The Experts below are selected from a list of 8565 Experts worldwide ranked by ideXlab platform
Wallace Arneson - One of the best experts on this subject based on the ideXlab platform.
-
is hepato imino diacetic acid scan a better imaging modality than abdominal ultrasound for diagnosing Acute Cholecystitis
American Journal of Surgery, 2015Co-Authors: Christodoulos Kaoutzanis, Eric Davies, Stefan W Leichtle, Kathleen B Welch, Suzanne Winter, Richard M Lampman, Michael G Franz, Wallace ArnesonAbstract:Abstract Background The role of hepato-imino diacetic acid scan (HIDA) in the diagnosis of Acute Cholecystitis remains controversial when compared with the more commonly used abdominal ultrasound (AUS). Methods The diagnostic imaging workup of 1,217 patients who presented to the emergency department at a single hospital with Acute abdominal pain and suspicion of Acute Cholecystitis was reviewed to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AUS and HIDA. Results In patients undergoing both imaging modalities, HIDA had significantly higher sensitivity (90.7% vs 64.0%, P P = .005) than AUS for the diagnosis of Acute Cholecystitis. Additionally, PPV and NPV of HIDA (56.2% and 95.0%, respectively) were higher than PPV and NPV of AUS (38.4% and 80.0%, respectively) when both imaging modalities were used for the same patient. Conclusion In adults with Acute abdominal pain, HIDA significantly increases the accuracy of the correct diagnosis.
-
abdominal ultrasound versus hepato imino diacetic acid scan in diagnosing Acute Cholecystitis what is the real benefit
Journal of Surgical Research, 2014Co-Authors: Christodoulos Kaoutzanis, Eric Davies, Stefan W Leichtle, Kathleen B Welch, Suzanne Winter, Richard M Lampman, Wallace ArnesonAbstract:Background Acute Cholecystitis is one of the most common surgical problems, yet substantial debate remains over the utility of simple examination, abdominal ultrasound (AUS), or advanced imaging such as hepato-imino diacetic acid (HIDA) scan to support the diagnosis. Materials and methods The preoperative diagnostic workup of patients who underwent cholecystectomy with histologically confirmed Acute Cholecystitis was reviewed to calculate the sensitivity of AUS, HIDA scan, or both. In addition, the sensitivity of the commonly described ultrasonographic findings was assessed. Results From 2010 through 2012, 406 patients among 9087 reviewed charts presented to the emergency department with Acute upper abdominal pain and met inclusion criteria. 32.5% (N = 132) of patients underwent AUS only, 11.3% (N = 46) underwent HIDA scan only, and 56.2% (N = 228) had both studies performed for workup. 52.7% (N = 214) of patients had histopathologically confirmed Acute Cholecystitis. The sensitivities of AUS, HIDA, and AUS combined with HIDA for Acute Cholecystitis were 73.3% (95% confidence interval [CI] = 66.3%–79.5%), 91.7% (95% CI = 86.2%–95.5%), and 97.7% (95% CI = 93.4%–99.5%), respectively. Although of limited sensitivity, AUS findings of sonographic Murphy sign, gallbladder distension, and gallbladder wall thickening were associated with a diagnosis of Acute Cholecystitis. Conclusions The sensitivity of AUS for diagnosing Acute Cholecystitis in patients with Acute upper abdominal pain is limited. The addition of a HIDA scan in the diagnostic workup significantly improves sensitivity and can add valuable information in the appropriate clinical setting.
Michael R Cox - One of the best experts on this subject based on the ideXlab platform.
