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ECR 2019 / C-1666
Cholecystectomy or percutaneous cholecystostomy as treatment for acute acalculous cholecystitis: 12 years of experience
Congress: ECR 2019
Poster No.: C-1666
Type: Scientific Exhibit
Keywords: Biliary Tract / Gallbladder, Interventional non-vascular, Emergency, Percutaneous, Ultrasound, Catheters, Drainage, Surgery, Infection, Inflammation, Outcomes
Authors: I. Vicente Zapata, D. Flores Funes, A. Blanco Barrio, J. F. Sánchez Melgarejo; Murcia/ES
DOI:10.26044/ecr2019/C-1666

Methods and materials

Patient population

We carried out a retrospective matched cohort study of84 patients who had AAC between 2004 and 2016(Fig. 4). 

For the diagnosis of AAC, compatible clinical and laboratory findings are needed, as well as an image study, usually ultrasound, to confirm this. If there are doubts, a CT scan can be performed.

The ultrasonographic signs of AAC measured are (Fig. 5):

•       - Absence of gallstones

•       - Enlargement

•       - Wall thickening > 3 mm and doppler signal increase.

•       - Sonographic Murphy’s sign

•       - Pericholecystic fluid/fat alteration

In this series of patients, we assessed how many had been treated with cholecystectomy (open or laparoscopic) and how many had received a conservative treatment (cholecystostomy or antiobiotics). We performed a bivariate analysis of the results.

 

In the study we included patients with clinical AAC, confirmed with imaging techniques, who did not have gallstones at ultrasound study or surgery.

We excluded patients with gallbladder sludge and pancreatitis. (Fig. 6)

 

Technique(Fig. 7)

Cholecystectomies were open or laparoscopic

Cholecystostomies were guided by ultrasound using the modified seldinger technique y following the protocol in Fig. 7.

The coagulation standards that must be met are: INR < 1.5, 50,000/mm3 platelet count and PT > 60%.

The material that we used: local anesthetic, Coaxial needle 17G, Guidewire  and Catheter 8F.

 

Data analysis(Fig. 8)

The analysis of the data was carried out by 3 residents. We evaluated the following variables in the image storage system and in the patient's clinical history: 

-      - Admission variables: Treatment, length of Hospital Stay (LHS), ICU admission, Clavien-Dindo, Reintervention and Mortality.

-      - Baseline characteristics: Age, Sex, Charlson Comorbidity Index (CCI) and ASA score.

-      - Discharge variables: Readmission < 30 days and elective cholecystectomy.

 

Statistical analysis(Fig. 9)

 

We performed a bivariate statistical analysis using T student, Anova, Mann-Whitney U, Kruskal Wallis, Chi 2 and Linear-by-linear association tests. We established the statistical significance in P < 0.05

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