Management of Acute Cholecystitis in High-Risk Patients: Percutaneous Gallbladder Drainage as a Definitive Treatment vs. Emergency Cholecystectomy-Systematic Review and Meta-Analysis.
acute cholecystitis
cholecystectomy
cholecystostomy
cholecystostomy tube
gallbladder drain
gallbladder tube
laparoscopic cholecystectomy
open cholecystectomy
percutaneous cholecystectomy
severe cholecystitis
transhepatic gallbladder drain
transhepatic gallbladder tube
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
26 Jul 2023
26 Jul 2023
Historique:
received:
21
04
2023
revised:
23
07
2023
accepted:
24
07
2023
medline:
12
8
2023
pubmed:
12
8
2023
entrez:
12
8
2023
Statut:
epublish
Résumé
This systematic review aims to investigate whether percutaneous transhepatic gallbladder biliary drainage (PTGBD) is superior to emergency cholecystectomy (EC) as a definitive treatment in high-risk patients with acute cholecystitis (AC). A systematic literature search was performed until December 2022 using the Scopus, Medline/PubMed and Web of Science databases. Seventeen studies have been included with a total of 783,672 patients (32,634 treated with PTGBD vs. 4663 who underwent laparoscopic cholecystectomy, 343 who had open cholecystectomy and 746,032 who had some form of cholecystectomy, but without laparoscopic or open approach being specified). An analysis of the results shows that PTGBD, despite being less invasive, is not associated with lower morbidity with respect to EC (RR 0.77 95% CI [0.44 to 1.34]; I In our systematic review, the majority of studies have very low-quality evidence and more RCTs are needed; furthermore, PTGBD is inferior in the treatment of AC in high-risk patients. The definition of high-risk patients is important in interpreting the results, but the methods of assessment and definitions differ between studies. The results of our systematic review and meta-analysis failed to demonstrate any advantage of using PTGBD over ER as a definitive treatment of AC in critically ill patients, which suggests that EC should be considered as the treatment of choice even in very high-risk patients. Most likely, the inferiority of PTGBD versus early LC for high-risk patients is related to an association of various patient-side factor conditions and the severity of acute cholecystitis.
Sections du résumé
BACKGROUND
BACKGROUND
This systematic review aims to investigate whether percutaneous transhepatic gallbladder biliary drainage (PTGBD) is superior to emergency cholecystectomy (EC) as a definitive treatment in high-risk patients with acute cholecystitis (AC).
MATERIAL AND METHODS
METHODS
A systematic literature search was performed until December 2022 using the Scopus, Medline/PubMed and Web of Science databases.
RESULTS
RESULTS
Seventeen studies have been included with a total of 783,672 patients (32,634 treated with PTGBD vs. 4663 who underwent laparoscopic cholecystectomy, 343 who had open cholecystectomy and 746,032 who had some form of cholecystectomy, but without laparoscopic or open approach being specified). An analysis of the results shows that PTGBD, despite being less invasive, is not associated with lower morbidity with respect to EC (RR 0.77 95% CI [0.44 to 1.34]; I
CONCLUSIONS
CONCLUSIONS
In our systematic review, the majority of studies have very low-quality evidence and more RCTs are needed; furthermore, PTGBD is inferior in the treatment of AC in high-risk patients. The definition of high-risk patients is important in interpreting the results, but the methods of assessment and definitions differ between studies. The results of our systematic review and meta-analysis failed to demonstrate any advantage of using PTGBD over ER as a definitive treatment of AC in critically ill patients, which suggests that EC should be considered as the treatment of choice even in very high-risk patients. Most likely, the inferiority of PTGBD versus early LC for high-risk patients is related to an association of various patient-side factor conditions and the severity of acute cholecystitis.