-
early laparoscopic cholecystectomy is superior to delayed Acute Cholecystitis a meta analysis of case control studies
Surgical Endoscopy and Other Interventional Techniques, 2016Co-Authors: Amy M Cao, Guy D. Eslick, Michael R CoxAbstract:Since the advent of laparoscopic cholecystectomy (LC) there has been continued debate regarding the management of Acute Cholecystitis with either early or delayed LC. Nearly all studies have demonstrated that early LC has a significantly shorter total length of hospital stay compared with delayed LC. Although previous randomized controlled trials and meta-analysis have shown clinical outcomes to favour early surgery, clinical practice continues to vary significantly worldwide. In addition, there is much confusion in the optimal timing for early LC with definitions of early varying from 72 h to 7 days. There have been numerous case–control studies investigating the timing of LC in Acute Cholecystitis. The aim of this paper is to pool the results from all case–control studies to investigate outcomes including mortality rates, complication rates, length of hospital stay and conversion rates to open procedures. A search of electronic databases was performed for case–control studies published between 1985–February 2015. Results from 77 case–control studies showed statistically significant reductions in mortality, complications, bile duct leaks, bile duct injuries, wound infections, conversion rates, length of hospital stay and blood loss associated with early LC. Although LC within the 72-h window is optimal, patients operated after this window still benefit from early surgery compared to delayed surgery. The duration of symptoms in Acute Cholecystitis should not influence the surgeons’ willingness to operate Acutely. Early LC is clearly superior to delayed LC in Acute Cholecystitis. The most recent evidence-based practice strongly suggests that early LC should be standard of care in the management of Acute Cholecystitis.
-
early cholecystectomy is superior to delayed cholecystectomy for Acute Cholecystitis a meta analysis
Journal of Gastrointestinal Surgery, 2015Co-Authors: Amy M Cao, Guy D. Eslick, Michael R CoxAbstract:Introduction The timing of laparoscopic cholecystectomy for Acute Cholecystitis remains an issue for debate amongst general surgeons. The aim of this study was to compare clinical outcomes between early and delayed cholecystectomy for Acute Cholecystitis. The primary outcome measures included mortality rates, complication rates, length of hospital stay and conversion rates to open procedures.
-
early cholecystectomy is superior to delayed cholecystectomy for Acute Cholecystitis a meta analysis
Journal of Gastrointestinal Surgery, 2015Co-Authors: Amy M Cao, Guy D. Eslick, Michael R CoxAbstract:The timing of laparoscopic cholecystectomy for Acute Cholecystitis remains an issue for debate amongst general surgeons. The aim of this study was to compare clinical outcomes between early and delayed cholecystectomy for Acute Cholecystitis. The primary outcome measures included mortality rates, complication rates, length of hospital stay and conversion rates to open procedures. A search of electronic databases was performed for randomised controlled trials. Fifteen studies were included. Early surgery has a decreased risk of wound infections (RR 0.57, 95 % CI 0.35–0.93, p = 0.01) compared with delayed surgery but no difference in mortality, bile duct injuries, bile duct leaks and the risk of conversion to open surgery. Of patients in the delayed group, 9.7 % failed initial non-operative management and underwent emergency LC. Early surgery had a significantly reduced total hospital stay and mean hospital costs compared with delayed surgery. Early laparoscopic cholecystectomy in Acute Cholecystitis demonstrated decreased incidence of wound infections, a shorter total length of stay and decreased costs with no difference in the rates of mortality, bile duct injuries, bile leaks and conversions. These results support that early laparoscopic cholecystectomy is the best care and should be considered a routine in patients presenting with Acute Cholecystitis.
Henry A. Pitt - One of the best experts on this subject based on the ideXlab platform.
-
TG13 surgical management of Acute Cholecystitis.
Journal of Hepato-Biliary-Pancreatic Sciences, 2013Co-Authors: Yuichi Yamashita, Tadahiro Takada, Steven M. Strasberg, Henry A. Pitt, Dirk J. Gouma, O. James Garden, Markus W. Büchler, Harumi Gomi, Christos Dervenis, John A. WindsorAbstract:Background Laparoscopic cholecystectomy is now accepted as a surgical procedure for Acute Cholecystitis when it is performed by an expert surgeon. There are several lines of strong evidence, such as randomized controlled trials (RCTs) and meta-analyses, supporting the introduction of laparoscopic cholecystectomy for patients with Acute Cholecystitis. The updated Tokyo Guidelines 2013 (TG13) describe the surgical treatment for Acute Cholecystitis according to the grade of severity, the timing, and the procedure used for Cholecystitis in a question-and-answer format using the evidence concerning surgical management of Acute Cholecystitis.
