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      Percutaneous cholecystostomy: An update for the 2020s

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          Abstract

          Cholecystectomy is the standard treatment of acute cholecystitis. Surgery, however, poses significant risks for patients with advanced age and/or comorbid conditions. For such patients, percutaneous cholecystostomy (PC) is the only option. This interventional procedure does not have any absolute contraindications because of the life-threatening nature of the disease, in which other treatment options cannot be offered due to their risks. Nonetheless, these risk factors necessitate performing PC under urgent, rapid, and in many cases suboptimal conditions. In this article, PC was revisited in the light of our extensive experience in addition to the most current literature. Pre-procedural evaluation including the risk assessment and procedural steps was presented in detail. If conducted properly, PC provides significant clinical improvement in the short term and is life-saving, especially in the elderly and in patients with comorbid diseases or high surgical risk. It may also be the definitive treatment method for acute cholecystitis.

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          A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.

          P Pompei, M Charlson, Tippi MacKenzie … (1986)
          The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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            GRADING OF PATIENTS FOR SURGICAL PROCEDURES

            Meyer Saklad (1941)
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              Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos).

              Steven M. Strasberg, Horacio Asbun, Go Wakabayashi … (2018)
              The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians from all over the world. The 1st edition of the Tokyo Guidelines 2007 (TG07) was revised in 2013. According to that revision, the TG13 diagnostic criteria of acute cholecystitis provided better specificity and higher diagnostic accuracy. Thorough our literature search about diagnostic criteria for acute cholecystitis, new and strong evidence that had been released from 2013 to 2017 was not found with serious and important issues about using TG13 diagnostic criteria of acute cholecystitis. On the other hand, the TG13 severity grading for acute cholecystitis has been validated in numerous studies. As a result of these reviews, the TG13 severity grading for acute cholecystitis was significantly associated with parameters including 30-day overall mortality, length of hospital stay, conversion rates to open surgery, and medical costs. In terms of severity assessment, breakthrough and intensive literature for revising severity grading was not reported. Consequently, TG13 diagnostic criteria and severity grading were judged from numerous validation studies as useful indicators in clinical practice and adopted as TG18/TG13 diagnostic criteria and severity grading of acute cholecystitis without any modification. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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                Author and article information

                Journal
                Journal ID (nlm-ta): North Clin Istanb
                Journal ID (iso-abbrev): North Clin Istanb
                Title: Northern Clinics of Istanbul
                Publisher: Kare Publishing (Turkey )
                ISSN (Print): 2148-4902
                ISSN (Electronic): 2536-4553
                Publication date Collection: 2021
                Publication date (Electronic): 06 October 2021
                Volume: 8
                Issue: 5
                Pages: 537-542
                Affiliations
                [1 ]Department of Radiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
                [2 ]Department of General Surgery, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
                Author notes
                Correspondence: Gulsah YILDIRIM, MD. Saglik Bilimleri Universitesi, Istanbul Fatih Sultan Mehmet Egitim ve Arastirma Hastanesi, Genel Cerrahi Anabilim Dali, Istanbul, Turkey. Tel: +90 216 578 30 00 e-mail: dr.gulsah.yildirim@ 123456gmail.com
                Article
                Publisher ID: NCI-8-537
                DOI: 10.14744/nci.2021.81594
                PMC ID: 8630714
                PubMed ID: 34909596
                SO-VID: b786ef34-f3b5-4690-801c-abd8ab662170
                Copyright © Copyright: © 2021 by Istanbul Northern Anatolian Association of Public Hospitals
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

                History
                Date received : 01 February 2021
                Date accepted : 02 March 2021
                Categories
                Subject: Review

                Keywords: cholecystitis,cholecystostomy,gallbladder,interventional procedure
                Data availability:
                Keywords: cholecystitis, cholecystostomy, gallbladder, interventional procedure

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