of confirmed cholangitis. The durations for prophylaxis and treatment of suspected and confirmed cholangitis were uniformly agreed upon by the experts. (4) Conclusions: for the first time, an international consensus was found for guidelines for definition, treatment, and prophylaxis for cholangitis during the first year after Kasai HPE. Applicability will need further prospective multicentered studies.
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Affiliation(s)
- Ana M. Calinescu
- Division of Child’s and Adolescent’s Surgery, Swiss Pediatric Liver Center, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland;
- Correspondence: ; Tel.: +41-22-382-46-62
| | - Omid Madadi-Sanjani
- Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany; (O.M.-S.); (C.P.)
| | - Cara Mack
- Section of Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO 80011, USA;
| | - Richard A. Schreiber
- Division of Gastroenterology, Hepatology and Nutrition, BC Children’s Hospital, University of British Columbia, Vancouver, BC V5Z 4H4, Canada;
| | - Riccardo Superina
- Division of Transplant Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Deirdre Kelly
- Liver Unit, Birmingham Women’s and Children’s Hospital, Birmingham B15 2TG, UK;
| | - Claus Petersen
- Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany; (O.M.-S.); (C.P.)
| | - Barbara E. Wildhaber
- Division of Child’s and Adolescent’s Surgery, Swiss Pediatric Liver Center, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland;
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Rosa F, Covino M, Cozza V, Fransvea P, Quero G, Fiorillo C, Simeoni B, Sganga G, Gasbarrini A, Franceschi F, Alfieri S. Management of acute cholecystitis in elderly patients: A propensity score-matched analysis of surgical vs. medical treatment. Dig Liver Dis 2021; 53:1620-1626. [PMID: 33500239 DOI: 10.1016/j.dld.2021.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/09/2020] [Accepted: 01/13/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute cholecystitis (AC) is a life-threatening emergency in elderly patients. AIMS To compare the commonly used management strategies for elderly patients with AC as well as resulting morbidity, mortality and length of hospital stay (LOS). METHODS All patients ≥ 65 years admitted to our emergency department for AC between January 1st, 2014 and December 31st, 2018 were included in the study. We compared patients that received medical treatment to patients who received operative procedures. In order to correct for baseline covariates and factors associated to clinical management, we used a 1:1 propensity score matching (PSM) analysis. The primary outcome was the overall in-hospital mortality. Secondary outcomes included occurrence of major complications and LOS. RESULTS A total of 1075 patients were enrolled: 483 patients received a medical treatment and 592 patients underwent interventional procedures. After PSM, 770 patients (385 for each treatment group) were included in the analysis. The analysis revealed that both mortality and cumulative major complications were similar in medical and interventional group. We found that among comorbidities, Charlson comorbidity index and congestive heart failure were significantly higher in the medical treatment group (5 [4-6] vs. 4 [3-6] and 11.7% vs. 4.7%, respectively; p<0.001). LOS was slightly lower in the medical treatment group (7.0 days [4.9-11.1] vs. 7.9 [4.9-13.5]; p = 0.046). CONCLUSION Medical management outcomes for AC in elderly patients were similar to operative treatments in terms of mortality and cumulative major complications. A conservative approach should always be considered.
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Affiliation(s)
- Fausto Rosa
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Marcello Covino
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Cozza
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Pietro Fransvea
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giuseppe Quero
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Fiorillo
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Benedetta Simeoni
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gabriele Sganga
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Alfieri
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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Han J, Xue D, Tuo H, Liang Z, Wang C, Peng Y. Percutaneous Transhepatic Gallbladder Drainage Combined with Laparoscopic Cholecystectomy Versus Emergency Laparoscopic Cholecystectomy for the Treatment of Moderate Acute Cholecystitis: A Meta-Analysis. J Laparoendosc Adv Surg Tech A 2021; 32:733-739. [PMID: 34748409 DOI: 10.1089/lap.2021.0579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: We compared the clinical outcomes of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) with those of emergency LC (ELC) in patients with moderate acute cholecystitis (AC) as per the Tokyo Guidelines. Methods: A meta-analysis of clinical comparative studies investigating the efficacy of PTGBD combined with LC (PTGBD + LC) versus ELC for moderate AC patients was performed. Results: The PTGBD + LC group had a shorter operative time (mean difference [MD] = -25.02 minutes; 95% confidence interval [95% CI] -35.50 to -14.54; P < .00001), less intraoperative bleeding (MD = -33.38 mL; 95% CI -45.43 to -21.33; P < .00001), shorter postoperative hospital stay (MD = -2.37 days; 95% CI -3.30 to -1.44; P < .00001), lower conversion rate (odds ratio [OR] 0.23; 95% CI 0.11-0.48; P < .0001), and lower total postoperative morbidity (OR 0.26; 95% CI, 0.10-0.67; P = .005) compared with the ELC group. There was no significant difference in total hospital stay (MD = 1.71 days; 95% CI -0.17 to 3.60; P = .08) and the incidence of bile leak (OR 0.30; 95% CI 0.07-1.29; P = .11). Conclusions: Compared with ELC, LC after PTGBD can effectively reduce the difficulty of operation, total postoperative morbidity, and conversion rate, and shorten the postoperative hospital stay and operative duration in patients with moderate AC as per the Tokyo Guidelines. In clinical practice, it is necessary to formulate individualized treatment plans based on the condition and willingness of the patients.
