Routine surveillance cholangiography after percutaneous cholecystostomy delays drain removal and cholecystectomy
| Autor: | Camille G. Dessaigne, R. Stephen Smith, Frederick A. Moore, Alicia M. Mohr, Scott C. Brakenridge, William J. Zingarelli, George A. Sarosi, Chasen A. Croft, Tyler J. Loftus, Janeen R. Jordan, Philip A. Efron |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Cholecystitis Acute Comorbidity 030230 surgery Critical Care and Intensive Care Medicine Gastroenterology Severity of Illness Index Article Biliary disease 03 medical and health sciences 0302 clinical medicine Cholangiography Internal medicine medicine Humans Cholecystectomy Cholecystostomy Device Removal Aged Retrospective Studies Cholangiopancreatography Endoscopic Retrograde Common bile duct medicine.diagnostic_test business.industry General surgery Gallstones Length of Stay medicine.disease Systemic Inflammatory Response Syndrome medicine.anatomical_structure 030220 oncology & carcinogenesis Cholecystitis Florida Cystic duct Drainage Surgery business |
| Zdroj: | The journal of trauma and acute care surgery. 82(2) |
| ISSN: | 2163-0763 |
| Popis: | INTRODUCTION Percutaneous cholecystostomy (PC) is often performed for patients with acute cholecystitis who are at high risk for operative morbidity and mortality. However, the necessity for routine cholangiography after PC remains unclear. We hypothesized that routine surveillance cholangiography (RSC) after PC would provide no benefit compared to on-demand cholangiography (ODC) triggered by signs or symptoms of biliary pathology. METHODS We performed a 3-year retrospective cohort analysis of patients managed with PC for acute cholecystitis at two tertiary care hospitals. Patients who had routine surveillance cholangiography (RSC, n = 43) were compared to patients who had on-demand cholangiography (ODC, n = 41) triggered by recurrent biliary disease. RESULTS RSC and ODC groups were similar by severity of acute cholecystitis, presence of gallstones, systemic inflammatory response syndrome (SIRS) criteria at the time of PC, SIRS criteria 72 hours after PC, and hospital length of stay. Two patients in the ODC group developed clinical indications for cholangiography. All 44 RSC patients had cholangiography, and 67 total cholangiograms were performed in this group. Surveillance cholangiography identified six patients (14%) with cystic duct filling defect and seven patients (16%) with a common bile duct filling defect, all of whom were asymptomatic. Fifteen patients (35%) in the RSC group had 32 ERCP procedures; five patients (12%) in the ODC group had 7 ERCPs (p = 0.021). The ODC group had fewer days to drain removal (35 vs. 61, p < 0.001) and days to cholecystectomy (39 vs. 81, p = 0.005). Rates of recurrent cholecystitis, cholangitis, gallstone pancreatitis, drain removal, and cholecystectomy were similar between groups. CONCLUSION RSC after PC for acute cholecystitis identified biliary pathology in asymptomatic patients and propagated further testing, but did not provide clinical benefit. ODC was associated with earlier drain removal, earlier cholecystectomy, and decreased resource utilization. LEVEL OF EVIDENCE Prognostic study, level III; therapeutic study, level IV. |
| Databáze: | OpenAIRE |
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