Current role of percutaneous transhepatic gallbladder aspiration: from palliative to curative management for acute cholecystitis

Background The present study assessed conservative management of acute cholecystitis (AC) with a focus on percutaneous transhepatic gallbladder aspiration (PTGBA). Methods Consecutive 275 patients with AC who underwent PTGBA were reviewed. Patients aged ≥80 years and/or with American Society of Anes...

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Published in:Journal of hepato-biliary-pancreatic sciences 2016-11, Vol.23 (11), p.708-714
Main Authors: Komatsu, Shohei, Tsuchida, Shinobu, Tsukamoto, Tadashi, Wakahara, Tomoyuki, Ashitani, Hiroshi, Ueno, Nozomi, Toyokawa, Akihiro, Watanabe, Akihiko, Sugahara, Atsushi, Mukai, Hidekazu
Format: Article
Language:English
Subjects:
Acute cholecystitis
Aged
Aged, 80 and over
Cholecystectomy, Laparoscopic - methods
Cholecystitis, Acute - diagnosis
Cholecystitis, Acute - surgery
Cohort Studies
Conservative Treatment
Elective cholecystectomy
Female
Follow-Up Studies
Gallbladder
Gallbladder diseases
Humans
Male
Middle Aged
Palliative Care - methods
Percutaneous transhepatic gallbladder aspiration
Retrospective Studies
Risk Assessment
Role
Severity of Illness Index
Suction - methods
Surgery
Treatment Outcome
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Summary:Background The present study assessed conservative management of acute cholecystitis (AC) with a focus on percutaneous transhepatic gallbladder aspiration (PTGBA). Methods Consecutive 275 patients with AC who underwent PTGBA were reviewed. Patients aged ≥80 years and/or with American Society of Anesthesiologists score III to IV and/or performance status 3 to 4 were defined as high risk. Patients were classified according to duration from symptom onset to first PTGBA: within 3 days (early PTGBA) or over 3 days (late PTGBA). They were also classified according to duration from first PTGBA to surgery: within 30 days (early surgery) or over 30 days (late surgery). Results A total of 263 patients (95.6%) showed recovery after PTGBA. There were no significant differences in operating time, blood loss, operating procedure, conversion rate to open surgery, postoperative complications, or postoperative hospital stay between the early and late PTGBA groups or between the early and late surgery groups. No significant complications associated with PTGBA or surgery were observed, including in those at high risk. Conclusions Percutaneous transhepatic gallbladder aspiration can be a useful alternative for most patients with AC, including those at high risk. Elective cholecystectomy can be performed safely regardless of the timing of PTGBA or surgery. Highlight Komatsu and colleagues evaluated the safety and efficacy of percutaneous transhepatic gallbladder aspiration (PTGBA) in the management of acute cholecystitis. PTGBA is a useful alternative for most patients with acute cholecystitis, including those at high risk, and elective cholecystectomy can be performed safely regardless of the timing of PTGBA or surgery.
ISSN:1868-6974
1868-6982
DOI:10.1002/jhbp.394