Study on effects of percutaneous transhepatic gallbladder drainage in treatment of acute biliary pancreatitis

doi:10.16139/j.1007-9610.2023.03.014

Abstract

Abstract:

Objective To evaluate retrospectively the clinical efficacy of percutaneous transhepatic gallbladder drainage (PTGBD) in the patients with acute biliary pancreatitis (ABP). Methods A total of 244 patients with ABP recei-ving treatment in our department from January 2014 to November 2021 were included in this study. There were 76 cases in study group using PTGBD treatment, among them, 41 cases with performed endoscopic retrograde cholangiopancreatography (ERCP) after symptoms remission, and 168 cases without PTGBD in control group with 49 cases using ERCP and 119 cases with conservative treatment. The rate of post-ERCP pancreatitis (PEP) and postoperative adverse events were compared between two groups. Results The rate of PEP was significantly lower in study group (11/41) than in control group (23/49), 26.8% vs.46.9%, P=0.008. The patients in both groups were performed cholecystectomy or cholecystectomy with bile duct drainage in late stage (73 cases in study group and 152 cases in control group). The shorter operative time [(76.3±28.3) min vs.(121.6±34.9) min, P=0.011], less intraoperative blood loss [(65.7±27.6) mL vs. (99.2±60.3) mL, P=0.028], shorter abdominal drainage duration [(3.6±2.5) d vs. (8.9±4.9) d, P=0.016] in study group than in control group. The rate of postoperative sepsis [2.7% (2 cases) vs. 5.3% (8 cases), P=0.003], rate of reoperation [1.4%(1 case) vs. 3.9%(6 cases), P<0.001], rate of admission to intensive care unit [4.1%(3 cases) vs. 7.2%(11 cases), P=0.028], and mortality [0 vs. 1.3% (2 cases), P<0.001] in study group were lower than those in control group. Conclusions PTGBD could be simple and effective in the treatment of ABP and consistent with treatment of damage control surgery which should be worthy clinical application.

Key words: Acute biliary pancreatitis, Percutaneous transhepatic gallbladder drainage, Adverse event

CLC Number:

ZHANG Zhen, HAN Jinyan, YU Xiaopeng, DENG Tianlin, WU Xiaodong, WU Shuodong. Study on effects of percutaneous transhepatic gallbladder drainage in treatment of acute biliary pancreatitis[J]. Journal of Surgery Concepts & Practice, 2023, 28(03): 260-266.