Identifiants
pubmed: 37568306
pii: jcm12154903
doi: 10.3390/jcm12154903
pmc: PMC10419867
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Références
J Am Coll Surg. 2010 May;210(5):668-77, 677-9
pubmed: 20421027
Surg Laparosc Endosc Percutan Tech. 2022 Jun 01;32(3):342-349
pubmed: 35258017
HPB (Oxford). 2009 May;11(3):183-93
pubmed: 19590646
ANZ J Surg. 2010 Apr;80(4):280-3
pubmed: 20575957
Medicina (Kaunas). 2021 Mar 02;57(3):
pubmed: 33801408
J Gastrointest Surg. 2020 Nov;24(11):2579-2586
pubmed: 31792903
Ann Surg. 2013 Jun;257(6):1112-5
pubmed: 23263191
Scand J Gastroenterol. 2008;43(5):593-6
pubmed: 18415753
JSLS. 2019 Jan-Mar;23(1):
pubmed: 30675093
ScientificWorldJournal. 2014;2014:274516
pubmed: 25133217
J Gastrointest Surg. 2015 May;19(5):848-57
pubmed: 25749854
Langenbecks Arch Surg. 2001 Apr;386(3):212-7
pubmed: 11382324
J Gastrointest Surg. 2019 Mar;23(3):503-509
pubmed: 30225792
J Surg Res. 2014 Aug;190(2):517-21
pubmed: 24679697
Pol Przegl Chir. 2021 Oct 20;93(0):7-12
pubmed: 35384856
Am J Surg. 2012 Jul;204(1):54-9
pubmed: 22000114
Surgeon. 2023 Aug;21(4):e201-e223
pubmed: 36577652
BMJ. 2021 Mar 29;372:n71
pubmed: 33782057
Am J Surg. 2008 Jan;195(1):40-7
pubmed: 18070735
Eur Rev Med Pharmacol Sci. 2017 Oct;21(20):4668-4674
pubmed: 29131247
Surg Laparosc Endosc Percutan Tech. 2014 Apr;24(2):187-91
pubmed: 24686358
BMC Surg. 2017 Dec 07;17(1):130
pubmed: 29212485
Surg Endosc. 2017 Apr;31(4):1707-1712
pubmed: 27519595
Am J Surg. 2019 Jan;217(1):83-89
pubmed: 30392677
Arch Surg. 2012 May;147(5):416-22
pubmed: 22785633
Trauma Surg Acute Care Open. 2019 Mar 27;4(1):e000281
pubmed: 31058240
BMJ. 2018 Oct 8;363:k3965
pubmed: 30297544
J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):55-72
pubmed: 29045062
South Med J. 2008 Jun;101(6):586-90
pubmed: 18475218
JAMA. 2022 Mar 8;327(10):965-975
pubmed: 35258527
World J Emerg Surg. 2016 Jun 14;11:25
pubmed: 27307785
BMJ. 2016 Oct 12;355:i4919
pubmed: 27733354
Surg Today. 2005;35(7):553-60
pubmed: 15976952
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD006231
pubmed: 17054285
J Minim Access Surg. 2011 Jul;7(3):165-8
pubmed: 22022097
Surg Endosc. 2013 Sep;27(9):3406-11
pubmed: 23549767
Surg Laparosc Endosc Percutan Tech. 2014 Dec;24(6):523-7
pubmed: 24710246
World J Surg. 2011 Apr;35(4):826-33
pubmed: 21318431
Surg Endosc. 2012 May;26(5):1343-51
pubmed: 22089258
Am J Surg. 2018 Jul;216(1):116-119
pubmed: 29128102
Cochrane Database Syst Rev. 2013 Jun 30;(6):CD005440
pubmed: 23813477
Br J Surg. 1983 Mar;70(3):163-5
pubmed: 6338991
BMJ. 2019 Aug 28;366:l4898
pubmed: 31462531
Br J Surg. 2015 Oct;102(11):1302-13
pubmed: 26265548
Am J Surg. 2013 Dec;206(6):935-40; discussion 940-1
pubmed: 24112675
Am J Surg. 1989 Sep;158(3):174-8
pubmed: 2672837
Front Surg. 2021 Apr 15;8:616320
pubmed: 33937313
Surg Endosc. 2017 Nov;31(11):4568-4575
pubmed: 28409378
World J Emerg Surg. 2020 Nov 5;15(1):61
pubmed: 33153472
Ann R Coll Surg Engl. 2018 Oct 5;:1-14
pubmed: 30286647
Proc R Soc Med. 1975 Nov;68(11):676-8
pubmed: 1105588
Am Surg. 2018 Mar 1;84(3):438-442
pubmed: 29559062
Front Digit Health. 2022 Sep 15;4:845453
pubmed: 36339515
Ulus Travma Acil Cerrahi Derg. 2020 Dec;27(1):89-94
pubmed: 33394477
HPB (Oxford). 2015 Apr;17(4):326-31
pubmed: 25395238
Am J Surg. 2018 Sep;216(3):595-603
pubmed: 29429546
Surgery. 2014 Apr;155(4):615-22
pubmed: 24548617