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PubMed1982

Gallbladder function in the human female: effect of the ovulatory cycle, pregnancy, and contraceptive steroids.

We have previously shown that in pregnancy fasting gallbladder volume is increased and emptying after a small volume liquid meal is incomplete. In this study we measured gallbladder volume throughout day and night in healthy women ingesting regular meals. Pregnant women, postpartum women, contraceptive-steroid users, and controls in both phases of the ovulatory cycle were studied. After an overnight fast gallbladder volume was measured by realtime ultrasonography in the fasting state and every 5-10 min for 90 min after breakfast. Residual volume was the lowest volume achieved and the rate constant of gallbladder emptying was calculated from the ln/linear regression of gallbladder volume vs. time. Gallbladder volume was also measured hourly from 11 AM to midnight while subjects ate regular, standard meals, allowing the determination of an average hourly volume. There was no effect of phase of the ovulatory cycle on any measure of gallbladder function. Fasting, residual, and average hourly volume were increased in all trimesters of pregnancy, but tended to return to normal in the postpartum period. Women taking contraceptive steroids had an increased fasting volume. Two distinct rates of emptying after breakfast, an early and a late one, were identified. The early rate was the same in all groups. Pregnant women had a slower late rate of emptying, but women taking contraceptive steroids had emptying rates similar to controls. Retention of bile in the gallbladder may be one reason for the increased risk of cholesterol cholelithiasis in pregnant women and in those taking contraceptive steroids.

Adult↗

PubMed1981

Gallbladder function in experimental cholecystitis.

Experimental cholecystitis was induced by implanting gallstones from human beings into the gallbladder of the cat. Three months later the concentrating function of the gallbladder, the motility, and hepatic bile flow were studied by a perfusion technique in the anesthetized animal. Gallbladder function was correlated to morphologic changes. After 3 months, the cystic duct was patent in nine animals and bile was found in the gallbladder. In 17 animals the cystic duct was obstructed and colorless contents were found in the gallbladder. Animals with a patent cystic duct showed slight or moderate inflammation and intact concentrating activity in the gallbladder, whereas animals with obstructed animals had pronounced inflammation and continuous fluid "secretion" into the lumen. Both groups had increased bile outflow from the liver. Indomethacin, a prostaglandin synthetase inhibitor, promptly reversed gallbladder fluid "secretion" into absorption and reduced the increased bile flow to a normal level. These results are discussed in relation to clinical findings in man. A mechanism by which prostaglandins are responsible for the inflammatory gallbladder "secretion" and the increased bile flow from the liver is proposed.

Animals↗

PubMed1981

[Ultrasound measurement of gallbladder response to cholecystokinin in patients with chronic liver disease (author's transl)].

Size of gallbladder after overnight fasting and the kinetics of gallbladder contraction following i.v. injection of 1 I. U. of CCK was investigated in patients with chronic liver disease (liver cirrhosis: n = 26; chronic hepatitis: = 12; fatty liver: n = 5). The results were compared with those obtained in an age and sex matched control group of subjects without symptoms of diseases of the liver or gastrointestinal tract (n = 15). Ultrasound was used for continuous monitoring of gallbladder emptying. In the cirrhotics the cartographically determined initial area of the gallbladder was significantly greater than in the controls (p less than 0,01). The kinetic of gallbladder emptying following CCK-pancreozymin stimulation was similar in the groups of patients with liver diseases to that of the control subjects. However, the residual area of the gallbladder following maximal contraction was again significantly greater in the cirrhotics when compared to the control group (p less than 0.05). The area of the gallbladder in patients with chronic hepatitis exhibited similar changes of the values in the fasting state and after maximal contraction as seen in the patients with liver cirrhosis, although the differences when compared to the control group were not significant. The results show that in spite of distinct signs of a hypotonic state of the unstimulated gallbladder in patients with chronic liver disease the kinetic of contraction following an exogenous stimulus with CCK remains normal.

