Cholecystostomy Research Articles

Safety and efficacy of a novel electrocautery-enhanced lumen-apposing metal stent in interventional EUS procedures (with video)

Electrocautery-tip lumen-apposing metal stents (EC-LAMSs) have extended the indications of therapeutic EUS. We aimed to retrospectively evaluate safety and technical and clinical success of a newly developed EC-LAMS, the Hot-Spaxus (Taewoong Medical Co, Gimpo, Korea), for various EUS-guided procedures. We included and retrospectively analyzed consecutive patients at 8 tertiary care referral centers whohad undergone EUS interventional procedures using the Hot-Spaxus between October 2018 and February2021. Of 58 included patients (male-to-female, 36:22; mean age, 63.5 ± 14.9 years), 29 had undergone pancreatic fluid collection drainage (50%), 22 (37.9%) biliary drainage for malignant distal obstruction, 3 (5.1%) gallbladder drainage for acute cholecystitis, 3 gastroenteroanastomoses, and 1 (1.7%) pelvic collection drainage. Technical success was achieved in 54 of 58 patients (93.1%) and clinical success in all 58. Adverse events occurred in 6 patients (11.1%): 2 early (3.7%), 1 late (1.8%), and 3 long term (5.6%). The outcomes were similar to those observed in a control group of patients treated with the Hot-Axios (Boston Scientific, Marlborough, Mass, USA), the other available EC-LAMS. Our study showed that the novel EC-LAMS has high technical and clinical success rates for various interventional EUS indications. Future multicenter prospective studies will better clarify the role of this new EC-LAMS for different indications.

Endoscopic ultrasound-guided gallbladder drainage: a backdoor for biliary decompression?

Endoscopic ultrasound-guided gallbladder drainage: a backdoor for biliary decompression?

Efficacy and safety of conversion of percutaneous cholecystostomy to endoscopic transpapillary gallbladder stenting in high-risk surgical patients

BackgroundEndoscopic transpapillary gallbladder stenting (ETGBS) has been used as an alternative to percutaneous cholecystostomy in patients with acute cholecystitis who are considered unfit for surgery. However, there are few data on the efficacy and safety of ETGBS replacement of percutaneous cholecystostomy in high-risk surgical patients. This study aimed to evaluate the feasibility, efficacy, and safety of ETGBS to replace percutaneous cholecystostomy in high-risk surgical patients. MethodsThis single center retrospective study reviewed the data of patients who attempted ETGBS to replace percutaneous cholecystostomy between January 2017 and September 2019. The technical success, clinical success, adverse events, and stent patency were evaluated. ResultsETGBS was performed in 43 patients (24 male, mean age 80.7 ± 7.4 years) to replace percutaneous cholecystostomy due to high surgical risk. The technical success rate and clinical success rate were 97.7% (42/43) and 90.5% (38/42), respectively. Procedure-related adverse events and stent-related late adverse events occurred in 7.0% (3/43) and 11.6% (5/43), respectively. Of the patients who successfully underwent ETGBS (n = 42), only one had recurrent acute cholecystitis during follow-up. The median stent patency was 415 days (interquartile range 240–528 days). ConclusionsETGBS, as a secondary intervention for the purpose of internalizing gallbladder drainage in patients following placement of a percutaneous cholecystostomy, is safe, effective, and technically feasible. Thus, conversion of percutaneous cholecystostomy to ETGBS may be considered as a viable option in high-risk surgical patients.

The Influence of Pre-Procedural Imaging and Cystic Duct Cholangiography on Endoscopic Transpapillary Gallbladder Drainage in Acute Cholecystitis.

Endoscopic transpapillary gallbladder drainage (ETGBD) for acute cholecystitis is challenging. We evaluated the influence of pre-procedural imaging and cystic duct cholangiography on ETGBD. Patients who underwent ETGBD for acute cholecystitis were retrospectively examined. The rate of gallbladder contrast on cholangiography, the accuracy of cystic duct direction and location by computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP), and the relationship between pre-procedural imaging and the technical success of ETGBD were investigated. A total of 145 patients were enrolled in this study. Gallbladder contrast on cholangiography was observed in 29 patients. The accuracy of cystic duct direction and location (proximal or distal, right or left, and cranial or caudal) by CT were, respectively, 79%, 60%, and 58% by CT and 68%, 55%, and 58% by MRCP. Patients showing gallbladder contrast on cholangiography underwent ETGBD with a significantly shorter procedure time and a lower rate of cystic duct injury. No other factors affecting procedure time, technical success, and cystic duct injury were identified. Pre-procedural evaluation of cystic duct direction and location by CT or MRCP was difficult in patients with acute cholecystitis. Patients who showed gallbladder contrast on cholangiography showed a shorter procedure time and a lower rate of cystic duct injury.

