Endosonography-Guided Versus Percutaneous Gallbladder Drainage Versus Cholecystectomy in Fragile Patients with Acute Cholecystitis—A High-Volume Center Study
Hayato Kurihara,
Francesca M. Bunino,
Alessandro Fugazza,
Enrico Marrano,
Giulia Mauri,
Martina Ceolin,
Ezio Lanza,
Matteo Colombo,
Antonio Facciorusso,
Alessandro Repici,
Andrea Anderloni
Affiliations
Hayato Kurihara
Emergency Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Francesca M. Bunino
Emergency Surgery and Trauma Section, Department of Surgery, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
Alessandro Fugazza
Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
Enrico Marrano
General Surgery, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain
Giulia Mauri
Emergency Surgery and Trauma Section, Department of Surgery, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
Martina Ceolin
Emergency Surgery and Trauma Section, Department of Surgery, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
Ezio Lanza
Department of Diagnostic and Interventional Radiology, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
Matteo Colombo
Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS—Humanitas Research Hospital, 20089 Rozzano, Italy
Antonio Facciorusso
Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Foggia, 71122 Foggia, Italy
Alessandro Repici
Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy
Andrea Anderloni
Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Background and Objectives: Acute cholecystitis is a frequent cause of admission to the emergency department, especially in old and frail patients. Percutaneous drainage (PT-GBD) and endosonographic guided drainage (EUS-GBD) could be an alternative option for relieving symptoms or act as a definitive treatment instead of a laparoscopic or open cholecystectomy (LC, OC). The aim of the present study was to compare different treatment groups. Materials and Methods: This is a five-year monocentric retrospective study including patients ≥65 years old who underwent an urgent operative procedure. A descriptive analysis was conducted comparing all treatment groups. A propensity score was estimated based on the ACS score, incorporated into a predictive model, and tested by recursive partitioning analysis. Results: 163 patients were included: 106 underwent a cholecystectomy (81 laparoscopic (LC) and 25 Open (OC)), 33 a PT-GBD and 21 EUS-GBD. The sample was categorized into three prognostic groups according to the adverse event occurrence rate. All patients treated with EUS-GBD or LC resulted in the low risk group, and the adverse event rate (AE) was 10/96 (10.4%). The AE was 4/28 (14.2%) and 21/36 (58.3%) in the middle- and high-risk groups respectively (p Conclusions: Surgery still represents the gold standard for AC treatment. Nevertheless, EUS-GBD is a good alternative to PT-GBD in terms of clinical success, RR and AEs in all kinds of patients.