Adult↗

PubMed1993

Anomalous junction of pancreaticobiliary duct with carcinoma of the gallbladder: report of two cases.

Anomalous junction of the pancreaticobiliary duct (AJPB) is a rare, congenital anatomic abnormality of the biliary system and is thought to be associated with a high risk of developing carcinoma of the gallbladder. We have had two cases of AJPB-associated gallbladder carcinoma in the past four years. Case 1: a 42-year-old female complaining of right upper quadrant pain was found in an abdominal sonogram to have irregular thickening of the gallbladder wall. Endoscopic retrograde cholangiopancreaticography revealed an abnormally elongated common channel; an abdominal CT scan and celiac angiogram showed a gallbladder tumor with invasion to the liver base. Case 2: a 36-year-old female presented with right upper quadrant pain and a palpable mass. A gallbladder tumor was found in an abdominal sonogram. Intraoperative cholangiography showed an abnormally elongated junction of the pancreaticobiliary duct. In these two cases, adenocarcinoma of the gallbladder was proven by pathology after surgical excision. Since AJPB and bladder carcinoma are both rare, the coexistence of these two diseases indicates that patients with AJPB have a high risk of developing gallbladder carcinoma. It is suggested that patients with AJPB should be closely followed. A prophylactic cholecystectomy may be indicated in some cases because of the high risk of developing gallbladder carcinoma.

Adenocarcinoma↗

PubMed1993

[In vitro contractility of the musculature of human gallbladders with and without gallstones--relevance of the prostaglandin system for CCK regulated motoricity].

This study describes the influence of endogenous and exogenous prostaglandins upon CCK-induced motility patterns of human gallbladders with and without stones (indomethacin and nocloprost; an exogenous PGE2-analogon). From 48 gallbladders with- and 22 gallbladders without stones (control group) longitudinal muscle stripes were dissected and transferred to an organ bath and CCK, indomethacin and nocloprost dose response curves were established. In another experimental protocol, the effect of CCK after indomethacin or nocloprost preincubation is demonstrated. Moreover, specimens of gallbladders were taken for histology and gallstones for analyse. The results demonstrate that gallbladders with stones have a significant higher basic tonus and phasic activities compared to the stone-free controls. Because of these different responses to CCK, gallbladders of the stone-diseased group were divided in two groups: 64% of the gallbladders show a sensitivity and tonic response to CCK like the controls (contractors), 36% demonstrate a reduced sensitivity to CCK and only a slight tonic response (non-contractors). Indomethacin causes a fall in tonus in both stone-diseased groups. It stops spontaneous activity in the contractor and non-contractor group. With indomethacin preincubation all three groups response to CCK with a significant reduced sensitivity. CCK-induced activity is reduced in the control and contractor group. In the non-contractor group, muscle strips do not contract after indomethacin preincubation. Nocloprost induces significant contractions in the control and contractor group. In both groups, the response to CCK after nocloprost preincubation is stronger than the reaction without preincubation. In the non-contractor group, a change in tonus after nocloprost application cannot be demonstrated, there also is no response to CCK after nocloprost preincubation. These results corroborate the notion of a significant contribution of the endogenous prostaglandin system to the regulation of gallbladder motility by CCK.

Adult↗

PubMed1994

Gallbladder emptying to endogenous and exogenous stimulation in chronic pancreatitis patients.

