Long-term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis
| Autor: | Kwang Hyuck Lee, Jae Keun Park, Joo Kyung Park, Yang Jm, Kyu Taek Lee, Jong Kyun Lee, Jin Woo Wi |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Cholecystitis Acute Malignancy 03 medical and health sciences 0302 clinical medicine Recurrence Risk Factors medicine Secondary Prevention Humans Cholecystostomy Aged Retrospective Studies Aged 80 and over Hepatology Receiver operating characteristic Common bile duct business.industry Gastroenterology Area under the curve Cancer Odds ratio Middle Aged medicine.disease Confidence interval Surgery medicine.anatomical_structure Treatment Outcome ROC Curve 030220 oncology & carcinogenesis Cholecystitis 030211 gastroenterology & hepatology Female business Follow-Up Studies |
| Zdroj: | Journal of gastroenterology and hepatology. 34(4) |
| ISSN: | 1440-1746 |
| Popis: | Background and aim Percutaneous cholecystostomy (PC) has been frequently used as an alternative treatment for acute cholecystitis in seriously ill patients unfit for surgery. The aim of this study was to investigate the recurrence rate and risk factors of recurrence. Methods Medical records of 102 patients who were followed up for more than 1 year after PC tube removal among 716 patients who underwent PC for acute cholecystitis treatment were retrospectively analyzed. Results The recurrence rate of acute cholecystitis after PC tube removal was 20.6% (21/102), and the mean time to recur was 660 days. Underlying cancer (odds ratio [OR]: 3.369; 95% confidence interval [CI]: 1.006-11.282; P = 0.0489), PC duration shorter than 44 days (OR: 5.596; 95% CI: 1.35-23.201; P = 0.0176), and the presence of common bile duct stone in initial imaging studies (OR: 24.393; 95% CI: 2.696-220.746; P = 0.0045) were positively correlated with recurrence. Tubogram before PC tube removal did not significantly lower the recurrence. However, PC tube clamping for several days significantly lowered the recurrence (OR: 0.108; 95% CI: 0.015-0.794; P = 0.0288). Fifty-nine (57.8%) had acalculous cholecystitis. Calculous cholecystitis was negatively correlated with recurrence (OR: 0.267; 95% CI: 0.074-0.967; P = 0.0444). Receiver operating characteristic curve of the prediction model for recurrence verified its accuracy (area under the curve: 0.8475). Conclusion We should try to keep PC more than 6 weeks and clamp for 1-2 weeks before removal. For those with the presence of common bile duct stones, calculous cholecystitis, and underlying malignancy, we should keep PC for longer duration and carefully observe symptoms and signs of recurrence. |
| Databáze: | OpenAIRE |
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