Yu-Liang Hung1, Sio-Wai Chong2, Chi-Tung Cheng3, Chien-Hung Liao3, Chih-Yuan Fu3, Chi-Hsun Hsieh3, Ta-Sen Yeh2, Chun-Nan Yeh2, Yi-Yin Jan2, Shang-Yu Wang4,5,6. 1. School of Traditional Chinese Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China. 2. Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China. 3. Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China. 4. Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China. d0100106@cgu.edu.tw. 5. Graduate Institute of Clinical Medical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China. d0100106@cgu.edu.tw. 6. School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China. d0100106@cgu.edu.tw.
Abstract
BACKGROUND: Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative treatment for acute cholecystitis (AC). We aimed to understand the natural course of AC in patients treated with PTGBD but without later definitive treatments, such as laparoscopic cholecystectomy. METHODS: This was a retrospective study of the period from June 2010 to December 2016, during which time 2371 patients were diagnosed with AC and 625 received PTGBD treatment. Among the 625 patients, 237 received no definitive treatment. A biliary event after the initial AC episode was the outcome of interest. In addition, the competing risk of death unrelated to biliary causes was present in the cohort. Therefore, a competing risk model was applied for analysis. RESULTS: The cumulative incidence of biliary events was 29.8% with a median of 4.27 months, while the competing event, i.e., death unrelated to a biliary event, was noted in 14.9% of patients with a median 23.54 months. The risk factors of biliary events were prolonged PTGBD indwelling and an abnormal PTGBD cholangiogram. The risk factors of death unrelated to a biliary event included a high Charlson comorbidity index and the initial AC severity. CONCLUSIONS: Definitive cholecystectomy is still recommended for patients undergoing PTGBD treatment due to the high incidence of later biliary events. A thorough preoperative evaluation is necessary for those patients before elective cholecystectomy because of the inferior life expectancy and physical status.
BACKGROUND: Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative treatment for acute cholecystitis (AC). We aimed to understand the natural course of AC in patients treated with PTGBD but without later definitive treatments, such as laparoscopic cholecystectomy. METHODS: This was a retrospective study of the period from June 2010 to December 2016, during which time 2371 patients were diagnosed with AC and 625 received PTGBD treatment. Among the 625 patients, 237 received no definitive treatment. A biliary event after the initial AC episode was the outcome of interest. In addition, the competing risk of death unrelated to biliary causes was present in the cohort. Therefore, a competing risk model was applied for analysis. RESULTS: The cumulative incidence of biliary events was 29.8% with a median of 4.27 months, while the competing event, i.e., death unrelated to a biliary event, was noted in 14.9% of patients with a median 23.54 months. The risk factors of biliary events were prolonged PTGBD indwelling and an abnormal PTGBD cholangiogram. The risk factors of death unrelated to a biliary event included a high Charlson comorbidity index and the initial AC severity. CONCLUSIONS: Definitive cholecystectomy is still recommended for patients undergoing PTGBD treatment due to the high incidence of later biliary events. A thorough preoperative evaluation is necessary for those patients before elective cholecystectomy because of the inferior life expectancy and physical status.
Authors: L Ansaloni; M Pisano; F Coccolini; A B Peitzmann; A Fingerhut; F Catena; F Agresta; A Allegri; I Bailey; Z J Balogh; C Bendinelli; W Biffl; L Bonavina; G Borzellino; F Brunetti; C C Burlew; G Camapanelli; F C Campanile; M Ceresoli; O Chiara; I Civil; R Coimbra; M De Moya; S Di Saverio; G P Fraga; S Gupta; J Kashuk; M D Kelly; V Koka; H Jeekel; R Latifi; A Leppaniemi; R V Maier; I Marzi; F Moore; D Piazzalunga; B Sakakushev; M Sartelli; T Scalea; P F Stahel; K Taviloglu; G Tugnoli; S Uraneus; G C Velmahos; I Wani; D G Weber; P Viale; M Sugrue; R Ivatury; Y Kluger; K S Gurusamy; E E Moore Journal: World J Emerg Surg Date: 2016-06-14 Impact factor: 5.469
Authors: Agnieszka Popowicz; Lars Lundell; Peter Gerber; Ulf Gustafsson; Emil Pieniowski; Helen Sinabulya; Krister Sjödahl; Andrianos Tsekrekos; Gabriel Sandblom Journal: Gastroenterol Res Pract Date: 2015-12-29 Impact factor: 2.260
Authors: Seung Jae Lee; In Seok Choi; Ju Ik Moon; Dae Sung Yoon; Sang Eok Lee; Nak Song Sung; Sung Uk Kwon; In Eui Bae; Seung Jae Roh; Won Jun Choi Journal: J Gastrointest Surg Date: 2021-06-25 Impact factor: 3.452