OBJECTIVES: The present study was designed to analyze the underlying mechanism of gallbladder motor disturbance in chronic pancreatitis patients. METHODS: Gallbladder emptying to endogenous (oral test meal, Daiyan 13 g) and exogenous stimulation (iv cerulein, 30 ng/kg for 5 min) was examined by real-time ultrasonography in 12 patients with chronic pancreatitis and 10 normal subjects (controls). Plasma cholecystokinin levels during the endogenous stimulation were measured by bioassay. RESULTS: In chronic pancreatitis patients compared with controls, the fasting gallbladder volume was significantly increased (29.5 +/- 2.2 vs. 21.5 +/- 2.8 ml), whereas the gallbladder emptying (percent change of the basal volume) to oral test meal was significantly decreased. Neither cholecystokinin secretion induced by the test meal, nor the gallbladder emptying response to intravenous cerulein, differed significantly between the two groups. However, when chronic pancreatitis patients were divided according to pathogenesis, it became clear that gallbladder emptying to intravenous cerulein was significantly greater in patients with alcoholic chronic pancreatitis than in patients with idiopathic pancreatitis. CONCLUSIONS: Gallbladder emptying during the intestinal phase is generally reduced in patients with chronic pancreatitis, but gallbladder responsiveness to exogenous stimulation might be heterogeneous according to the pathogenesis.

Adult↗

PubMed1994

Effects of gastric fundusectomy and antrectomy on gallbladder epithelial proliferation in the hamster.

BACKGROUND: Exogenous administration of cholecystokinin or its analog cerulein induces epithelial hyperplasia in the mouse gallbladder. The effects on the gallbladder of resectional surgery of the stomach with hormonal consequences are not known. METHODS: The effects of gastric fundusectomy and antrectomy on proliferation and growth of the gallbladder epithelium were studied in male Syrian golden hamsters during periods of 5 and 25 days. Sham-operated animals served as controls. RESULTS: Basal plasma gastrin concentrations were significantly increased after fundusectomy and significantly decreased after antrectomy, whereas basal plasma cholecystokinin concentrations were not significantly affected. Five days after fundusectomy, there was a significant increase in the tritiated thymidine DNA labeling index of gallbladder epithelial cells. On day 25, the gallbladder weight and total number of epithelial cells were significantly increased after fundusectomy. Antrectomy significantly decreased the gallbladder weight on day 25, whereas the labeling index and total number of epithelial cells were not significantly affected on days 5 and 25. CONCLUSIONS: These results suggest that gastric fundusectomy at least transiently induces gallbladder epithelial hyperplasia and hypertrophy in the hamster. Although achlorhydria and hypergastrinemia are prominent features, the actual mechanism behind this effect of fundusectomy on the gallbladder needs further clarification.

Animals↗

PubMed1993

Ca2+ calmodulin regulates basal gallbladder absorption.

BACKGROUND: Gallbladder absorption is altered during gallstone formation, a phenomenon that may be partly the result of elevated biliary Ca2+ levels. Recent studies suggest that changes in gallbladder absorption are mediated by intracellular Ca2+ ([Ca2+]ic). However, the mechanisms by which [Ca2+]ic regulates gallbladder ion transport are not known. Calmodulin is a Ca2+ receptor protein in the Ca2+ messenger system that modulates ion transport in the small intestine. We hypothesized that Ca(2+)-calmodulin mediates the effects of [Ca2+]ic on gallbladder absorption. METHODS: Prairie dog gallbladders were mounted in Ussing chambers, and standard electrophysiologic parameters were recorded. Unidirectional Na+, Cl-, and water fluxes were measured before and after mucosal exposure to 5 x 10(-5) mol/L trifluoperazine, a potent calmodulin antagonist. In addition, the ion transport effects of increased extracellular calcium and theophylline were determined in the presence of calmodulin inhibition. RESULTS: Inhibition of calmodulin resulted in an increase in net Na+ and water absorption and converted the gallbladder from a Cl- absorptive state. Similar results were obtained during exposure to two other calmodulin antagonists that differ only in their affinity for calmodulin but not in their hydrophobicity, suggesting that the observed changes were caused by specific calmodulin inhibition. Effects of trifluoperazine were reversed by increasing luminal [Ca2+] or theophylline exposure. CONCLUSIONS: The effects of calmodulin inhibition are directly opposite of the effects of the Ca2+ ionophore. We conclude that Ca(2+)-calmodulin regulates gallbladder absorption at basal [Ca2+]ic. Further studies are needed to determine whether altered calmodulin activity is responsible for increased gallbladder absorption during gallstone formation.

