Endosonography-Guided Versus Percutaneous Gallbladder Drainage Versus Cholecystectomy in Fragile Patients with Acute Cholecystitis-A High-Volume Center Study
Background and Objectives: Acute cholecystitis is a frequent cause of admission to the emergency department, especially in old and frail patients. Percutaneous drainage (PT-GBD) and endosonographic guided drainage (EUS-GBD) could be an alternative option for relieving symptoms or act as a definitive treatment instead of a laparoscopic or open cholecystectomy (LC, OC). The aim of the present study was to compare different treatment groups. Materials and Methods: This is a five-year monocentric retrospective study including patients ≥65 years old who underwent an urgent operative procedure. A descriptive analysis was conducted comparing all treatment groups. A propensity score was estimated based on the ACS score, incorporated into a predictive model, and tested by recursive partitioning analysis. Results: 163 patients were included: 106 underwent a cholecystectomy (81 laparoscopic (LC) and 25 Open (OC)), 33 a PT-GBD and 21 EUS-GBD. The sample was categorized into three prognostic groups according to the adverse event occurrence rate. All patients treated with EUS-GBD or LC resulted in the low risk group, and the adverse event rate (AE) was 10/96 (10.4%). The AE was 4/28 (14.2%) and 21/36 (58.3%) in the middle- and high-risk groups respectively (p < 0.001). These groups included all the patients who underwent an OC or a PT-GBD. The PT-GBD group had a lower clinical success rate (55.5%) and higher RR (16,6%) when compared with other groups. Conclusions: Surgery still represents the gold standard for AC treatment. Nevertheless, EUS-GBD is a good alternative to PT-GBD in terms of clinical success, RR and AEs in all kinds of patients.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:58 |
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| Enthalten in: |
Medicina (Kaunas, Lithuania) - 58(2022), 11 vom: 14. Nov. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kurihara, Hayato [VerfasserIn] |
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| Links: |
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| Themen: |
ACS score |
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| Anmerkungen: |
Date Completed 28.11.2022 Date Revised 08.03.2023 published: Electronic Citation Status MEDLINE |
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| doi: |
10.3390/medicina58111647 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM349352593 |
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| 245 | 1 | 0 | |a Endosonography-Guided Versus Percutaneous Gallbladder Drainage Versus Cholecystectomy in Fragile Patients with Acute Cholecystitis-A High-Volume Center Study |
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| 520 | |a Background and Objectives: Acute cholecystitis is a frequent cause of admission to the emergency department, especially in old and frail patients. Percutaneous drainage (PT-GBD) and endosonographic guided drainage (EUS-GBD) could be an alternative option for relieving symptoms or act as a definitive treatment instead of a laparoscopic or open cholecystectomy (LC, OC). The aim of the present study was to compare different treatment groups. Materials and Methods: This is a five-year monocentric retrospective study including patients ≥65 years old who underwent an urgent operative procedure. A descriptive analysis was conducted comparing all treatment groups. A propensity score was estimated based on the ACS score, incorporated into a predictive model, and tested by recursive partitioning analysis. Results: 163 patients were included: 106 underwent a cholecystectomy (81 laparoscopic (LC) and 25 Open (OC)), 33 a PT-GBD and 21 EUS-GBD. The sample was categorized into three prognostic groups according to the adverse event occurrence rate. All patients treated with EUS-GBD or LC resulted in the low risk group, and the adverse event rate (AE) was 10/96 (10.4%). The AE was 4/28 (14.2%) and 21/36 (58.3%) in the middle- and high-risk groups respectively (p < 0.001). These groups included all the patients who underwent an OC or a PT-GBD. The PT-GBD group had a lower clinical success rate (55.5%) and higher RR (16,6%) when compared with other groups. Conclusions: Surgery still represents the gold standard for AC treatment. Nevertheless, EUS-GBD is a good alternative to PT-GBD in terms of clinical success, RR and AEs in all kinds of patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ACS score | |
| 650 | 4 | |a cholecystectomy | |
| 650 | 4 | |a cholecystitis | |
| 650 | 4 | |a endosonography-guided gallbladder drainage | |
| 650 | 4 | |a frailty | |
| 650 | 4 | |a percutaneous gallbladder drainage | |
| 700 | 1 | |a Bunino, Francesca M |e verfasserin |4 aut | |
| 700 | 1 | |a Fugazza, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Marrano, Enrico |e verfasserin |4 aut | |
| 700 | 1 | |a Mauri, Giulia |e verfasserin |4 aut | |
| 700 | 1 | |a Ceolin, Martina |e verfasserin |4 aut | |
| 700 | 1 | |a Lanza, Ezio |e verfasserin |4 aut | |
| 700 | 1 | |a Colombo, Matteo |e verfasserin |4 aut | |
| 700 | 1 | |a Facciorusso, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Repici, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Anderloni, Andrea |e verfasserin |4 aut | |
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