-
tg13 diagnostic criteria and severity grading of Acute Cholecystitis with videos
Journal of Hepato-biliary-pancreatic Sciences, 2013Co-Authors: Masamichi Yokoe, Tadahiro Takada, Steven M. Strasberg, Henry A. Pitt, Harumi Gomi, Toshihiko Mayumi, James O Garden, Joseph S Solomkin, Seiki Kiriyama, Jiro HataAbstract:Since its publication in 2007, the Tokyo Guidelines for the management of Acute cholangitis and Cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for Acute Cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. Discussion by the Tokyo Guidelines Revision Committee concluded that Acute Cholecystitis should be suspected when Murphy’s sign, local inflammatory findings in the gallbladder such as right upper quadrant abdominal pain and tenderness, and fever and systemic inflammatory reaction findings detected by blood tests are present but that definite diagnosis of Acute Cholecystitis can be made only on the basis of the imaging of ultrasonography, computed tomography or scintigraphy (HIDA scan). These proposed diagnostic criteria provided better specificity and accuracy rates than the TG07 diagnostic criteria. As for the severity assessment criteria in TG07, there is evidence that TG07 resulted in clarification of the concept of severe Acute Cholecystitis. Furthermore, there is evidence that severity assessment in TG07 has led to a reduction in the mean duration of hospital stay. As for the factors used to establish a moderate grade of Acute Cholecystitis, such as leukocytosis, ALP, old age, diabetes, being male, and delay in admission, no new strong evidence has been detected indicating that a change in the criteria used in TG07 is needed. Therefore, it was judged that the severity assessment criteria of TG07 could be applied in the updated Tokyo Guidelines (TG13) with minor changes. TG13 presents new standards for the diagnosis, severity grading and management of Acute Cholecystitis. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html .
-
tg13 indications and techniques for gallbladder drainage in Acute Cholecystitis with videos
Journal of Hepato-biliary-pancreatic Sciences, 2013Co-Authors: Toshio Tsuyuguchi, Tadahiro Takada, Steven M. Strasberg, Henry A. Pitt, Toshihiko Mayumi, Masahiro Yoshida, Takao Itoi, Myunghwan Kim, A N Supe, Fumihiko MiuraAbstract:Percutaneous transhepatic gallbladder drainage (PTGBD) is considered a safe alternative to early cholecystectomy, especially in surgically high-risk patients with Acute Cholecystitis. Although randomized prospective controlled trials are lacking, data from most retrospective studies demonstrate that PTGBD is the most common gallbladder drainage method. There are several alternatives to PTGBD. Percutaneous transhepatic gallbladder aspiration is a simple alternative drainage method with fewer complications; however, its clinical usefulness has been shown only by case-series studies. Endoscopic naso-gallbladder drainage and gallbladder stenting via a transpapillary endoscopic approach are also alternative methods in Acute Cholecystitis, but both of them have technical difficulties resulting in lower success rates than that of PTGBD. Recently, endoscopic ultrasonography-guided transmural gallbladder drainage has been reported as a special technique for gallbladder drainage. However, it is not yet an established technique. Therefore, it should be performed in high-volume institutes by skilled endoscopists. Further prospective evaluations of the feasibility, safety, and efficacy of these various approaches are needed. This article describes indications and techniques of drainage for Acute Cholecystitis.
