REGULAR CONTENT
Final ID
630
Type
Educational Exhibit-Poster Only
Authors
D Gans1, J Davidson1, C Sutter1, S Tavri1, E McLoney1, I Patel1
Institutions
1University Hospitals - Cleveland Medical Center, Cleveland, OH
Purpose
-Review acute calculous and acalculous cholecystitis, its pathophysiology, and morbidity/mortality-Discuss clinical assessment tools and the Tokyo guidelines, a severity grading system-Discuss the treatment options, including a historical perspective, current therapies, and future perspectives-Discuss treatment algorithms and the best clinical setting for percutaneous cholecystostomy
Materials & Methods
Acute calculous cholecystitis carries a mortality risk of 12% in patients older than 80 years, and acute acalculous cholecystitis carries a mortality risk of 41%, irrespective of age (1,2). Additionally, acute acalculous cholecystitis is most commonly seen in already critically ill patients, complicating the situation. Urgent therapy is therefore indicated, although determining the optimal therapy is not always clear. We aim to discuss current treatment options and their outcomes, algorithms to choose the best therapy, and future perspectives.
Results
Main therapeutic options include medical therapy/observation, 'early' laparoscopic cholecystectomy (LC) (during first presenting admission), and percutaneous cholecystostomy (PC) with or without delayed LC (6-12 weeks after initial nonoperative management). The Tokyo guidelines (3) is a severity grading system largely based on lab values, physical exam findings, and vital signs. Treatment algorithms based on this grading system have since been developed.Although LC and PC are currently the main interventions for acute cholecystitis, new minimally invasive therapies are being developed, including natural orifice transluminal endoscopic surgery (NOTES) and peroral endoscopic transpapillary/transmural drainage (4,5).
Conclusions
Acute cholecystitis is a potentially lethal condition, especially acalculous cholecystitis, requiring urgent therapy. The best therapy is not always clear, although clinical assessment can help lead to the best option.
Final ID
630
Type
Educational Exhibit-Poster Only
Authors
D Gans1, J Davidson1, C Sutter1, S Tavri1, E McLoney1, I Patel1
Institutions
1University Hospitals - Cleveland Medical Center, Cleveland, OH
Purpose
-Review acute calculous and acalculous cholecystitis, its pathophysiology, and morbidity/mortality-Discuss clinical assessment tools and the Tokyo guidelines, a severity grading system-Discuss the treatment options, including a historical perspective, current therapies, and future perspectives-Discuss treatment algorithms and the best clinical setting for percutaneous cholecystostomy
Materials & Methods
Acute calculous cholecystitis carries a mortality risk of 12% in patients older than 80 years, and acute acalculous cholecystitis carries a mortality risk of 41%, irrespective of age (1,2). Additionally, acute acalculous cholecystitis is most commonly seen in already critically ill patients, complicating the situation. Urgent therapy is therefore indicated, although determining the optimal therapy is not always clear. We aim to discuss current treatment options and their outcomes, algorithms to choose the best therapy, and future perspectives.
Results
Main therapeutic options include medical therapy/observation, 'early' laparoscopic cholecystectomy (LC) (during first presenting admission), and percutaneous cholecystostomy (PC) with or without delayed LC (6-12 weeks after initial nonoperative management). The Tokyo guidelines (3) is a severity grading system largely based on lab values, physical exam findings, and vital signs. Treatment algorithms based on this grading system have since been developed.Although LC and PC are currently the main interventions for acute cholecystitis, new minimally invasive therapies are being developed, including natural orifice transluminal endoscopic surgery (NOTES) and peroral endoscopic transpapillary/transmural drainage (4,5).
Conclusions
Acute cholecystitis is a potentially lethal condition, especially acalculous cholecystitis, requiring urgent therapy. The best therapy is not always clear, although clinical assessment can help lead to the best option.