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01-04-2020 | Cholecystitis | Original Article

Natural Course of Acute Cholecystitis in Patients Treated With Percutaneous Transhepatic Gallbladder Drainage Without Elective Cholecystectomy

Authors: Yu-Liang Hung, Sio-Wai Chong, Chi-Tung Cheng, Chien-Hung Liao, Chih-Yuan Fu, Chi-Hsun Hsieh, Ta-Sen Yeh, Chun-Nan Yeh, Yi-Yin Jan, Shang-Yu Wang

Published in: Journal of Gastrointestinal Surgery | Issue 4/2020

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.

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Title: Natural Course of Acute Cholecystitis in Patients Treated With Percutaneous Transhepatic Gallbladder Drainage Without Elective Cholecystectomy
Authors: Yu-Liang Hung
Sio-Wai Chong
Chi-Tung Cheng
Chien-Hung Liao
Chih-Yuan Fu
Chi-Hsun Hsieh
Ta-Sen Yeh
Chun-Nan Yeh
Yi-Yin Jan
Shang-Yu Wang
Publication date: 01-04-2020
Publisher: Springer US
Keywords: Cholecystitis
Cholecystectomy
Published in: Journal of Gastrointestinal Surgery / Issue 4/2020
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04213-0

At a glance: The STEP trials

Springer Medicine

Natural Course of Acute Cholecystitis in Patients Treated With Percutaneous Transhepatic Gallbladder Drainage Without Elective Cholecystectomy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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