-
new diagnostic criteria and severity assessment of Acute Cholecystitis in revised tokyo guidelines
Journal of Hepato-biliary-pancreatic Sciences, 2012Co-Authors: Masamichi Yokoe, Tadahiro Takada, Steven M. Strasberg, Henry A. Pitt, Dirk J. Gouma, Harumi Gomi, Toshihiko Mayumi, James O Garden, Joseph S Solomkin, Markus W. BüchlerAbstract:Background The Tokyo Guidelines for the management of Acute cholangitis and Cholecystitis (TG07) were published in 2007 as the world’s first guidelines for Acute cholangitis and Cholecystitis. The diagnostic criteria and severity assessment of Acute Cholecystitis have since been widely used all over the world. A validation study of TG07 has shown that the diagnostic criteria for Acute Cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. In addition, considerable new evidence referring to Acute Cholecystitis as well as evaluations of TG07 have been published. Consequently, we organized the Tokyo Guidelines Revision Committee to evaluate TG07, recognize new evidence, and conduct a multi-center analysis to revise the guidelines (TG13).
-
surgical treatment of patients with Acute Cholecystitis tokyo guidelines
Journal of Hepato-biliary-pancreatic Surgery, 2007Co-Authors: Yuichi Yamashita, Tadahiro Takada, Steven M. Strasberg, Yoshifumi Kawarada, Yuji Nimura, Masahiko Hirota, Fumihiko Miura, Toshihiko Mayumi, Masahiro Yoshida, Henry A. PittAbstract:Cholecystectomy has been widely performed in the treatment of Acute Cholecystitis, and laparoscopic cholecystectomy has been increasingly adopted as the method of surgery over the past 15 years. Despite the success of laparoscopic cholecystectomy as an elective treatment for symptomatic gallstones, Acute Cholecystitis was initially considered a contraindication for laparoscopic cholecystectomy. The reasons for it being considered a contraindication were the technical difficulty of performing it in Acute Cholecystitis and the development of complications, including bile duct injury, bowel injury, and hepatic injury. However, laparoscopic cholecystectomy is now accepted as being safe for Acute Cholecystitis, when surgeons who are expert at the laparoscopic technique perform it. Laparoscopic cholecystectomy has been found to be superior to open cholecystectomy as a treatment for Acute Cholecystitis because of a lower incidence of complications, shorter length of postoperative hospital stay, quicker recuperation, and earlier return to work. However, laparoscopic cholecystectomy for Acute Cholecystitis has not become routine, because the timing and approach to the surgical management in patients with Acute Cholecystitis is still a matter of controversy. These Guidelines describe the timing of and the optimal surgical treatment of Acute Cholecystitis in a question-and-answer format.
Tadahiro Takada - One of the best experts on this subject based on the ideXlab platform.
-
TG13 surgical management of Acute Cholecystitis.
Journal of Hepato-Biliary-Pancreatic Sciences, 2013Co-Authors: Yuichi Yamashita, Tadahiro Takada, Steven M. Strasberg, Henry A. Pitt, Dirk J. Gouma, O. James Garden, Markus W. Büchler, Harumi Gomi, Christos Dervenis, John A. WindsorAbstract:Background Laparoscopic cholecystectomy is now accepted as a surgical procedure for Acute Cholecystitis when it is performed by an expert surgeon. There are several lines of strong evidence, such as randomized controlled trials (RCTs) and meta-analyses, supporting the introduction of laparoscopic cholecystectomy for patients with Acute Cholecystitis. The updated Tokyo Guidelines 2013 (TG13) describe the surgical treatment for Acute Cholecystitis according to the grade of severity, the timing, and the procedure used for Cholecystitis in a question-and-answer format using the evidence concerning surgical management of Acute Cholecystitis.