Absorption↗

PubMedDate not supplied

Surgical treatment for carcinoma of the gallbladder.

Carcinoma of the gallbladder has always been associated with dismal prognosis. In this study we present single institution experience in surgical treatment for gallbladder cancer obtained during last five years. Even with recent improvement in diagnostic imaging modalities gallbladder malignancies are still diagnosed too late. The choice of operative procedure for a treatment of gallbladder carcinoma still remained the open question. Carcinoma of the gallbladder is not very common disease in Europe, but some how more common in Poland. According to the National Register, based on a study from 1991, 1863 cases of death from the gallbladder carcinomas were registered [13]. At the same time 2015 new cancer cases were diagnosed and registered. These gave us a crude rate of new cases in 1991 as follows: 2.7/100,000 man and 7.7/100,000 female. Those were even higher for some voivodeships in 1988, for example: Lódź (M = 3.95/100,000, F = 10.58/100,000) and Warsaw (M = 3.15/100,000, F = 7.59/100,000). Carcinoma of the gallbladder has always been associated with dismal prognosis. This was essentially the result of the slow and asymptomatic growth of the neoplasm that infiltrates the surrounding structures, such as the portal vein, hepatic artery and liver parenchyma, making a curative surgical treatment almost impossible. So there is a general impression that no progress has been made during last 20 years in the treatment for carcinoma of the gallbladder [2, 7, 9, 12]. However, in last years, we have observed improvements in diagnostic, surgical and intensive care techniques that allowed to offer a wider range of surgical and non-surgical options to our patients [1, 3, 4, 6, 8].(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1996

[Effects of changes of plasma motilin level on the motility of gallbladder in patients with chronic renal failure].

In order to study the relationship between plasma motilin and motility of gallbladder in patients with chronic renal failure (CRF). Gallbladder volumes were determined with ultrasound in 17 normal subjects and 22 patients with CRF. Fasting gallbladder volumes (FGVs) and postprandial residual gallbladder volumes in patients with CRF were much smaller than those of normal subjects (P < 0.01, P < 0.01). There was no significant difference of maximal percentage emptying of gallbladder between normal subjects and patients with CRF (P > 0.05). In 17 normal subjects oral erythromycin administration reduce FGVs and postprandial residual gallbladder volumes (P < 0.05, P < 0.05). In 22 patients with CRF oral erythromycin administration changed neither FGVs nor postprandial residual gallbladder volumes. Radioimmunoassay was employed to measure plasma motilin concentration. The results showed that mean level of plasma motilin of patients with CRF was much higher than that of normal subjects (P < 0.01). There was sighificant negative correlation between plasma motilin level and FGVs. It is suggested that hypermotilinemia may be one of the major reasons for motility disorder of gallbladder in patients with CRF.

Adult↗

PubMedDate not supplied

Gallbladder carcinoma: a 28 year experience.

BACKGROUND: Despite the fact that several studies have been conducted to demonstrate advancements in the treatment and prognosis of gallbladder carcinoma, no standard method of treatment has been identified or agreed upon. OBJECTIVE: The aim of this study were to review the presentation, staging, treatment and prognosis of subjects with cancer of the gallbladder at Howard University and its affiliated Institutions over the last three decades to see if there were any improvement in the survival. METHODS: A retrospective analysis of a 28 year experience at Howard University was performed. Patient gender, age, symptoms, signs, the diagnostic tests, pathology reports, operative and adjuvant treatments of each case were reviewed. A review of the English literature on the subject of gallbladder carcinoma covering the last twenty years using a Medlars search of the subject was also performed. An attempt was made to determine the utility of the various radiological tests used to diagnose and stage gallbladder, cancer. RESULTS: Patients with Stage I tumors using the Nevin classification had a 100% survival at 5 years. Patients with Stage V had 0% survival at 5 years. Stages II, III and IV had survivals of 51%, 12% and 10% respectively. The most common presenting symptom was abdominal pain which was present in 45% of cases. Gallbladder ultrasound studies had a sensitivity of 50% while the CT scanning had a sensitivity of 40% for disease detection. ERCP, when used, had a sensitivity of 75%. Radio and chemotherapy did not influence the survival of patients in this series. The most common surgical procedure performed was cholecystectomy with or without an associated hepatic resection for stage II and III, combined with adjuvant chemotherapy. CONCLUSIONS: The current prognosis of individuals with gallbladder carcinoma is dismal, nevertheless a slightly improvement over the last three decades has been achieved particularly regarding the sensitivity of the radiological tests to diagnosis GBC. Five fluorouracyl may be promising as adjuvant therapy associated with radiotherapy. Consideration should be given to a more aggressive screening with the up-to-date radiological tools, of high risk individuals and early resection of the gallbladder in high risk cases with any findings suggestive of gallbladder cancer.