Endoscopic gallbladder drainage for symptomatic gallbladder disease: a cumulative systematic review meta-analysis.

Endoscopic ultrasound (EUS)-guided transmural or endoscopic retrograde cholangiography (ERC)-based transpapillary drainage may provide alternative treatment strategies for high-risk surgical candidates with symptomatic gallbladder (GB) disease. The primary aim of this study was to perform a systematic review and meta-analysis to investigate the efficacy and safety of endoscopic GB drainage for patients with symptomatic GB disease. Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed in accordance with PRISMA and MOOSE guidelines. Pooled proportions were calculated for measured outcomes including technical success, clinical success, adverse event rate, recurrence rate, and rate of reintervention. Subgroup analyses were performed for transmural versus transpapillary, transmural lumen apposing stent (LAMS), and comparison to percutaneous transhepatic drainage. Heterogeneity was assessed with I2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing. Thirty-six studies (n = 1538) were included. Overall, endoscopic GB drainage achieved a technical and clinical success of 87.33% [(95% CI 84.42-89.77); I2 = 39.55] and 84.16% [(95% CI 80.30-87.38); I2 = 52.61], with an adverse event rate of 11.00% [(95% CI 9.25-13.03); I2 = 7.08]. On subgroup analyses, EUS-guided transmural compared to ERC-assisted transpapillary drainage resulted in higher technical and clinical success rates [OR 3.91 (95% CI 1.52-10.09); P = 0.005 and OR 4.59 (95% CI 1.84-11.46); P = 0.001] and lower recurrence rate [OR 0.17 (95% CI 0.06-0.52); P = 0.002]. Among EUS-guided LAMS studies, technical success was 94.65% [(95% CI 91.54-96.67); I2 = 0.00], clinical success was 92.06% [(95% CI 88.65-94.51); I2 = 0.00], and adverse event rate was 11.71% [(95% CI 8.92-15.23); I2 = 0.00]. Compared to percutaneous drainage, EUS-guided drainage possessed a similar efficacy and safety with significantly lower rate of reintervention [OR 0.05 (95% CI 0.02-0.13); P < 0.001]. Endoscopic GB drainage is a safe and effective treatment for high-risk surgical candidates with symptomatic GB disease. EUS-guided transmural drainage is superior to transpapillary drainage and associated with a lower rate of reintervention compared to percutaneous transhepatic drainage.

Peroral cholecystoscopy using a multibending ultraslim endoscope through a lumen-apposing metal stent for endoscopic ultrasound-guided gallbladder drainage: a feasibility study

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS) has rendered endoscopic gallbladder assessment through a stent possible, but an appropriate endoscope is required. We assessed the feasibility of peroral cholecystoscopy (POCC) using a multibending ultraslim endoscope passed through a LAMS after EUS-GBD. 14 patients with a LAMS for EUS-GBD who consecutively underwent POCC were included. POCC was performed using a multibending endoscope inserted through the LAMS. The primary outcome was the technical success rate, defined as complete endoscopic examination of the gallbladder from the orifice of the cystic duct to the fundus. The types of intervention and adverse events were recorded. 17 POCCs were performed in 14 patients. Of the 17 POCCs, 15 (88.2 %) were technically successful. Narrow-band imaging endoscopy was performed in 12 procedures (70.6 %), and cholecystoscopy-guided target biopsies were obtained in six. Gallstone extraction was performed in two patients. After POCC, all LAMSs remained stable and no adverse events were observed. POCC using a multibending ultraslim endoscope can be effectively and safely performed through a LAMS after EUS-GBD.