Figures/Tables 3

Tab 1

Tab 2

Tab 3

References 29

[13]	CHEN Q, JIN P, JI X, et al. Management of difficult or failed biliary access in initial ERCP: a review of current literature[J]. Clin Res Hepatol Gastroenterol, 2019, 43(4):365-372. doi: 10.1016/j.clinre.2018.09.004 URL
[14]	KÜHN J P, BUSEMANN A, LERCH M M, et al. Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts compared with patients with dilated intrahepatic bile ducts[J]. Am J Roentgenol, 2010, 195(4):851-857. doi: 10.2214/AJR.09.3461 URL
[15]	DEBENEDET A T, ELMUNZER B J, MCCARTHY S T, et al. Intraprocedural quality in endoscopic retrograde cholangiopancreatography: a meta-analysis[J]. Am J Gastroentrol, 2013, 108(11):1696-1704. doi: 10.1038/ajg.2013.217 URL
[16]	SHENOY S M, SHENOY S, GOPAL S, et al. Clinicomicrobiological analysis of patients with cholangitis[J]. Indian J Med Microbiol, 2014, 32(2):157-160. doi: 10.4103/0255-0857.129802 URL
[17]	BAI Y, GAI F, GAO J, et al. Prophylactic antibiotics cannot prevent endoscopic retrograde cholangiopancreato-graphy-induced cholangitis: a meta-analysis[J]. Pancreas, 2009, 38(2):126-130. doi: 10.1097/MPA.0b013e318189fl6d URL
[18]	MASCI E, TOTI G, MARIONA A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study[J]. Am J Gastroenterol, 2001, 96(2):417-423. doi: 10.1111/j.1572-0241.2001.03594.x URL
[19]	MUANGKAEW P, KAMALAPORN P, MINGPHRUEDHI S, et al. Outcomes of delayed endoscopic retrograde cho-langiopancreatography in patients with acute biliary pancreatitis with cholangitis[J]. Asian J Surg, 2020, 43(9):913-918. doi: 10.1016/j.asjsur.2019.11.011 URL
[20]	MUKAI S, ITOI T, TSUCHIYA T, et al. Urgent and emergency endoscopic retrograde cholangiopancreatography for gallstone-induced acute cholangitis and pancreatitis[J]. Dig Endosc, 2023, 35(1):47-57. doi: 10.1111/den.v35.1 URL
[21]	BANKS P A, BOLLEN T L, DERVENIS C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62(1):102-111. doi: 10.1136/gutjnl-2012-302779 URL
[22]	SCHEPERS N J, HALLENSLEBEN N D L, BESSELINK M G, et al. Urgent endoscopic retrograde cholangiopancreatography with sphincterotomy versus conservative treatment in predicted severe acute gallstone pancreatitis (APEC): a multicentre randomised controlled trial[J]. Lancet, 2020, 396(10245):167-176. doi: 10.1016/S0140-6736(20)30539-0 URL
[23]	YANG J P, TIAN Z. Analysis of the effect of laparoscopic cholecystectomy for acute cholecystitis after percuta-neous transhepatic gallbladder puncture and drainage[J]. Evid Based Complementary Altern Med, 2022, 2022:2071326.
[24]	YU B R, ZHI X T, LI Q, et al. The efficacy and safety of preoperative cholangiography via percutaneous transhepatic gallbladder drainage (PTGBD) for difficult laparoscopic cholecystectomy (LC)[J]. Surg Endosc, 2022, 36(2):1355-1361. doi: 10.1007/s00464-021-08414-0
[25]	SEE T C. Acute biliary interventions[J]. Clin Radiol, 2020, 75(5):398.e9-398.e18. doi: 10.1016/j.crad.2020.11.041 URL
[26]	LI Y L, WONG K H, CHIU K W, et al. Percutaneous cholecystostomy for high-risk patients with acute cholangitis[J]. Medicine(Baltimore), 2018, 97(19):e0735.
[27]	YU W, LI W, WANG Z, et al. Early percutaneous transhepatic gallbladder drainage compared with endoscopic retrograde cholangiopancreatography and papillotomy treatment for severe gallstone associated acute pancreatitis[J]. Postgrad Med J, 2007, 83(977):187-191. doi: 10.1136/pgmj.2006.047746 URL
[28]	KUCSERIK L P, MÁRTA K, VINCZE Á, et al. Endoscopic sphincterotomy for delaying cholecystectomy in mild acute biliarry pancreatitis (EMILY study): protocol of a multicentre randomized clinical trial[J]. BMJ Open, 2019, 9(7):e02555.
[1]	LOWENFELS A B, LANKISCH P G, MAISONNEUVE P. What is the risk of biliary pancreatitis in patients with gallstones[J]. Gastroenterology, 2000, 119(3):879-880.
[2]	毛恩强, 李兆申. 急性胰腺炎病因诊断与分类的再认识[J]. 中华胰腺病杂志, 2019, 19 (6):401-403.
	MAO E Q, LI Z S. Re-recognition of the etiological diagnosis and classification for acute pancreatitis[J]. Chin J Pancreatology, 2019, 19(6):401-403.
[3]	MAURER L R, MAATMAN T K, LUCKHURST C M, et al. Risk of gallstone-related complications in necrotizing pancreatitis patients treated with a step-up approach: the experience of two tertiary care centers[J]. Surgery, 2021, 169(5):1086-1092. doi: 10.1016/j.surg.2020.11.002 URL
[4]	NITSCHE C, MAERTIN S, SCHEIBER J, et al. Drug-induced pancreatitis[J]. Curr Gastroenterol Rep, 2012, 14(2):131-138. doi: 10.1007/s11894-012-0245-9 URL
[5]	SADR-AZODI O, ANDRÉN-SANDBERG Å, ORSINI N, et al. Cigarette smoking, smoking cessation and acute pancreatitis: a prospective population-based study[J]. Gut, 2012, 61(2):262-267. doi: 10.1136/gutjnl-2011-300566 URL
[6]	GARCÍA DE LA FILIA MOLINA I, GARCÍA GARCÍA DE PAREDES A, MARTÍNEZ ORTEGA A, et al. Biliary sphincterotomy reduces the risk of acute gallstone pancreatitis recurrence in non-candidates for cholecystectomy[J]. Dig Liver Dis, 2019, 51(11):1567-1573. doi: 10.1016/j.dld.2019.05.007 URL
[7]	杨玉龙. 从胆胰管汇合部疾病角度分析和认识急性胆源性胰腺炎及治疗[J]. 外科理论与实践, 2020, 25(6):456-459.
	YANG Y L. Treatment of acute biliary pancreatitis induced by biliary-pancreatic confluence disease[J]. J Surg Concepts Pract, 2020, 25(6):456-459.
[8]	LEPPÄNIEMI A, TOLONEN M, TARASCONI A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis[J]. World J Emerg Surg,2019, 14(1):27. doi: 10.1186/s13017-019-0247-0
[9]	LEE P J, PAPACHRISTOU G I. New insights into acute pancreatitis[J]. Nat Rev Gastroenterol Hepatol, 2019, 16(8):479-496. doi: 10.1038/s41575-019-0158-2
[10]	TSE F, YUAN Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis[J]. Cochrane Database Syst Rev, 2012, 16(5):CD009779.
[11]	SCHULZ C, SCHIRRA J, MAYERLE J. Indications for endoscopic retro-grade cholangiopancreatography and cholecystectomy in biliary pancreatitis[J]. Br J Surg, 2020, 107(1):11-13. doi: 10.1002/bjs.11402 URL
[12]	SVATOŇ R, KALA Z, NOVOTNÝ I, et al. The timing of ERCP in acute biliary pancreatitis[J]. Rozhl Chir, 2019, 98(1):10-13.
[29]	KIRIYAMA S, KOZAKA K, TAKADA T, et al. Tokyo guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)[J]. J Hepatobiliary Pancreat Sci, 2018, 25(1):17-30. doi: 10.1002/jhbp.2018.25.issue-1 URL