-
tg13 diagnostic criteria and severity grading of Acute Cholecystitis with videos
Journal of Hepato-biliary-pancreatic Sciences, 2013Co-Authors: Masamichi Yokoe, Tadahiro Takada, Steven M. Strasberg, Henry A. Pitt, Harumi Gomi, Toshihiko Mayumi, James O Garden, Joseph S Solomkin, Seiki Kiriyama, Jiro HataAbstract:Since its publication in 2007, the Tokyo Guidelines for the management of Acute cholangitis and Cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for Acute Cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. Discussion by the Tokyo Guidelines Revision Committee concluded that Acute Cholecystitis should be suspected when Murphy’s sign, local inflammatory findings in the gallbladder such as right upper quadrant abdominal pain and tenderness, and fever and systemic inflammatory reaction findings detected by blood tests are present but that definite diagnosis of Acute Cholecystitis can be made only on the basis of the imaging of ultrasonography, computed tomography or scintigraphy (HIDA scan). These proposed diagnostic criteria provided better specificity and accuracy rates than the TG07 diagnostic criteria. As for the severity assessment criteria in TG07, there is evidence that TG07 resulted in clarification of the concept of severe Acute Cholecystitis. Furthermore, there is evidence that severity assessment in TG07 has led to a reduction in the mean duration of hospital stay. As for the factors used to establish a moderate grade of Acute Cholecystitis, such as leukocytosis, ALP, old age, diabetes, being male, and delay in admission, no new strong evidence has been detected indicating that a change in the criteria used in TG07 is needed. Therefore, it was judged that the severity assessment criteria of TG07 could be applied in the updated Tokyo Guidelines (TG13) with minor changes. TG13 presents new standards for the diagnosis, severity grading and management of Acute Cholecystitis. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html .
-
tg13 indications and techniques for gallbladder drainage in Acute Cholecystitis with videos
Journal of Hepato-biliary-pancreatic Sciences, 2013Co-Authors: Toshio Tsuyuguchi, Tadahiro Takada, Steven M. Strasberg, Henry A. Pitt, Toshihiko Mayumi, Masahiro Yoshida, Takao Itoi, Myunghwan Kim, A N Supe, Fumihiko MiuraAbstract:Percutaneous transhepatic gallbladder drainage (PTGBD) is considered a safe alternative to early cholecystectomy, especially in surgically high-risk patients with Acute Cholecystitis. Although randomized prospective controlled trials are lacking, data from most retrospective studies demonstrate that PTGBD is the most common gallbladder drainage method. There are several alternatives to PTGBD. Percutaneous transhepatic gallbladder aspiration is a simple alternative drainage method with fewer complications; however, its clinical usefulness has been shown only by case-series studies. Endoscopic naso-gallbladder drainage and gallbladder stenting via a transpapillary endoscopic approach are also alternative methods in Acute Cholecystitis, but both of them have technical difficulties resulting in lower success rates than that of PTGBD. Recently, endoscopic ultrasonography-guided transmural gallbladder drainage has been reported as a special technique for gallbladder drainage. However, it is not yet an established technique. Therefore, it should be performed in high-volume institutes by skilled endoscopists. Further prospective evaluations of the feasibility, safety, and efficacy of these various approaches are needed. This article describes indications and techniques of drainage for Acute Cholecystitis.
-
new diagnostic criteria and severity assessment of Acute Cholecystitis in revised tokyo guidelines
Journal of Hepato-biliary-pancreatic Sciences, 2012Co-Authors: Masamichi Yokoe, Tadahiro Takada, Steven M. Strasberg, Henry A. Pitt, Dirk J. Gouma, Harumi Gomi, Toshihiko Mayumi, James O Garden, Joseph S Solomkin, Markus W. BüchlerAbstract:Background The Tokyo Guidelines for the management of Acute cholangitis and Cholecystitis (TG07) were published in 2007 as the world’s first guidelines for Acute cholangitis and Cholecystitis. The diagnostic criteria and severity assessment of Acute Cholecystitis have since been widely used all over the world. A validation study of TG07 has shown that the diagnostic criteria for Acute Cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. In addition, considerable new evidence referring to Acute Cholecystitis as well as evaluations of TG07 have been published. Consequently, we organized the Tokyo Guidelines Revision Committee to evaluate TG07, recognize new evidence, and conduct a multi-center analysis to revise the guidelines (TG13).