Optimal timing of subsequent laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage according to the severity of acute cholecystitis

Optimal timing of percutaneous transhepatic gallbladder drainage (PTGBD) and subsequent laparoscopic cholecystectomy (LC) according to the severity of acute cholecystitis (AC) is not established. Total 739 patients with AC without common bile duct stone who underwent PTGBD and subsequent LC from January 2010 to December 2019 were retrospectively reviewed. We defined difficult surgery (DS; open conversion, subtotal cholecystectomy, adjacent organ injury, transfusion, operative time ≥ 90 minutes, or estimated blood loss ≥ 100 milliliters) and poor postoperative outcomes (PPO; postoperative hospital stays ≥ 7 days, or postoperative complication ≥ grade II). The receiver operating characteristic analyses were performed for evaluating appropriate duration from onset of symptom to PTGBD (duration A) and from PTGBD to LC (duration B). Of the 739 patients, 458 were for grade I AC, and 281 were for grade II/III AC. In grade I AC, the cut-off value for the relationship between duration A and PIO was 4.5 days. The cut-off value for the relationship between duration B and PPO was 7.5 days. In multivariate analysis, duration A ≥ 5 days and duration B ≥ 8 days were statistically significant predictors for DS and PPO, respectively. In grade II/III AC, the cut-off value for the relationship between duration A and PPO was 2.5 days. In multivariate analysis, duration A ≤ 2 days was statistically significant predictor for PPO. Optimal timing of PTGBD and LC is for duration from onset of symptom to PTGBD ≤ 4 days with duration from PTGBD to LC ≤ 7 days in grade I AC, and for duration from onset of symptom to PTGBD > 2 days.

Clinical meaning of the existence of microbiome in gallbladder after laparoscopic cholecystectomy: Incidence and related factors

In general, bile is sterile in normal status. However, there have been reports that bactibilia may exist at certain instances and its causal factors have not fully elucidated yet. To investigate the factors affecting bactiblia, we analyzed possible preoperative predictors and microflora in bile. Bile samples were collected for culture during cholecystectomies from November 2018 to November 2019. A total of 463 laparoscopic cholecystectomies were performed. Preoperative, intraoperative, and postoperative variables were compared between culture-positive and culture-negative groups. Of all patients, 157 (36.7%) of patients were culture-positive. Gram-negative bacteria (92, 58.6%) were more common, and Escherichia coli (43, 46.7%) and Klebsiella (20, 21.7%) were common species. The culture-positive group was older (53.9 ± 16.2 vs. 68.4 ± 12.3, p < 0.001), more symptomatic (66.8% vs. 79.6%, p < 0.001), underwent more preoperative procedures including endoscopic retrograde cholangiopancreatography (18 vs. 54, p < 0.001), percutaneous transhepatic gallbladder drainage (24 vs. 41, p < 0.001), and had more cases of emergency hospitalization (32.8% vs. 63.1%, p < 0.001) than culture-negative group. In multivariate analysis, age (HR 2.874, 95% CI 1.769-4.670, p < 0.001), abdominal pain (HR 1.730, 95% CI 1.026-2.919, p = 0.002), ERCP (HR 9.00, 95% CI 4.833-16.75, p < 0.001), and PTGBD (HR 2.86, 95% CI 1.440-4.901, p = 0.002) were independent factors related with bactibila. Among the patients who underwent laparoscopic cholecystectomy, the elderly, symptomatic, and preoperative drainage patients were more likely to have bacteria in the bile. In such cases, surgeon should be careful to prevent bile leakage during surgery, and consider administration of antibiotics that could cover gram-negative bacteria.

Cholecystectomy versus conservative treatment in patients with acute cholecystitis over 80 years old after percutaneous transhepatic gallbladder drainage

There are controversies to whether cholecystectomy should be performed after percutaneous transhepatic gallbladder drainage (PTGBD) in elderly patients with acute cholecystitis (AC). 202 patients with AC over 80 years old without common bile duct stone (CBD) stones, who received PTGBD from January 2010 to December 2019 in a single center were retrospectively reviewed. 142 underwent elective laparoscopic cholecystectomy (ELC), and 60 underwent conservative treatment. Of 60 patients, 36 had PTGBD removed (PTGBD-R), and 24 maintained PTGBD (PTGBD-M). Postoperative major complication (POMC) rate in ELC group was 8.5%. Recurrence rate of biliary event after PTGBD removal in PTGBD-R group was 22.2%. PTGBD related problem rate after discharge in PTGBD-M group was 70.8%. Biliary event related mortality after index treatment were no significant differences (ELC 2.8% vs. PTGBD-R 2.8% vs. PTGBD-M 8.3%, p = 0.381). In multivariate analysis, CACI ≥6 and BMI ≤19 were significant risk factor for POMC after ELC, and closed cystic duct was significant risk factor for recurrent biliary event after PTGBD removal. ELC is recommended for patients with AC over 80 years old without CBD stones after PTGBD, due to the high recurrence rate of biliary event after PTGBD removal and difficulty of maintaining of PTGBD. Conservative treatment may be an alternative option in patients with high risk of postoperative major complication.