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Affiliation(s)
- Jingzhao Han
- Department of Graduate School, Hebei Medical University, Shijiazhuang, China.,Department of Hepatobiliary Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Dongdong Xue
- Department of Hepatobiliary Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Hongfang Tuo
- Department of Hepatobiliary Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Ze Liang
- Department of Hepatobiliary Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Chuncheng Wang
- Department of Hepatobiliary Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Yanhui Peng
- Department of Hepatobiliary Surgery, Hebei General Hospital, Shijiazhuang, China
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35
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Vaccari S, Lauro A, Cervellera M, Bellini MI, Palazzini G, Cirocchi R, Tonini V, D'Andrea V. Effect of antithrombotic therapy on postoperative outcome of 538 consecutive emergency laparoscopic cholecystectomies for acute cholecystitis: two Italian center's study. Updates Surg 2021; 73:1767-1774. [PMID: 33582984 DOI: 10.1007/s13304-021-00994-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
The risk of developing hemorrhagic complications during or after emergency cholecystectomy (EC) for acute cholecystitis (AC) in patients with antithrombotic therapy (ATT) remains uncertain. In this double-center study, we evaluated post-operative outcomes in patients with ATT undergoing EC. We retrospectively evaluated 538 patients who underwent laparoscopic EC for AC between May 2015 and December 2019 at two referral centers. 89 of them (17%) were on ATT. We defined postoperative complication rates, including bleeding, as our primary outcome. Mortality was higher in the ATT group. Morbidity was higher in the ATT group as well; however, the difference was not statistically significant. 12 patients (2%) experienced intraoperative blood loss over 500 ml and ten (2%) had postoperative bleeding complications. Two patients (< 1%) experienced both intraoperative and postoperative bleeding. On multivariate analysis, ATT was not significantly associated with worse postoperative outcomes. Antithrombotic therapy is not an independently associated factor of severe postoperative complications (including bleeding) or mortality. However, these patients still represent a challenging group and must be carefully managed to avoid postoperative bleeding complications.
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Affiliation(s)
- Samuele Vaccari
- Department of Surgical Sciences, Umberto I University Hospital, La Sapienza, Rome, Italy
| | - Augusto Lauro
- Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, c/o Policlinico Sant'Orsola-Malpighi Via Massarenti, 9, Bologna, Italy.
| | - Maurizio Cervellera
- Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, c/o Policlinico Sant'Orsola-Malpighi Via Massarenti, 9, Bologna, Italy
| | - Maria Irene Bellini
- Department of Surgical Sciences, Umberto I University Hospital, La Sapienza, Rome, Italy
| | - Giorgio Palazzini
- Department of Surgical Sciences, Umberto I University Hospital, La Sapienza, Rome, Italy
| | | | - Valeria Tonini
- Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum, c/o Policlinico Sant'Orsola-Malpighi Via Massarenti, 9, Bologna, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Umberto I University Hospital, La Sapienza, Rome, Italy
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Noitumyae J. Indocyanin greens cholangiography for intra-operative bile duct visualization during pediatric laparoscopic hepato-biliary surgery. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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37
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Imamovic A, Wagner D, Kornprat P, Bacher H, Werkgartner G, Mischinger HJ. Laparoscopic cholecystectomy in critically ill patients. Eur Surg 2021. [DOI: 10.1007/s10353-021-00717-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Shirinov ZT, Aliev YG, Gamidova NA, Mekhtizade SM, Akhmedov DS. [Diagnosis and surgical treatment of acute destructive calculous cholecystitis in advanced age patients]. Khirurgiia (Mosk) 2021:24-29. [PMID: 34029032 DOI: 10.17116/hirurgia202106124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To develop an algorithm for surgical treatment of acute destructive cholecystitis in elderly and senile patients and to improve postoperative outcomes in this cohort of patients. MATERIAL AND METHODS A prospective analysis included 50 patients with acute destructive cholecystitis aged 60-90 years, who admitted to the Topchubashov Research Surgical Center for the period from 2015 to 2019. All patients had diabetes mellitus, obesity or cardiovascular diseases. Ultrasound was performed in all patients, CT - in 60% of patients, MRI - in 36% of cases. Thirty-six (72%) patients underwent laparoscopic cholecystectomy, 14 (28%) patients - open cholecystectomy. RESULTS Intra- and postoperative complications were analyzed in both groups. In our opinion, subtotal 'fundus first' cholecystectomy should be preferred for safe cholecystectomy and prevention of iatrogenic lesions. Laparoscopic 'fundus first' cholecystectomy was carried out in 16% of patients (including 10% of subtotal cholecystectomies). Pribram subtotal cholecystectomy was performed in 5 (10%) patients. Iatrogenic damage to the common bile duct was absent. CONCLUSION We have developed an algorithm for the diagnosis and surgical treatment of acute destructive calculous cholecystitis in advanced age patients.
