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Percutaneous cholecystostomy for high-risk patients with acute cholangitis.

Abstract Percutaneous cholecystostomy (PC) is a well-established treatment for acute cholecystitis. We investigate the performance and role of PC in managing acute cholangitis.Retrospective review on all patients who underwent PC for acute cholangitis between January 2012 and June 2017 at a major regional hospital in Hong Kong.Thirty-two patients were included. The median age was 84 years and median American Society of Anaesthesiologists (ASA) physical status was Class III (severe systemic disease). All fulfilled Tokyo Guidelines 2013 (TG13) diagnostic criteria for moderate or severe cholangitis. Eighty-four percent of the patients were shown to have lower common bile duct stones on imaging. The majority had previously failed intervention by endoscopic retrograde cholangiopancreatography (38%), percutaneous transhepatic biliary drainage (38%), or both (13%)The technical success rate for PC was 100% with no procedure-related mortality. The overall 30-day mortality was 9%. Rest of the patients (91%) had significant improvement in clinical symptoms and could be discharged with median length of stay of 14 days. Significant postprocedural biochemical improvement was observed in terms of white cell count (P < .001), serum bilirubin (P < .001), alkaline phosphatase (P = .001), and alanine transaminase levels (P < .001). Time from admission to PC was associated with excess mortality (P = .002).PC is an effective treatment for acute cholangitis in high-risk elderly patients. Early intervention is associated with lower mortality. PC is particularly valuable as a temporising measure before definitive treatment in critical patients or as salvage therapy where other methods endoscopic retrograde cholangiopancreatography/percutaneous transhepatic biliary drainage (ERCP/PTBD) have failed.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29742738
OWN - NLM
STAT- MEDLINE
DCOM- 20180516
LR  - 20180516
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 19
DP  - 2018 May
TI  - Percutaneous cholecystostomy for high-risk patients with acute cholangitis.
PG  - e0735
LID - 10.1097/MD.0000000000010735 [doi]
AB  - Percutaneous cholecystostomy (PC) is a well-established treatment for acute
      cholecystitis. We investigate the performance and role of PC in managing acute
      cholangitis.Retrospective review on all patients who underwent PC for acute
      cholangitis between January 2012 and June 2017 at a major regional hospital in
      Hong Kong.Thirty-two patients were included. The median age was 84 years and
      median American Society of Anaesthesiologists (ASA) physical status was Class III
      (severe systemic disease). All fulfilled Tokyo Guidelines 2013 (TG13) diagnostic 
      criteria for moderate or severe cholangitis. Eighty-four percent of the patients 
      were shown to have lower common bile duct stones on imaging. The majority had
      previously failed intervention by endoscopic retrograde cholangiopancreatography 
      (38%), percutaneous transhepatic biliary drainage (38%), or both (13%)The
      technical success rate for PC was 100% with no procedure-related mortality. The
      overall 30-day mortality was 9%. Rest of the patients (91%) had significant
      improvement in clinical symptoms and could be discharged with median length of
      stay of 14 days. Significant postprocedural biochemical improvement was observed 
      in terms of white cell count (P &lt; .001), serum bilirubin (P &lt; .001), alkaline
      phosphatase (P = .001), and alanine transaminase levels (P &lt; .001). Time from
      admission to PC was associated with excess mortality (P = .002).PC is an
      effective treatment for acute cholangitis in high-risk elderly patients. Early
      intervention is associated with lower mortality. PC is particularly valuable as a
      temporising measure before definitive treatment in critical patients or as
      salvage therapy where other methods endoscopic retrograde
      cholangiopancreatography/percutaneous transhepatic biliary drainage (ERCP/PTBD)
      have failed.
FAU - Li, Yan-Lin
AU  - Li YL
AD  - Department of Radiology, Queen Mary Hospital, Pok Fu Lam.
AD  - Department of Radiology, North District Hospital, Sheung Shui.
FAU - Wong, Kin-Hoi
AU  - Wong KH
AD  - Department of Radiology, Queen Mary Hospital, Pok Fu Lam.
AD  - Department of Radiology, North District Hospital, Sheung Shui.
FAU - Chiu, Keith Wan-Hang
AU  - Chiu KW
AD  - Department of Radiology, Queen Mary Hospital, Pok Fu Lam.
AD  - Department of Diagnostic Radiology, University of Hong Kong, Pokfulam, Hong Kong.
FAU - Cheng, Andrew Kai-Chun
AU  - Cheng AK
AD  - Department of Radiology, Queen Mary Hospital, Pok Fu Lam.
AD  - Department of Radiology, North District Hospital, Sheung Shui.
FAU - Cheung, Ronald Kin-On
AU  - Cheung RK
AD  - Department of Radiology, North District Hospital, Sheung Shui.
FAU - Yam, Max Kai-Ho
AU  - Yam MK
AD  - Department of Radiology, Queen Mary Hospital, Pok Fu Lam.
AD  - Department of Radiology, North District Hospital, Sheung Shui.
FAU - Chan, Angie Lok-Chi
AU  - Chan AL
AD  - Department of Radiology, North District Hospital, Sheung Shui.
FAU - Chan, Victor Siang-Hua
AU  - Chan VS
AD  - Department of Radiology, Queen Mary Hospital, Pok Fu Lam.
FAU - Law, Martin Wai-Ming
AU  - Law MW
AD  - Department of Radiology, Queen Mary Hospital, Pok Fu Lam.
FAU - Lee, Paul Sing-Fun
AU  - Lee PS
AD  - Department of Radiology, North District Hospital, Sheung Shui.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cholecystitis, Acute/diagnostic imaging/*surgery
MH  - Cholecystostomy/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Minimally Invasive Surgical Procedures/methods
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Ultrasonography
EDAT- 2018/05/10 06:00
MHDA- 2018/05/17 06:00
CRDT- 2018/05/10 06:00
PHST- 2018/05/10 06:00 [entrez]
PHST- 2018/05/10 06:00 [pubmed]
PHST- 2018/05/17 06:00 [medline]
AID - 10.1097/MD.0000000000010735 [doi]
AID - 00005792-201805110-00057 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 May;97(19):e0735. doi: 10.1097/MD.0000000000010735.