Elective Laparoscopic Cholecystectomy Is Better than Conservative Treatment in Elderly Patients with Acute Cholecystitis After Percutaneous Transhepatic Gallbladder Drainage

BackgroundIt is unclear whether cholecystectomy is beneficial after percutaneous transhepatic gallbladder drainage (PTGBD) in elderly patients with acute cholecystitis (AC). MethodsThis single-center, retrospective study included 202 patients aged >80 years with AC without common bile duct (CBD) stones who underwent PTGBD between January 2010 and December 2019. ResultsOne hundred and forty-two patients underwent elective laparoscopic cholecystectomy (ELC), and 60 underwent conservative treatment, specifically PTGBD removal (PTGBD-R) in 36 patients and PTGBD maintained (PTGBD-M) in 24 patients. The postoperative major complication (POMC) rate in the ELC group was 8.5%. The cumulative incidence for recurrence of biliary events (BE) in the PTGBD-R group was 22.2%. The cumulative incidence for PTGBD-related complication in the PTGBD-M group was 70.8%. Mortality after initial treatment was not significantly different between the three groups (2.8% vs. 2.8% vs. 8.3%, p=0.381). In multivariate analysis, a Charlson age comorbidity index ≥6 and body mass index ≤19 were significant risk factors for POMC after ELC, and a closed cystic duct was a significant risk factor for recurrent BE after PTGBD-R. ConclusionELC is recommended in AC after PTGBD for selected patients aged >80 years without CBD stones due to the high recurrence rate of BE after PTGBD-R and the difficulty associated with PTGBD-M.

Endoscopic ultrasound-guided transportal cholangiography and jejunoduodenostomy to facilitate through-the-stent ERCP and transmural gallbladder drainage in Roux-en-Y gastrectomy.

Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS)-guided gallbladder drainage can be combined in one session [1] but remain challenging in postsurgical anatomy [2]. EUS-directed transgastric ERCP has led to favorable results in Roux-en-Y gastric bypass; several other through-the-stent endoscopic procedures are also possible in gastric bypass, including EUS [3]. ERCP may similarly be performed in Roux-en-Y hepaticojejunostomy by creating a fistula from the stomach or duodenum to the afferent limb using a lumen-apposing metal stent (LAMS) [4].

Interventional endoscopic ultrasound.

To update on recent advances in interventional endoscopic ultrasound (INVEUS) techniques. The introduction of linear echoendoscopes with larger instrument channels and the combined development of new tools and devices have enabled various new applications of minimally invasive endoscopic ultrasound (EUS)-guided transluminal interventions of the pancreas, biliary system and peri-gastrointestinal structures. In this review, EUS-guided interventions are discussed and evaluated: drainage of peripancreatic fluid collections, access and drainage of bile ducts, gallbladder and pancreatic duct, treatment of gastrointestinal haemorrhage, coeliac plexus block and coeliac plexus neurolysis, fiducial placement, solid and cystic tumour ablation, drug delivery and brachytherapy, gastroenterostomy, angiotherapy and other EUS-guided applications. The EUS-guided interventions are classified based on the available evidence as established or experimental, standardized or nonstandardized procedures in common or rare diseases with well or little known complications and their established or nonestablished treatment. Some EUS-guided interventions have sparse published evidence with only single-centre studies, case series or individual case reports, others like drainage of peripancreatic fluid collections have become widely accepted practice. INVEUS has been accepted as an alternative to several surgical approaches, EUS-guided techniques result in faster recovery times, shorter hospital stay and lower costs.

Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis using Two Gallbladder Stents (Dual Gallbladder Stenting).

Background/AimsEndoscopic transpapillary gallbladder drainage (ETPGBD) is gaining popularity for the management of acute cholecystitis (AC) in high-risk patients. However, the stents placed during the procedure are not immune to obstruction. Here we describe a novel technique of stenting with two transpapillary stents and evaluate its technical feasibility, safety, and efficacy in AC. MethodsA retrospective analysis of all patients undergoing ETPGBD using dual stents for AC at our institution between November 1, 2017 and August 31, 2020 was conducted. We abstracted patient data to evaluate technical and clinical success, adverse events, and long-term outcomes. Two stents were placed either during the index procedure or during an interval procedure performed 4–6 weeks after the index procedure. ResultsA total of 21 patients underwent ETPGBD with dual stenting (57.14% male, mean age: 62.14±17.21 years). The median interval between the placement of the first and the second stents was 37 days (range: 0–226 days). Technical and clinical success rates were 100%, with a recurrence rate of 4.76% (n=1) and adverse event rate of 9.52% (n=2) during a mean follow-up period of 471.74±345.64 days (median: 341 days, range: 55–1084 days). ConclusionsETPGBD with dual gallbladder stenting is a safe and effective technique for long-term gallbladder drainage in non-surgical candidates. Larger controlled studies are needed to validate our findings for the widespread implementation of this technique.

