Cholecystitis, Acute, Common Bile Duct Calculi
Conditions
Brief summary
Early laparoscopic cholecystectomy is the current standard therapy for acute cholecystitis, but temporary decompression of the gallbladder (GB) through percutaneous or endoscopic route can be required to alleviate inflammatory process and reach an appropriate time for elective surgery in patients with high operative risk or marked local inflammation or organ dysfunction. Also preoperative endoscopic retrograde cholangiopancreatography (ERCP) is often needed because common bile duct (CBD) stone is accompanied in patients with acute cholecystitis at reported rate from 7-20%. Two-steps approach of percutaneous transhepatic GB drainage (PTGBD) followed by ERCP or vice versa has been performed for the treatment of acute cholecystitis with concomitant CBD stone who are not suitable for urgent cholecystectomy. However single-step drainage of CBD and GB through ERCP and endoscopic transpapillary GB drainage (ETGD) using nasocystic tube or plastic stent has alternatively been attempted in patients who have contraindications for PTGBD. In clinical practice, many endoscopists have hesitated to perform ETGD because of its relatively low technical success rate and specific concern about post-ERCP adverse event but it minimizes catheter keeping duration, and provides effective clinical improvement via physiologic route. Currently there are scarce data on if ETGD using nasocystic tube or plastic stent are comparable in terms of clinical efficacy and safety.
Interventions
DEVICE7-Fr Pigtail type naso-cholecystic drainage tube (Liguory nasal biliary drainage set; Wilson-Cook Medical, Salem, NC, USA)
Endoscopic
DEVICE7-Fr double pigtail plastic stent (Zimmon; Wilson-Cook Medical, Salem, NC, USA)
Sponsors
Ajou University School of Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* grade II or III acute cholecystitis met Tokyo 13 diagnostic criteria * a high suspicion of CBD stone based on laboratory and imaging study * informed consent given.
Exclusion criteria
* bilo-pancreatic malignancy or surgically altered enteric anatomy * subsequent elective surgery is expected to be impossible even after GB decompression based on American Society of Anesthesiologist class
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Techncal success rate | From the time of randomization until the time when the endoscopic procedure is ended, assessed up to 24hours | This outcome was defined as successful deep GB cannulation and placement of assigned drainage device by randomization, and determined by the operator based on the fluoroscoic images of the procedures. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical success rate | From the date of randomization until the date of clinical improvement (fever, leukocytosis, abdominal pain), assessed up to 72 hours | This outcome was defined as improvement of three clinical parameters of acute cholecystitis (fever, abdominal pain, leukocytosis) within 72 hours following either type of ETGD procedure, and assessed by the review of patient's mediacal records. |
| early adverse event | From the date of the randomization until the date of the elective cholecystectomy, assessed up to 2 weeks | This outcome was defined as any procedure related event occurring between the endoscopic procedure and elective cholecystectomy, and assessed by the patient's medical records. |
Countries
South Korea
Outcome results
None listed