Highlights
- •Obstruction: 24.6, 19.2, 13.6/1000 for PTGBD, cholecystectomy, laparoscopic cholecystectomy.
- •Compared with PTGBD, HR was 0.77 and 0.57 for cholecystectomy, laparoscopic cholecystectomy.
- •Subsequent cholecystectomy could benefit with a lower risk of bowel events.
Abstract
Aims
This study aimed to evaluate the risk of bowel events among elderly patients treated
using only PTGBD (Percutaneous Gallbladder Drainage), or a cholecystectomy on its
own, or PTGBD combined with a subsequent cholecystectomy.
Methods
A retrospective population-based cohort study was conducted with newly diagnosed cholelithiasis
and cholecystitis patients who had no bowel obstruction history and were aged over
65 years during the period of January 1, 2000 to December 31, 2010. These patients
were placed into 3 separate study cohorts; PTGBD alone, cholecystectomy alone and
PTGBD with subsequent laparoscopic cholecystectomy, with the cohort frequencies matched
by age and gender. We defined the index date as the time of the initial cholelithiasis
and cholecystitis diagnosis date and began observation and suspended follow-up when
the patient had either withdrawn from their health insurance, developed bowel obstruction
or reached the date of December 31, 2011.
Results
The incidences of bowel obstruction were 24.6, 19.2 and 13.6 per 1000 person-years
for PTGBD cohort, cholecystectomy cohort and PTGBD respectively, with a subsequent
laparoscopic cholecystectomy cohort. Compared with the PTGBD cohort, (which was adjusted
for age, gender, CCI score and laparotomy history), the hazard ratio of bowel obstruction
was 0.77 (95% Confidence Interval (CI) = 0.59–1.00) and 0.57 (95% CI = 0.43–0.76)
for the cholecystectomy cohort and PTGBD with a subsequent laparoscopic cholecystectomy
cohort respectively.
Conclusion
For treatment of cholelithiasis and cholecystitis in elderly patients, PTGBD with
a subsequent cholecystectomy could benefit patients by providing a lower risk of ileus
or intestinal obstruction.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Long-term outcomes in patients with gallstones detected by mass screening.J Hepatobiliary Pancreat Sci. 2016; 23: 622-627
- Gallstones.Nat Rev Dis Primers. 2016; 216024
- A prediction rule for risk stratification of incidentally discovered gallstones: results from a large cohort study.Gastroenterology. 2016; 150: 156-167.e1
- Gallstones.BMJ. 2007; 335: 295-299
- Tokyo guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos).J Hepatobiliary Pancreat Sci. 2018; 25: 87-95
- Tokyo guidelines 2018: flowchart for the management of acute cholecystitis.J Hepatobiliary Pancreat Sci. 2018; 25: 55-72
- The natural history of gallstones: the GREPCO experience. The GREPCO group.Hepatology. 1995; 21: 655-660
- Natural history of gallstone disease: expectant management or active treatment? Results from a population-based cohort study.J Gastroenterol Hepatol. 2010; 25: 719-724
- Long-term follow-up after laparoscopic cholecystectomy.Endoscopy. 1992; 24: 754-758
- Long-term follow-up after open cholecystectomy.Br J Surg. 1993; 80: 100-102
- A randomized controlled trial to compare a restrictive strategy to usual care for the effectiveness of cholecystectomy in patients with symptomatic gallstones (SECURE trial protocol).BMC Surg. 2016; 16: 46
- Potential risk factors for postoperative complications and deaths after laparoscopic cholecystectomy in the elderly.Nihon Shokakibyo Gakkai Zasshi. 2017; 114: 1649-1657
- How safe is performing cholecystectomy in the oldest old? A 15-year retrospective study from a single institution.World J Surg. 2018; 42: 73-81
- Postoperative ileus: mechanisms and future directions for research.Clin Exp Pharmacol Physiol. 2014; 41: 358-370
- Patterns of treatment of gallstone ileus over a 45-year period.Am J Gastroenterol. 1985; 80: 95-98
- Gallstone ileus, clinical presentation, diagnostic and treatment approach.World J Gastrointest Surg. 2016; 8: 65-76
- Management of gallstones and its related complications.Expert Rev Gastroenterol Hepatol. 2016; 10: 93-112
- TG13 flowchart for the management of acute cholangitis and cholecystitis.J Hepatobiliary Pancreat Sci. 2013; 20: 47-54
- TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos).J Hepatobiliary Pancreat Sci. 2013; 20: 35-46
- Laparoscopic cholecystectomy for acute cholecystitis: early or delayed?: evidence from a systematic review of discordant meta-analyses.Medicine (Baltimore). 2016; 95: e3835
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol. 1992; 45: 613-619
- Ileus and intestinal obstruction.Nihon Rinsho. 2013; 71: 1027-1030
- Ultrasonically guided cholangiography and bile drainage.Ultrasound Med Biol. 1984; 10: 617-623
- Ultrasonically guided percutaneous transhepatic gallbladder drainage (US guided PTGBD)—method and results.Nihon Igaku Hoshasen Gakkai Zasshi. 1986; 46: 873-879
- Preceding PTGBD decreases complications of laparoscopic cholecystectomy for patients with acute suppurative cholecystitis.J Laparoendosc Surg. 1996; 6: 161-165
- Percutaneous transhepatic gallbladder drainage changes emergency laparoscopic cholecystectomy to an elective operation in patients with acute cholecystitis.J Laparoendosc Adv Surg Tech A. 2011; 21: 941-946
- Percutaneous transhepatic gallbladder drainage followed by elective laparoscopic cholecystectomy in patients with moderate acute cholecystitis under antithrombotic therapy.J Hepatobiliary Pancreat Sci. 2014; 21: 335-342
- Optimal timing for performing percutaneous transhepatic gallbladder drainage and subsequent cholecystectomy for better management of acute cholecystitis.J Hepatobiliary Pancreat Sci. 2015; 22: 855-861
- Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis.BMC Gastroenterol. 2017; 17: 71
Article info
Publication history
Published online: July 09, 2018
Accepted:
July 3,
2018
Received in revised form:
May 22,
2018
Received:
March 15,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