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Affiliation(s)
- Z T Shirinov
- Topchubashev Research Surgical Center, Baku, Azerbaijan
| | - Yu G Aliev
- Azerbaijan Medical University, Baku, Azerbaijan
| | - N A Gamidova
- Topchubashev Research Surgical Center, Baku, Azerbaijan
| | | | - D S Akhmedov
- Topchubashev Research Surgical Center, Baku, Azerbaijan
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Tan M, Jensen TG, Nielsen SL, Schaffalitzky de Muckadell OB, Laursen SB. Analysis of patterns of bacteremia and 30-day mortality in patients with acute cholangitis over a 25-year period. Scand J Gastroenterol 2021; 56:578-584. [PMID: 33764841 DOI: 10.1080/00365521.2021.1902558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Acute cholangitis (AC) is a condition of bacterial infection in the biliary tract with a high mortality rate of around 10%. Direct association between presence of bacteremia and 30-day mortality among AC patients is sparsely investigated and remains unclear. AIMS AND METHODS Our aim was to investigate association between bacteremia and 30-day mortality among patients with AC included over a period of 25 years. All AC patients that underwent endoscopic retrograde cholangiopancreatography (ERCP) at Odense University Hospital, between 1 January 1990 and 31 October 2015, were identified using a prospective ERCP database. Blood culture results from the patients along with antimicrobial resistance patterns were collected from a bacteremia research database. RESULTS During the study period, 775 consecutive AC patients underwent ERCP and blood cultures were collected from 528 patients. Among these patients 48% (n = 260) had bacteremia. Overall, 30-day mortality in patients with blood cultures performed was 13% (n = 69). In patients with bacteremia, 30-day mortality was 19% (n = 49), compared to 7% (n = 20) in patients without bacteremia (p < .01). Presence of bacteremia was associated with increased 30-day mortality (OR [95% CI]: 3.43 [1.92-6.13]; p < .01) following adjustment for confounding factors. Among the species, bacteremia with Enterobacter cloacae was significantly associated with increased 30-day mortality (OR [95% CI]: 2.97 [1.16-7.62]; p = .02). CONCLUSION Our results indicate that presence of bacteremia was associated with a nearly fourfold increase in 30-day mortality among AC patients.
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Affiliation(s)
- Ming Tan
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thøger Gorm Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Stig Lønberg Nielsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Ove B Schaffalitzky de Muckadell
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Stig Borbjerg Laursen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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40
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Bejarano González N, Romaguera Monzonís A, Rebasa Cladera P, García Monforte N, Labró Ciurans M, Badia Closa J, Criado Paredes E, García Borobia FJ. Is percutaneous cholecystostomy safe and effective in acute cholecystitis? Analysis of adverse effects associated with the technique. Cir Esp 2021; 100:S0009-739X(21)00124-X. [PMID: 33902894 DOI: 10.1016/j.ciresp.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The main objective of our study is to assess the safety and efficacy of percutaneous cholecystostomy for the treatment of acute cholecystitis, determining the incidence of adverse effects in patients undergoing this procedure. MATERIAL AND METHOD Observational study with consecutive inclusion of all patients diagnosed with acute cholecystitis for 10 years. The main variable studied was morbidity (adverse effects) collected prospectively. Minimum one-year follow-up of patients undergoing percutaneous cholecystostomy. RESULTS Of 1223 patients admitted for acute cholecystitis, 66 patients required percutaneous cholecystostomy. 21% of these have presented some adverse effect, with a total of 22 adverse effects. Only 5 of these effects, presented by 5 patients (7.6%), could have been attributed to the gallbladder drainage itself. The mortality associated with the technique is 1.5%. After cholecystostomy, one third of the patients (22 patients) have undergone cholecystectomy. Urgent surgery was performed due to failure of percutaneous treatment in 2 patients, and delayed in another 2 patients due to recurrence of the inflammatory process. The rest of the cholecystectomized patients underwent scheduled surgery, and the procedure could be performed laparoscopically in 16 patients (72.7%). CONCLUSION We consider percutaneous cholecystostomy as a safe and effective technique because it is associated with a low incidence of morbidity and mortality, and it should be considered as a bridge or definitive alternative in those patients who do not receive urgent cholecystectomy after failure of conservative antibiotic treatment.
