Optimal Timing of Cholecystectomy for Patients with Concurrent Acute Cholecystitis and Acute Cholangitis after Successful Biliary Drainage by Interventional Endoscopic Retrograde Cholangiopancreatography

Yau Ren Chang, Chi Huan Wu, Huan Wu Chen, Yu Liang Hung, Chia Hsiang Hu, Ruo Yi Huang, Min Jung Wu, Hao Wei Kou, Ming Yang Chen, Chun Yi Tsai, Shang Yu Wang*, Keng Hao Liu, Jun Te Hsu, Chun Nan Yeh, Nai Jen Liu, Yi Yin Jan

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

Abstract

Background: Concurrent acute cholecystitis and acute cholangitis is a unique clinical situation. We tried to investigate the optimal timing of cholecystectomy after adequate biliary drainage under this condition. Methods: From January 2012 to November 2017, we retrospectively screened all in-hospitalized patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and then identified patients with concurrent acute cholecystitis and acute cholangitis from the cohort. The selected patients were stratified into two groups: one-stage intervention (OSI) group (intended laparoscopic cholecystectomy at the same hospitalization) vs. two-stage intervention (TSI) group (interval intended laparoscopic cholecystectomy). Interrogated outcomes included recurrent biliary events, length of hospitalization, and surgical outcomes. Results: There were 147 patients ultimately enrolled for analysis (OSI vs. TSI, 96 vs. 51). Regarding surgical outcomes, there was no significant difference between the OSI group and TSI group, including intraoperative blood transfusion (1.0% vs. 2.0%, p = 1.000), conversion to open procedure (3.1% vs. 7.8%, p = 0.236), postoperative complication (6.3% vs. 11.8%, p = 0.342), operation time (118.0 min vs. 125.8 min, p = 0.869), and postoperative days until discharge (3.37 days vs. 4.02 days, p = 0.643). In the RBE analysis, the OSI group presented a significantly lower incidence of overall RBE (5.2% vs. 41.2%, p < 0.001) than the TSI group. Conclusions: Patients with an initial diagnosis of concurrent acute cholecystitis and cholangitis undergoing cholecystectomy after ERCP drainage during the same hospitalization period may receive some benefit in terms of clinical outcomes.

Original languageEnglish
Article number6603
JournalJournal of Clinical Medicine
Volume11
Issue number21
DOIs
StatePublished - 11 2022

Bibliographical note

Publisher Copyright:
© 2022 by the authors.

Keywords

  • ERCP
  • cholangitis
  • cholecystectomy
  • cholecystitis
  • cholecystolithiasis
  • cholelithiasis
  • endoscopic retrograde cholangiopancreatography
  • gallbladder stones
  • laparoscopic cholecystectomy

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