Adult↗

PubMed1998

Is laparoscopic cholecystectomy hazardous for gallbladder cancer?

BACKGROUND: There have been several case reports of unexpected gallbladder cancer diagnosed after laparoscopic cholecystectomy (LC) being associated with fatal recurrence of cancer in the abdominal wall. Therefore there is a risk that LC might worsen the prognosis of gallbladder cancer. The objective of this study was to examine the frequency of recurrence of cancer in the abdominal wall and the prognosis of patients with unexpected gallbladder cancer diagnosed after LC. METHODS: A clinicopathologic study was performed on 30 patients with postoperatively diagnosed gall-bladder cancer among 3566 patients undergoing LC at 19 institutions. The cumulative survival rate was compared with that reported for gallbladder cancer diagnosed after open cholecystectomy. RESULTS: Recurrence of cancer in the abdominal wall occurred in three patients, and two of them died. The 3-year survival rate was 100% for early gallbladder cancer and 70% for advanced tumors. These results were comparable to the 3-year survival rates for gallbladder cancer diagnosed after open cholecystectomy. CONCLUSIONS: The incidence of recurrence of cancer in the abdominal wall was increased, but the medium-term prognosis was not worsened by laparoscopy. It does not appear necessary to exclude patients with cholecystitis or gallbladder wall hypertrophy from undergoing laparoscopic procedures on the grounds that they might have gallbladder cancer.

Abdominal Muscles↗

PubMed2000

Transpapillary biopsy in gallbladder disease.

BACKGROUND: Endoscopic biopsy is routine in gastrointestinal disease; similarly, histopathologic diagnosis is desirable in gallbladder disease. In this study we examined the clinical usefulness and the problems associated with transpapillary gallbladder biopsy. METHODS: Transpapillary gallbladder biopsy was attempted in 9 patients with gallbladder disease. After inserting a catheter sheath into the gallbladder using a guidewire via the transpapillary route without sphincterotomy, we inserted a biopsy forceps into the lumen of the sheath up to the gallbladder lumen and obtained specimens. RESULTS: We could obtain sufficient specimens for histopathologic diagnosis in 8 of 9 cases (88.9%). Of the 8 successful cases, targeted specimens were obtained in 7 (87.5%). Diagnostic accuracy with respect to malignant versus benign disease was 100% (2 of 2) and 83.3% (5 of 6), respectively. There were no complications. CONCLUSION: Transpapillary gallbladder biopsy is a clinically useful technique because it facilitates histopathologic diagnosis and therefore guides the choice of therapy.

Biopsy↗

PubMed2000

[Expression of p53 in gallbladder carcinoma and in dysplastic and metaplastic lesions of the surrounding mucosa].