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Affiliation(s)
- Natalia Bejarano González
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España.
| | - Andreu Romaguera Monzonís
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Pere Rebasa Cladera
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Neus García Monforte
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Meritxell Labró Ciurans
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Cirugía General y del Aparato Digestivo, Althaia Xarxa Assistencial Universitària, Manresa, Barcelona, España
| | - Jesús Badia Closa
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Eva Criado Paredes
- Unidad de Radiología Vascular Intervencionista, Servicio de Radiología, UDIAT Centro Diagnóstico, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Francisco Javier García Borobia
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
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41
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Kaplan U, Handler C, Chazan B, Weiner N, Hatoum OA, Yanovskay A, Kopelman D. The Bacteriology of Acute Cholecystitis: Comparison of Bile Cultures and Clinical Outcomes in Diabetic and Non-Diabetic Patients. World J Surg 2021; 45:2426-2431. [PMID: 33860354 DOI: 10.1007/s00268-021-06107-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND Acute cholecystitis is one of the most common acute surgical diseases. Diabetic patients have been shown to have an increased risk for gallbladder disease, but the correlation between the severity of gallstone disease and diabetes is still debated. The aim of this study is to examine the possible difference in the disease process between patients with diabetes mellitus (DM) and those without. PATIENTS AND METHODS A retrospective study was conducted of all patients who underwent percutaneous cholecystostomy between 2005 and 2015 at Emek Medical Center, Afula, Israel. Demographic and medical history including data on bile and blood culture results, antimicrobial susceptibility, and clinical outcomes were retrieved from patient files. RESULTS The cohort included 272 patients. Mean age was 68 years old, 50.74% were male and 43.75% had diabetes mellitus. Bile cultures were obtained from 252 (92.64%) patients and were positive in 134 (53.2%) patients. In 11 patients (4%) two pathogens were isolated. Blood cultures obtained from 231 patients and were positive in 35 (15.2%). Escherichia coli was the most common isolate, and was seen in 22.3% of positive bile cultures and 40% of blood cultures. Although diabetic patients had significantly more positive bile cultures, the severity of the disease, according to the Tokyo guidelines, was not higher. CONCLUSIONS Acute cholecystitis was neither more severe nor had significant difference in bacteriological properties when comparing diabetic patients to non-diabetic ones.
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Affiliation(s)
- Uri Kaplan
- Department of General Surgery B, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel.
| | - Chovav Handler
- Department of General Surgery B, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel
| | - Bibiana Chazan
- Infectious Disease Unit, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology,, Efron st. 1, Bat Galim,, 3525433, Haifa, Israel
| | - Noam Weiner
- Department of General Surgery B, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel
| | - Ossama A Hatoum
- Department of General Surgery B, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology,, Efron st. 1, Bat Galim,, 3525433, Haifa, Israel
| | - Anna Yanovskay
- Infectious Disease Unit, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology,, Efron st. 1, Bat Galim,, 3525433, Haifa, Israel
| | - Doron Kopelman
- Department of General Surgery B, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology,, Efron st. 1, Bat Galim,, 3525433, Haifa, Israel
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Patra PS, Das A, Ahmed SKM, Mitra S, Dhali GK. Treatment response and long-term outcomes in biliary ascariasis: A prospective study. Arab J Gastroenterol 2021; 22:164-169. [PMID: 33752976 DOI: 10.1016/j.ajg.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/30/2020] [Accepted: 11/20/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND STUDY AIMS Anti-helminthic therapy and endoscopic worm extraction had variable success rates in biliary ascariasis. Recurrent biliary events after worm clearance are common. We aimed to evaluate the outcomes of management in biliary ascariasis and find out the incidence and risk factors for the development of recurrent biliary events. PATIENTS AND METHODS Consecutive patients with biliary ascariasis detected on abdominal ultrasound (AUS), were selected. Initial conservative treatment with oral Albendazole (400 mg) and analgesics was started in all. Successful therapy was defined as symptomatic resolution, and AUS confirmed biliary clearance after three weeks. ERCP (Endoscopic retrograde cholangiopancreatography) was performed in patients with failed conservative management. The patients were prospectively followed up for a minimum period of 1 year. RESULTS Among 98 patients with biliary ascariasis, 23 (23.5%) responded to medical management alone. A presentation with obstructive jaundice (p = 0.04) and cholangitis (p = 0.007) was significantly associated with failure to medical management. Sixty-five (86.7%) among 75 patients had successful biliary clearance with ERCP. During a median follow up of 16 months, 24 (24.5%) patients had recurrent biliary events. Lower socioeconomic status (OR = 0.78, p = 0.023) and longer follow-up (OR = 1.16, p = 0.001) were independent risk factors for recurrent biliary events. CONCLUSION Early ERCP among high-risk patients and proper hygiene are the keys to successful management in biliary ascariasis.