Novel Uses of Lumen-apposing Metal Stents: A Review of the Literature.

The field of therapeutic endoscopy has seen many recent advancements. One such emerging field is the use of lumen-apposing metal stents (LAMS). Although a few LAMS have been developed, the most commonly reviewed and the only Food and Drug Administration (FDA)-approved LAMS is the Axios stent by Boston Scientific. In 2013, LAMS were initially approved by the FDA for the management of pancreatic fluid collection drainage in the presence walled-off necrosis. Pancreatic fluid collections are traditionally drained with either a plastic stent or a covered biliary self-expanding metal stent. Plastic stents have a double pigtail feature which prevents stent migration. However, their narrow lumen poses limitations as it can lead to early stent occlusion. Fully covered metal stents have larger diameters, allowing improved drainage and decreased stent occlusion but their tubular shape is prone to migration. Consequently, this results in leakage, and frequent retrievals. Over the years, due to their versatility, LAMS now have many off label uses. This includes management of gastric outlet obstruction, superior mesenteric artery syndrome, strictures, gallbladder drainage, and postsurgical collection drainage. In this review, we will be discussing the FDA approved and the nonapproved uses of LAMS.

ID: 3520449 ENDOSCOPIC ULTRASOUND-GUIDED TRANSMURAL GALLBLADDER DRAINAGE (EUS-GBD) VERSUS PERCUTANEOUS TRANSHEPATIC GALLBLADDER DRAINAGE (PT-GBD) IN HIGH-RISK PATIENTS WITH ACUTE CHOLECYSTITIS - A SYSTEMATIC REVIEW AND META-ANALYSIS

Cholecystectomy is the gold-standard treatment for patients with acute calculous cholecystitis. Gallbladder drainage or cholecystostomy is an option for high-risk surgical patients who are critically ill or fail to improve with antibiotics. Percutaneous transhepatic gallbladder drainage (PT-GBD) is generally preferred due to its ease and safety. Recent studies have investigated the role of endoscopic ultrasound-guided transmural gallbladder drainage (EUS-GBD) as an alternative treatment, but its efficacy remains unclear because of paucity of studies.

ID: 3521184 EUS-GUIDED GALLBLADDER DRAINAGE USING A LUMEN APPOSING METAL STENT FOR ACUTE CHOLECYSTITIS: RESULTS OF A MULTICENTER STUDY

Endoscopic ultrasound guided gallbladder drainage (EUS-GBD) using lumen apposing metal stents (LAMS) has become one of treatment of choice for patients with acute cholecystitis (AC) considered poor candidates for cholecystectomy and its use is rapidly spreading among endoscopists.

ID: 3523182 ENDOSCOPIC ULTRASOUND-GUIDED TRANSMURAL GALLBLADDER DRAINAGE USING LUMEN-APPOSING METAL STENTS VERSUS PERCUTANEOUS CHOLECYSTOSTOMY FOR GALLBLADDER DRAINAGE IN HIGH-RISK CIRRHOTIC PATIENTS WITH ACUTE CHOLECYSTITIS: A MULTICENTER, COMPARATIVE TRIAL

Cirrhotic patients with acute cholecystitis who are considered high risk for surgery typically undergo percutaneous cholecystostomy (PC) tube placement to decompress the gallbladder. EUS-guided gallbladder drainage (EGBD) using lumen apposing metal stents (LAMS) is emerging as a new intervention for the management of cholecystitis in this clinical context. We performed a large multicenter study to compare procedural outcomes, clinical outcomes, and adverse events (AE) of EGBD and PC as a treatment for acute cholecystitis in patients with liver cirrhosis who are unfit for surgery.

Image-guided percutaneous cholecystostomy: a comprehensive review.

Acute cholecystitis (AC) is a common emergency condition with severity ranging from mild to severe. Gallstones and critical illnesses are the common predisposing factors. Mild AC is primarily managed with medical therapy and early cholecystectomy. Moderate and severe AC require individualized treatment with a preference for early cholecystectomy. However, cholecystectomy may not always be feasible due to co-morbidities. Hence, this group of patients needs minimally invasive methods to drain the gallbladder (GB). Percutaneous cholecystostomy (PC) is the image-guided drainage of GB in the setting of moderate to severe AC. There are different approaches to PC. The technical aspects, success, and complications of PC as well as management of cholecystostomy catheter after the patient recovers from the acute episode should be thoroughly understood by the interventional radiologist. We present an extensive up-to-date review of the essential aspects of PC including indications, contraindications, techniques, and outcomes, including complications and success rates.