We studied the expression of p53 in 80 gallbladder carcinomas, 43 peritumoral mucosae, 5 adenomas and 20 mucosae of non tumoral gallbladders. Gallbladder cancers were classified according to WHO criteria. We found p53 overexpression in 51 out of the 80 gallbladder cancers (64%). p53 expression was variable in different histologic subtypes: 100% of intestinal type, 66% of papillary type, 83% of adenosquamous carcinomas and 66% of giant cells cancers showed immunoreactive cells. In well and moderately differentiated conventional gallbladder adenocarcinomas we found 60% of positive cases, while, among poorly differentiated conventional cancers, 83% were immunoreactive. All mucinous adenocarcinomas were p53-negative. In peritumoral dysplastic mucosae, p53 was expressed in 23 out 38 cases (60%), 22 (96%) of which were associated to a p53-positive adenocarcinoma. On the contrary, only 5 of the 15 p53-negative dysplastic lesions (33%) were associated to an p53-immunoreactive adenocarcinoma. Metaplastic lesions, of gastric and intestinal type, and adenomas were completely p53-negative. In conclusion, our data suggest that p53 expression is an early event, frequently involved in gallbladder carcinogenesis, and related to different histologic subtypes of gallbladder adenocarcinomas.

Adenocarcinoma↗

PubMed1997

Sustained gallbladder stasis promotes cholesterol gallstone formation in the ground squirrel.

Although gallbladder stasis exists in most patients with cholesterol gallstones, it is unknown whether stasis is a causative factor of gallstone disease or merely a consequence of it. We studied the impact of sustained gallbladder stasis induced by a cholecystokinin (CCK)-A receptor antagonist (MK-329) on gallstone formation in ground squirrels fed either a trace or a high-cholesterol diet. MK-329 markedly inhibited gallbladder contraction in vitro in response to CCK (at EC100, control: 3.6 +/- 0.5 vs. MK-329: 1.1 +/- 0.3 g; P < .05) and increased gallbladder fasting volume in vivo (control: 462 +/- 66 vs. MK-329: 1,004 +/- 121 microL; P < .05). Whereas the high-cholesterol diet alone (1%-cholesterol diet + placebo) increased the cholesterol saturation index (CSI) in control animals (trace-cholesterol diet + placebo), MK-329 significantly (P < .05) decreased the CSI in both hepatic and gallbladder bile in animals on the trace-(trace-cholesterol diet + MK-329) as well as on the high-cholesterol diets (1%-cholesterol diet + MK-329). The mucin content of the mucus layer on the epithelial surface of the gallbladder wall more than doubled (P < .05) with the high-cholesterol diet; adding MK-329 to the latter group produced a further 82% increase (P < .05). The cholesterol diet + MK-329 group had the highest (100%) incidence of cholesterol crystals that were evident in fresh gallbladder bile, coincident with a shortened nucleation time (2.5 +/- 0.6 days; P < .05 vs. the cholesterol diet + placebo group, 5.8 +/- 1.0 days or the other 2 groups, >21 days). Bile from animals on the trace-cholesterol diet, whether or not receiving MK-329, lacked crystals in bile and exhibited a normal nucleation time (>21 days). Thus, stasis per se may lower the CSI, but its detrimental effect on the gallbladder predominates locally, and so accelerates cholesterol crystal formation in this model.

Animals↗

PubMed2005

Chemical ablation of the gallbladder: clinical application and long-term observations.

BACKGROUND: We investigated whether minicholecystostomy followed by chemical ablation of the gallbladder could be used as a alternative to cholecystectomy in patients at high risk for complications of surgery. METHODS: From January 1990 through January 2003, 34 patients at high risk underwent minicholecystostomy. Six weeks after the operation, microwave irradiation was provided to burn the mucosa of the cystic duct at locations at 3, 6, 9, and 12 o'clock around the orifice. Each location was treated eight times at 50 mA for 10 sec. Then chemical ablation of the gallbladder was performed by infusing 95% ethanol into the gallbladder cavity for 30 min. For each sclerosis course, the procedure was repeated every 4 h for a total of eight times. Approximately 2 weeks later, the drainage tube was removed from the gallbladder after cholecystography showed that no cavity other than the lumen of the tube remained in the gallbladder. RESULTS: Patients tolerated the procedure well and were followed with ultrasonography for 2-14 years (mean, 9). Twenty-nine patients had no complications or side effects, and five patients developed a 1.5- to 3- cm mucocele in the gallbladder. The long-term success rate of sclerotherapy was 85.3% (29/34). No recurrent cholecystitis, new stone or formation, canceration were encountered at the site of the gallbladder. CONCLUSIONS: Minicholecystostomy followed by chemical ablation of the gallbladder was a safe, effective, and simple procedure for treating high-risk patients with acute cholecystitis and/or cholelithiasis.