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Affiliation(s)
- Partha Sarathi Patra
- Department of Gastroenterology, School of Digestive and Liver Diseases (SDLD), IPGMER & SSKM Hospital, Kolkata, India
| | - Abhishek Das
- Department of Gastroenterology, School of Digestive and Liver Diseases (SDLD), IPGMER & SSKM Hospital, Kolkata, India.
| | - S K Mahiuddin Ahmed
- Department of Hepatology, School of Digestive and Liver Diseases (SDLD), IPGMER & SSKM Hospital, Kolkata, India
| | - Souveek Mitra
- Department of Hepatology, School of Digestive and Liver Diseases (SDLD), IPGMER & SSKM Hospital, Kolkata, India
| | - Gopal Krishna Dhali
- Department of Gastroenterology, School of Digestive and Liver Diseases (SDLD), IPGMER & SSKM Hospital, Kolkata, India
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Modified enhanced recovery after surgery protocol in patients with acute cholecystitis: efficacy, safety and feasibility. Multicenter randomized control study. Updates Surg 2021; 73:1407-1417. [PMID: 33751409 DOI: 10.1007/s13304-021-01031-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
Laparoscopic cholecystectomy (LC) is a common surgical procedure in acute cholecystitis (AC). Patients often suffer from considerable postoperative pain and indigestion, which prolongs in-hospital stay. The enhanced recovery after surgery (ERAS) program has proven its efficacy in elective surgery and could hypothetically improve outcomes of emergency LC. Currently, there is no ERAS program for LC in patients with AC. A modified ERAS (mERAS) protocol was studied in a prospective, randomized non-blinded clinical trial (NCT03754751). The mERAS group consisted of 88 patients the control group of 101 patients. The modified protocol included a patient information brochure; minimizing drain use; local anesthesia; low-pressure pneumoperitoneum; PONV prophylaxis, early mobilization and oral diet. The primary outcome was postoperative length of stay (pLOS). The postoperative length of stay in the mERAS group was shorter (24 (21-45.5) h) than in the control (45 (41-68) h) (p < 0.0001). One re-admission in the mERAS group was reported (p = 0.466). There difference in complications was insignificant (mERAS 6.8% vs 5% p = 0.757). Post-operative pain intensity was significantly lower in the mERAS group immediately after awaking (3.7 ± 1.8 vs 5.4 ± 1.3 p < 0.0001), 2 h (3.3 ± 1.7 vs 4.9 ± 1.6 p = 0.0006), 6 h (2.9 ± 1.5 vs 4.2 ± 1.2 p < 0.0001), 12 h (2.7 ± 0.9 vs 4.1 ± 1.2 p = 0.0001) and 24 h after surgery (2.1 ± 1.2 vs 3 ± 1.2 p < 0.0001). The incidence of shoulder and neck pain was lower in mERAS group (13.6% vs 34.7% p = 0.0009). Peristalsis recovery was similar in both groups. The proposed protocol improved postoperative recovery and reduced hospital stay in patients with AC without increasing the rate of complications or re-admissions.
