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Natural Course of Acute Cholecystitis in Patients Treated With Percutaneous Transhepatic Gallbladder Drainage Without Elective Cholecystectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative treatment for acute cholecystitis (AC). We aimed to understand the natural course of AC in patients treated with PTGBD but without later definitive treatments, such as laparoscopic cholecystectomy.

Methods

This was a retrospective study of the period from June 2010 to December 2016, during which time 2371 patients were diagnosed with AC and 625 received PTGBD treatment. Among the 625 patients, 237 received no definitive treatment. A biliary event after the initial AC episode was the outcome of interest. In addition, the competing risk of death unrelated to biliary causes was present in the cohort. Therefore, a competing risk model was applied for analysis.

Results

The cumulative incidence of biliary events was 29.8% with a median of 4.27 months, while the competing event, i.e., death unrelated to a biliary event, was noted in 14.9% of patients with a median 23.54 months. The risk factors of biliary events were prolonged PTGBD indwelling and an abnormal PTGBD cholangiogram. The risk factors of death unrelated to a biliary event included a high Charlson comorbidity index and the initial AC severity.

Conclusions

Definitive cholecystectomy is still recommended for patients undergoing PTGBD treatment due to the high incidence of later biliary events. A thorough preoperative evaluation is necessary for those patients before elective cholecystectomy because of the inferior life expectancy and physical status.

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Acknowledgments

We would like to thank the CGMH Acute Abdomen Database organization and database managers, Shu-Ping Liao, Ching-Hua Hsu, Chun-Ju Chen, Fen-Ping Kao, and Hui-Chen Tien.

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Author notes

  1. Yu-Liang Hung and Sio-Wai Chong contributed equally to this work.

Authors and Affiliations

  1. School of Traditional Chinese Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China

    Yu-Liang Hung

  2. Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China

    Sio-Wai Chong, Ta-Sen Yeh, Chun-Nan Yeh & Yi-Yin Jan

  3. Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China

    Chi-Tung Cheng, Chien-Hung Liao, Chih-Yuan Fu, Chi-Hsun Hsieh & Shang-Yu Wang

  4. Graduate Institute of Clinical Medical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China

    Shang-Yu Wang

  5. School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Republic of China

    Shang-Yu Wang

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  1. Yu-Liang Hung
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Contributions

Data acquisition: YL Hung and SW Chong. Manuscript drafting: YL Hung and SY Wang. Figure and table preparation: CH Liao, CT Cheng, and CY FU. Statistical analysis: SY Wang. Manuscript structuring: CN Yeh, TS Yeh, and YY Jan. Final approval: SY Wang and CH Hsieh.

Corresponding author

Correspondence to Shang-Yu Wang.

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The Institutional Review Board of CGMH approved the study.

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The authors declare that they have no conflicts of interest.

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Hung, YL., Chong, SW., Cheng, CT. et al. Natural Course of Acute Cholecystitis in Patients Treated With Percutaneous Transhepatic Gallbladder Drainage Without Elective Cholecystectomy. J Gastrointest Surg 24, 772–779 (2020). https://doi.org/10.1007/s11605-019-04213-0

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