Limits...
Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older.

Maekawa S, Nomura R, Murase T, Ann Y, Oeholm M, Harada M - BMC Gastroenterol (2013)

Bottom Line: The main outcome measure of this study was the efficacy of EGS.Permanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis.The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gastroenterological Medicine, Japan Labour Health and Welfare Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata 942-8502, Japan. s5083m@niirou.jp

ABSTRACT

Background: Endoscopic transpapillary pernasal gallbladder drainage and endoscopic gallbladder stenting (EGS) have recently been reported to be useful in patients with acute cholecystitis for whom a percutaneous approach is contraindicated. The aim of this study was to evaluate the efficacy of permanent EGS for management of acute cholecystitis in elderly patients who were poor surgical candidates.

Methods: We retrospectively studied 46 elderly patients aged 65 years or older with acute cholecystitis who were treated at Japan Labour Health and Welfare Organization Niigata Rosai Hospital. In 40 patients, acute cholecystitis was diagnosed by transabdominal ultrasonography and computed tomography, while 6 patients were transferred from other hospitals after primary management of acute cholecystitis. All patients underwent EGS, with a 7Fr double pig-tail stent being inserted into the gallbladder. If EGS failed, percutaneous transhepatic gallbladder drainage or percutaneous transhepatic gallbladder aspiration was subsequently performed. The main outcome measure of this study was the efficacy of EGS.

Results: Permanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis. The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13). In 30 of these 31 patients (96.7%), there was no recurrence of cholecystitis and 29 patients (93.5%) remained asymptomatic until death or the end of the study period (after 1 month to 5 years).

Conclusions: EGS can be effective for elderly patients with acute cholecystitis who are poor surgical candidates and can provide a solution for several years.

Show MeSH

Related in: MedlinePlus

Outcome of 46 elderly patients with acute cholecystitis received EGS.EGS, endoscopic gallbladder stenting; PTGBD, percutaneous transhepaticgallbladder drainage; PTGBA, percutaneous transhepatic gallbladderaspiration
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3675408&req=5

Figure 2: Outcome of 46 elderly patients with acute cholecystitis received EGS.EGS, endoscopic gallbladder stenting; PTGBD, percutaneous transhepaticgallbladder drainage; PTGBA, percutaneous transhepatic gallbladderaspiration

Mentions: We performed emergency EGS in 40 patients who presented with acute severecholecystitis and were poor candidates for cholecystectomy. In 31 patients (77.5%),emergency EGS was successful and the procedural time was 27.6 ± 15.1 min (mean± SD). Clinical success was achieved within 3 days in all 31 patients. Theirsymptoms (abdominal pain, fever, and vomiting) resolved and they started to eat fromthe day after emergency EGS, and all 31 showed normalization of WBC and a decreaseof C-reactive protein after 3 days. All were discharged from hospital within 1 week.We administered antibiotics to all 31patients for 3 days after emergency EGS, butthey did not need ICU support, intubation, or inotropes. Among the 31 successfulpatients, we used a microcatheter for EGS in 4 difficult cases. The reasons fordifficulty were severe stricture and kinking of the cystic duct and we accomplishedEGS in these cases by using an 0.018 inch guidewire and a microcatheter (Additionalfile 2). The microcatheter had an inner diameter of 0.59mm, outer diameter of 0.89 mm, and an effective length of 2,600 mm (Figure 1). Of the 31 patients, 6 patients underwent cholecystectomywithin 2 months of EGS, while 25 patients were followed up without surgery due totheir poor general condition (Figure 2).


Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older.

Maekawa S, Nomura R, Murase T, Ann Y, Oeholm M, Harada M - BMC Gastroenterol (2013)

Outcome of 46 elderly patients with acute cholecystitis received EGS.EGS, endoscopic gallbladder stenting; PTGBD, percutaneous transhepaticgallbladder drainage; PTGBA, percutaneous transhepatic gallbladderaspiration
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3675408&req=5

Figure 2: Outcome of 46 elderly patients with acute cholecystitis received EGS.EGS, endoscopic gallbladder stenting; PTGBD, percutaneous transhepaticgallbladder drainage; PTGBA, percutaneous transhepatic gallbladderaspiration
Mentions: We performed emergency EGS in 40 patients who presented with acute severecholecystitis and were poor candidates for cholecystectomy. In 31 patients (77.5%),emergency EGS was successful and the procedural time was 27.6 ± 15.1 min (mean± SD). Clinical success was achieved within 3 days in all 31 patients. Theirsymptoms (abdominal pain, fever, and vomiting) resolved and they started to eat fromthe day after emergency EGS, and all 31 showed normalization of WBC and a decreaseof C-reactive protein after 3 days. All were discharged from hospital within 1 week.We administered antibiotics to all 31patients for 3 days after emergency EGS, butthey did not need ICU support, intubation, or inotropes. Among the 31 successfulpatients, we used a microcatheter for EGS in 4 difficult cases. The reasons fordifficulty were severe stricture and kinking of the cystic duct and we accomplishedEGS in these cases by using an 0.018 inch guidewire and a microcatheter (Additionalfile 2). The microcatheter had an inner diameter of 0.59mm, outer diameter of 0.89 mm, and an effective length of 2,600 mm (Figure 1). Of the 31 patients, 6 patients underwent cholecystectomywithin 2 months of EGS, while 25 patients were followed up without surgery due totheir poor general condition (Figure 2).

Bottom Line: The main outcome measure of this study was the efficacy of EGS.Permanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis.The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gastroenterological Medicine, Japan Labour Health and Welfare Organization Niigata Rosai Hospital, 1-7-12 Touncho, Joetsu, Niigata 942-8502, Japan. s5083m@niirou.jp

ABSTRACT

Background: Endoscopic transpapillary pernasal gallbladder drainage and endoscopic gallbladder stenting (EGS) have recently been reported to be useful in patients with acute cholecystitis for whom a percutaneous approach is contraindicated. The aim of this study was to evaluate the efficacy of permanent EGS for management of acute cholecystitis in elderly patients who were poor surgical candidates.

Methods: We retrospectively studied 46 elderly patients aged 65 years or older with acute cholecystitis who were treated at Japan Labour Health and Welfare Organization Niigata Rosai Hospital. In 40 patients, acute cholecystitis was diagnosed by transabdominal ultrasonography and computed tomography, while 6 patients were transferred from other hospitals after primary management of acute cholecystitis. All patients underwent EGS, with a 7Fr double pig-tail stent being inserted into the gallbladder. If EGS failed, percutaneous transhepatic gallbladder drainage or percutaneous transhepatic gallbladder aspiration was subsequently performed. The main outcome measure of this study was the efficacy of EGS.

Results: Permanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis. The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13). In 30 of these 31 patients (96.7%), there was no recurrence of cholecystitis and 29 patients (93.5%) remained asymptomatic until death or the end of the study period (after 1 month to 5 years).

Conclusions: EGS can be effective for elderly patients with acute cholecystitis who are poor surgical candidates and can provide a solution for several years.

Show MeSH
Related in: MedlinePlus