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Reddy S, Jagtap N, Kalapala R, Ramchandani M, Lakhtakia S, Basha J, Nabi Z, Karyampudi A, Chavan R, Tandan M, Gupta R, Reddy DN. Choledocholithiasis in acute calculous cholecystitis: guidelines and beyond. Ann Gastroenterol 2021; 34:247-252. [PMID: 33654367 PMCID: PMC7903571 DOI: 10.20524/aog.2020.0562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background Acute calculous cholecystitis (ACC) is the most frequent complication of gallstones requiring cholecystectomy. These patients may have coexisting choledocholithiasis. We aimed to evaluate the role of current guidelines for choledocholithiasis in patients with ACC. Methods In this retrospective study, we included all patients diagnosed with ACC between December 2018 and May 2019. These patients were substratified according to the guidelines of the American and European Societies of Gastrointestinal Endoscopy (ASGE and ESGE) as having high, intermediate, or low likelihood of choledocholithiasis, and the diagnostic performance was measured. Binomial logistic regression analysis was applied to ascertain independent risk factors for choledocholithiasis. Results A total of 173 patients with ACC, mean age (±standard deviation) 49.89±15.74 years and 60.1% male, were included. Sixty-three (36.4%) had confirmed choledocholithiasis. ASGE high likelihood criteria had sensitivity and specificity of 61.9% (95% confidence interval [CI] 48.8-73.9) and 83.4% (95%CI 75.4-90.0) for predicting choledocholithiasis. ESGE high likelihood criteria had sensitivity and specificity of 49.2% (95%CI 36.4-62.1) and 87.3% (95%CI 79.6-92.9). On logistic regression analysis, an alkaline phosphatase level above the upper limit of normal (P=0.003; odds ratio [OR] 4.26, 95%CI 1.66-10.96) and a dilated common bile duct on ultrasound (P=0.001; OR 9.97, 95%CI 4.65-21.36) were independent positive predictors for choledocholithiasis, while acute biliary pancreatitis was an independent negative predictor (P=0.030; OR 0.36, 95%CI 0.14-0.91). Conclusions The performance of the ASGE and ESGE guidelines’ risk stratification criteria is inadequate in patients with ACC. We suggest the utilization of a separate predictive model for suspected choledocholithiasis in these patients.
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Affiliation(s)
- Siddhartha Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy)
| | - Nitin Jagtap
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy)
| | - Rakesh Kalapala
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy)
| | - Mohan Ramchandani
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy)
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy)
| | - Jahangeer Basha
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy)
| | - Zaheer Nabi
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy)
| | - Arun Karyampudi
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy)
| | - Radhika Chavan
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy)
| | - Manu Tandan
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy)
| | - Rajesh Gupta
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy)
| | - D Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy)
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Safety and Efficacy of Early Tube Removal Following Percutaneous Transhepatic Gallbladder Drainage: an Observational Study. Surg Laparosc Endosc Percutan Tech 2021; 30:164-168. [PMID: 31972834 PMCID: PMC7147403 DOI: 10.1097/sle.0000000000000761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Background: There are currently no guidelines concerning the advisability and timing of tube removal following percutaneous transhepatic gallbladder drainage (PTGBD). The present study aimed to assess the feasibility and risks of early removal of the PTGBD tube under the scenario of subsiding inflammation, patent cystic and common bile ducts, and absence of intraperitoneal leakage. Methods: Patient background and outcomes were assessed retrospectively in 701 cases of acute cholecystitis treated with PTGBD. The median times until tube removal and tube dislodgement and the cumulative rates of tube dislodgement were calculated. Results: Tube removal was performed in 275 patients after a median time of 16 days (range: 6 to 213 d); biliary peritonitis was observed in 2 patients following tube removal. Tubes were removed in 8 and 35 patients within 7 and 10 days, respectively. Tube dislodgement was observed in 82 patients after a median time of 12 days (range: 1 to 125 d). Conclusion: The present study suggests that drainage tube removal is safe and effective when performed after a short drainage period of 7 to 10 days if the criteria for the removal of the drainage tube were met.
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Lo Gullo A, Rifici C, Caliri S, Donato A, De Cola MC, Di Cara M, Corallo F, Bramanti P, Giuffrida C. Refeeding syndrome in a woman with pancreatitis: a case report. J Int Med Res 2021; 49:300060520986675. [PMID: 33535848 PMCID: PMC7871053 DOI: 10.1177/0300060520986675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Refeeding syndrome can occur in malnourished patients with acute pancreatitis who have electrolyte imbalances. Refeeding syndrome is characterized by severe electrolyte imbalances (mainly hypophosphatemia, hypomagnesemia, and hypokalemia), vitamin deficiency (mainly thiamine deficiency), fluid overload, and salt retention resulting in organ dysfunction and cardiac arrhythmias. We herein report a case involving a patient with severe pancreatitis and gallbladder stones who developed refeeding syndrome with shock and loss of consciousness. The patient was treated by opportune vitamin and electrolyte supplementation therapy and showed substantial improvement after 2 weeks of hospitalization, gaining the ability to eat small bites of solid food orally. Early diagnosis and treatment of refeeding syndrome may reduce morbidity and mortality in patients with acute pancreatitis. Patients should be fasted only if alimentation is contraindicated, and electrolyte values must be closely monitored.