The influence of the interval between percutaneous transhepatic gallbladder drainage and cholecystectomy on perioperative outcomes: a retrospective study

BackgroundPercutaneous transhepatic gallbladder drainage (PTGBD) is recommended for acute cholecystitis patients at high risk for surgical treatment. However, there is no evidence about the best timing of surgery after PTGBD. Here, we retrospectively investigated the influence of the interval between PTGBD and surgery on perioperative outcomes and examined the optimal timing of surgery after PTGBD.Methods We performed a retrospective analysis of 22 patients who underwent cholecystectomy after PTGBD from January 2008 to August 2019. We examined perioperative factors between patients with an interval of ≤ 7 days between PTGBD and cholecystectomy (≤ 7-day group; n = 12) and those with an interval of ≥ 8 days (≥ 8-day group; n = 10). Moreover, we also examined perioperative factors between patients with an interval of ≤ 14 days from PTGBD to cholecystectomy (≤ 14-day group; n = 10) and those with an interval of ≥ 15 days (≥ 15-day group; n = 12).ResultsOf the 22 patients, 9 had Grade I cholecystitis, 12 had Grade II cholecystitis, and 2 had Grade III cholecystitis. Nine patients had high-grade cholecystitis before PTGBD and 13 had a poor general condition. We examined perioperative factors between patients with an interval of ≤ 7 days between PTGBD and cholecystectomy (≤ 7-day group; n = 12) and those with an interval of ≥ 8 days (≥ 8-day group; n = 10). The C-reactive protein (CRP) level before surgery was significantly higher (12.70 ± 1.95 mg/dL vs. 1.13 ± 2.13 mg/dL, p = 0.0007) and the total hospitalization was shorter (17.6 ± 8.0 days vs. 54.1 ± 8.8 days, p = 0.0060) in the ≤ 7-day group than in the ≥ 8-day group. We also examined perioperative factors between patients with an interval of ≤ 14 days from PTGBD to cholecystectomy (≤ 14-day group; n = 14) and those with an interval of ≥ 15 days (≥ 15-day group; n = 8). The CRP level before surgery was significantly higher (11.13 ± 2.00 mg/dL vs. 0.99 ± 2.64 mg/dL, p = 0.0062) and the total hospitalization was shorter (19.5 ± 7.2 days vs. 59.9 ± 9.5 days, p = 0.0029) in the ≤ 14-day group than in the ≥ 15-day group. However, there were no significant differences between the ≤ 14-day group and the ≥ 15-day group in the levels of hepatic enzymes before surgery, adhesion grade, amount of bleeding during surgery, operative duration, frequency of surgical complications, or length of hospitalization after surgery.ConclusionsThe interval between PTGBD and surgery has little influence on perioperative outcomes.

The efficacy and safety of preoperative cholangiography via percutaneous transhepatic gallbladder drainage (PTGBD) for difficult laparoscopic cholecystectomy (LC).

Percutaneous transhepatic gallbladder drainage (PTGBD) is an important procedure for initial treatment of severe acute cholecystitis (AC) that is contraindicated for early laparoscopic cholecystectomy (LC). We presented our primary experience on a new approach of cholangiography via PTGBD (PTGBD-C) for preoperative delineation of biliary anatomy. A retrospective analysis was conducted on 93 patients who received PTGBD followed by LC for AC, with allocation into 2 groups that were PTGBD with (PTGBD-C group, 32 patients) or without (PTGBD-N group, 61 patients) cholangiography. All the clinical data, including demographics, cholangiography findings, operations, and complications, were collected and analyzed. Cholangiography was attempted in 32 patients with a success of 31 cases, and the most common complication was transient fever in 3 patients. PTGBD-C group of patients showed significantly less operation time (83.2 ± 22.32 vs. 106.5 ± 40.25 min, P = 0.041) and conversion rate (0 vs. 2). There was no statistical difference in terms of postoperative hospitalization and complications. PTGBD-C is a feasible and safe procedure for severe AC patients with delayed LC. It has advantages of direct cholangiography, being easy to perform and cost-effective, thus should be considered for clinical usage.