Aged↗

PubMed1999

Deoxycholic acid is not related to lithogenic factors in gallbladder bile.

The influence of deoxycholic acid (DCA) on the factors in gallbladder bile responsible for cholesterol gallstone disease has been a controversial subject of discussion. This might be partially due to patient selection or inappropriate methods. Therefore, we investigated the relationship between the percentage of DCA and lithogenic factors in the gallbladder bile of patients with cholesterol gallstones and with normal or moderately impaired gallbladder contractility. Patients with pigment stones served as a control group. The percentage of DCA in the gallbladder bile of 20 patients with cholesterol stones (23.2%+/-6.5%; mean+/-SD) was comparable to the DCA percentage in the gallbladder bile of 11 patients with pigment stones (26.5%+/-8.5%). No correlation was seen between the DCA percentage of total bile acids and the crystal observation time, cholesterol saturation index (CSI), total protein value, mucin level, and amount of cholesterol in vesicles or crystals in the total group of patients or in the subgroups with cholesterol or pigment stones, respectively. The lack of correlation between DCA percentage and CSI was determined in native bile (r = 0.048) as well as in crystal-free bile after ultracentrifugation (r = 0.107). Our findings demonstrate that in patients with gallstones, the percentage of DCA in gallbladder bile is not related to any of the known biliary factors associated with cholesterol gallstone disease. We conclude that in patients with normal or moderately impaired gallbladder function, an elevated DCA level in the gallbladder bile is of minor pathophysiologic significance for the formation of cholesterol gallstones.

Adult↗

PubMed2001

Treatment of acute cholecystitis in non-critically ill patients at high surgical risk: comparison of clinical outcomes after gallbladder aspiration and after percutaneous cholecystostomy.

OBJECTIVE: This study was performed to compare the clinical outcome after gallbladder aspiration with that after percutaneous cholecystostomy in non-critically ill patients with acute cholecystitis who were at high risk from surgery. MATERIALS AND METHODS: Medical records of 53 consecutive non-critically ill, high-surgical-risk patients admitted with acute cholecystitis between July 1995 and July 1999 were reviewed. Thirty-one had gallbladder aspiration and 22 had percutaneous cholecystostomy. The primary outcome measure of clinical response within 72 hr and the secondary outcome measures of overall positive response rate, complication rate, time to resolution, and rate of recurrence of acute cholecystitis were compared between the two groups. RESULTS: Gallbladder aspiration and percutaneous cholecystostomy were technically successful in 30 (97%) and 21 (97%) patients, respectively; of these, 23 (77%) and 19 (90%) patients responded clinically within 72 hr (p > 0.2). Complications occurred in three patients (12%) after percutaneous cholecystostomy and in none after gallbladder aspiration (p < 0.05). No significant difference was noted in the other secondary outcome measures of the two groups. CONCLUSION: We found no significant difference in the clinical outcomes of gallbladder aspiration and percutaneous cholecystostomy in the treatment of acute cholecystitis in high-surgical-risk patients who are not critically ill. However, we found gallbladder aspiration to be significantly safer. Therefore, gallbladder aspiration should be the procedure of choice in high-risk patients with acute cholecystitis who are not critically ill, and percutaneous cholecystectomy should be reserved as a salvage procedure if gallbladder aspiration is technically or clinically unsuccessful.

Acute Disease↗