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Sebastian M, Rudnicki J. Laparoscopic Ultrasound and Safe Navigation Around the Shrunken Gallbladder. J Laparoendosc Adv Surg Tech A 2021; 31:390-394. [PMID: 33471608 DOI: 10.1089/lap.2020.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The contracted gallbladder may predispose to a higher rate of biliary or vasculobiliary injury (VBI). It is usually associated with unclear anatomy due to chronic inflammation and fibrosis in the hepatoduodenal ligament region. Laparoscopic ultrasound (LUS) can very effectively delineate anatomical conditions during cholecystectomy. Our study aimed to compare the visual and ultrasonographic navigation around the shrunken gallbladder. Materials and Methods: The study group consisted of 612 patients qualified for laparoscopic cholecystectomy. The shrunken gallbladder was diagnosed intraoperatively in 13 patients (2.1%). In 6 patients, the only intraoperative navigation method was a visual evaluation of anatomical conditions, and in 7 patients, the method was LUS. Results: The operating time and the length of hospital stay after surgery were significantly lower, the number of conversions was insignificantly lower, and the number of successful visualization of anatomical conditions was significantly higher in the LUS group. We did not observe any bile duct and VBI in patients with the shrunken gallbladder. Conclusions: The combination of the fundus-first and subtotal cholecystectomy with LUS navigation might be an effective proposal when coming across the shrunken gallbladder.
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Affiliation(s)
- Maciej Sebastian
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland.,Videos demonstrating this technique are available online
| | - Jerzy Rudnicki
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland.,Videos demonstrating this technique are available online
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Surat G, Vogel U, Wiegering A, Germer CT, Lock JF. Defining the Scope of Antimicrobial Stewardship Interventions on the Prescription Quality of Antibiotics for Surgical Intra-Abdominal Infections. Antibiotics (Basel) 2021; 10:antibiotics10010073. [PMID: 33466628 PMCID: PMC7828676 DOI: 10.3390/antibiotics10010073] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/29/2022] Open
Abstract
Background: The aim of this study was to assess the impact of antimicrobial stewardship interventions on surgical antibiotic prescription behavior in the management of non-elective surgical intra-abdominal infections, focusing on postoperative antibiotic use, including the appropriateness of indications. Methods: A single-center quality improvement study with retrospective evaluation of the impact of antimicrobial stewardship measures on optimizing antibacterial use in intra-abdominal infections requiring emergency surgery was performed. The study was conducted in a tertiary hospital in Germany from January 1, 2016, to January 30, 2020, three years after putting a set of antimicrobial stewardship standards into effect. Results: 767 patients were analyzed (n = 495 in 2016 and 2017, the baseline period; n = 272 in 2018, the antimicrobial stewardship period). The total days of therapy per 100 patient days declined from 47.0 to 42.2 days (p = 0.035). The rate of patients receiving postoperative therapy decreased from 56.8% to 45.2% (p = 0.002), comparing both periods. There was a significant decline in the rate of inappropriate indications (17.4% to 8.1 %, p = 0.015) as well as a significant change from broad-spectrum to narrow-spectrum antibiotic use (28.8% to 6.5%, p ≤ 0.001) for postoperative therapy. The significant decline in antibiotic use did not affect either clinical outcomes or the rate of postoperative wound complications. Conclusions: Postoperative antibiotic use for intra-abdominal infections could be significantly reduced by antimicrobial stewardship interventions. The identification of inappropriate indications remains a key target for antimicrobial stewardship programs.
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Affiliation(s)
- Güzin Surat
- Department of Infection Control and Antimicrobial Stewardship, University Hospital of Würzburg, 97080 Würzburg, Germany;
- Correspondence:
| | - Ulrich Vogel
- Department of Infection Control and Antimicrobial Stewardship, University Hospital of Würzburg, 97080 Würzburg, Germany;
- Institute of Hygiene and Microbiology, University of Würzburg, 97080 Würzburg, Germany
| | - Armin Wiegering
- Department of General-, Visceral-, Transplant-, Vascular- and Paediatric Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany; (A.W.); (C.-T.G.); (J.F.L.)
| | - Christoph-Thomas Germer
- Department of General-, Visceral-, Transplant-, Vascular- and Paediatric Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany; (A.W.); (C.-T.G.); (J.F.L.)
| | - Johan Friso Lock
- Department of General-, Visceral-, Transplant-, Vascular- and Paediatric Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany; (A.W.); (C.-T.G.); (J.F.L.)
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Manrai M, Jha AA, Singh Shergill SP, Thareja S, Sood AK, Shukla R, Jain R, Dhiman P, Gaurab. Microbiology of bile in extrahepatic biliary obstruction: A tropical experience. Indian J Med Microbiol 2021; 39:54-58. [PMID: 33610257 DOI: 10.1016/j.ijmmb.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Bile is considered sterile, but in obstructed biliary system, growth of micro-organisms results in bacteraemia and toxaemia. We analysed bacterial profile of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and evaluated antibiotic resistance patterns to formulate strategy for antibiotics in patients undergoing ERCP. MATERIALS AND METHODS Patients with cholestasis who underwent ERCP were enrolled. Bile, collected aseptically, was cultured. Positive cultures were processed for isolate identification and antibiotic susceptibility. RESULTS One hundred and sixty-three patients (78 females; mean age - 55.1 ± 15.8 years) were enrolled and divided into two groups: Group I (n = 99) were naïve and Group II (n = 64) had undergone ERCP and stenting previously. Positive culture was seen in 68.1% (n = 111) with monomicrobial growth in 74.8% (n = 83) and poly-microbial growth in 25.2% (n = 28). Culture positivity was common in Group II vis-a-vis Group I (84.4% vs. 57.5%). Poly-microbial growth was significantly more common in Group II (35.2% vs. 15.8%, P = 0.028). Gram-negative bacilli were the predominant organisms isolated with Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae comprising 70% of the isolates. The most sensitive antibiotics were piperacillin-tazobactam and imipenem. The sensitivity of vancomycin, against Enterococcus spp. was in the range of 60%-70%. CONCLUSION Cholestasis leads to bacterial colonisation in most cases, regardless of the presence of a biliary stent. Biliary stent however predisposes to a polymicrobial growth. Most of the commonly used antibiotics continue to have significant sensitivity and may be used empirically. However, previously stented patients may have a higher incidence of infection with Enterococcus spp. and may require specific therapy.
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Affiliation(s)
- Manish Manrai
- Department of Medicine, AFMC, Pune, Maharashtra, India
| | - Atul A Jha
- Department of Medicine, 151 Base Hospital, Guwahati, Assam, India.
| | | | | | | | | | | | | | - Gaurab
- Military Hospital, Shillong, Meghalaya, India
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Zhang Z, He Y, Zhu XL, Liu X, Fu HX, Wang FR, Mo XD, Wang Y, Zhang YY, Han W, Chen Y, Yan CH, Wang JZ, Chen YH, Chang YJ, Xu LP, Liu KY, Huang XJ, Zhang XH. Acute Cholecystitis Following Allogeneic Hematopoietic Stem Cell Transplantation: Clinical Features, Outcomes, Risk Factors, and Prediction Model. Transplant Cell Ther 2020; 27:253.e1-253.e9. [PMID: 33781524 DOI: 10.1016/j.jtct.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
Acute cholecystitis (AC) is a potentially fatal complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT); however, only limited information is available on its clinical features, outcomes, and risk management strategies. This retrospective, nested, case-control study included 6701 patients undergoing allo-HSCT at our center from January 2004 to June 2019. In total, 72 patients (1.1%) were diagnosed with AC; among these, acute acalculous cholecystitis had a slightly higher prevalence (42 patients, 58.3%). Patients with moderate and severe AC exhibited remarkably worse overall survival (P = .001) and non-relapse mortality (P = .011) than others. Survival of haploidentical HSCT recipients with AC was comparable to that for patients with human leukocyte antigen (HLA)-identical donors. Age ≥ 18 years, antecedent stage II to IV acute graft-versus-host disease, and total parenteral nutrition were identified as potential risk factors for AC following allo-HSCT, while haploidentical transplantations were not more susceptible to AC than HLA-identical HSCT. Based on these criteria, a risk score model was developed and validated to estimate the probability of AC following allo-HSCT. The model separates all patients into low-, intermediate-, and high-risk groups and thereby provides a basis for early detection of this complication in the management of allo-HSCT.
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Affiliation(s)
- Zhuangyi Zhang
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Yun He
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xiao-Lu Zhu
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xiao Liu
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Hai-Xia Fu
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Feng-Rong Wang
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xiao-Dong Mo
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Yu Wang
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Yuan-Yuan Zhang
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Wei Han
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Yao Chen
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Chen-Hua Yan
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Jing-Zhi Wang
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Yu-Hong Chen
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Ying-Jun Chang
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Lan-Ping Xu
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Kai-Yan Liu
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xiao-Jun Huang
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xiao-Hui Zhang
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China.
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