-
surgical treatment of patients with Acute Cholecystitis tokyo guidelines
Journal of Hepato-biliary-pancreatic Surgery, 2007Co-Authors: Yuichi Yamashita, Tadahiro Takada, Steven M. Strasberg, Yoshifumi Kawarada, Yuji Nimura, Masahiko Hirota, Fumihiko Miura, Toshihiko Mayumi, Masahiro Yoshida, Henry A. PittAbstract:Cholecystectomy has been widely performed in the treatment of Acute Cholecystitis, and laparoscopic cholecystectomy has been increasingly adopted as the method of surgery over the past 15 years. Despite the success of laparoscopic cholecystectomy as an elective treatment for symptomatic gallstones, Acute Cholecystitis was initially considered a contraindication for laparoscopic cholecystectomy. The reasons for it being considered a contraindication were the technical difficulty of performing it in Acute Cholecystitis and the development of complications, including bile duct injury, bowel injury, and hepatic injury. However, laparoscopic cholecystectomy is now accepted as being safe for Acute Cholecystitis, when surgeons who are expert at the laparoscopic technique perform it. Laparoscopic cholecystectomy has been found to be superior to open cholecystectomy as a treatment for Acute Cholecystitis because of a lower incidence of complications, shorter length of postoperative hospital stay, quicker recuperation, and earlier return to work. However, laparoscopic cholecystectomy for Acute Cholecystitis has not become routine, because the timing and approach to the surgical management in patients with Acute Cholecystitis is still a matter of controversy. These Guidelines describe the timing of and the optimal surgical treatment of Acute Cholecystitis in a question-and-answer format.
Christodoulos Kaoutzanis - One of the best experts on this subject based on the ideXlab platform.
-
is hepato imino diacetic acid scan a better imaging modality than abdominal ultrasound for diagnosing Acute Cholecystitis
American Journal of Surgery, 2015Co-Authors: Christodoulos Kaoutzanis, Eric Davies, Stefan W Leichtle, Kathleen B Welch, Suzanne Winter, Richard M Lampman, Michael G Franz, Wallace ArnesonAbstract:Abstract Background The role of hepato-imino diacetic acid scan (HIDA) in the diagnosis of Acute Cholecystitis remains controversial when compared with the more commonly used abdominal ultrasound (AUS). Methods The diagnostic imaging workup of 1,217 patients who presented to the emergency department at a single hospital with Acute abdominal pain and suspicion of Acute Cholecystitis was reviewed to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AUS and HIDA. Results In patients undergoing both imaging modalities, HIDA had significantly higher sensitivity (90.7% vs 64.0%, P P = .005) than AUS for the diagnosis of Acute Cholecystitis. Additionally, PPV and NPV of HIDA (56.2% and 95.0%, respectively) were higher than PPV and NPV of AUS (38.4% and 80.0%, respectively) when both imaging modalities were used for the same patient. Conclusion In adults with Acute abdominal pain, HIDA significantly increases the accuracy of the correct diagnosis.
-
abdominal ultrasound versus hepato imino diacetic acid scan in diagnosing Acute Cholecystitis what is the real benefit
Journal of Surgical Research, 2014Co-Authors: Christodoulos Kaoutzanis, Eric Davies, Stefan W Leichtle, Kathleen B Welch, Suzanne Winter, Richard M Lampman, Wallace ArnesonAbstract:Background Acute Cholecystitis is one of the most common surgical problems, yet substantial debate remains over the utility of simple examination, abdominal ultrasound (AUS), or advanced imaging such as hepato-imino diacetic acid (HIDA) scan to support the diagnosis. Materials and methods The preoperative diagnostic workup of patients who underwent cholecystectomy with histologically confirmed Acute Cholecystitis was reviewed to calculate the sensitivity of AUS, HIDA scan, or both. In addition, the sensitivity of the commonly described ultrasonographic findings was assessed. Results From 2010 through 2012, 406 patients among 9087 reviewed charts presented to the emergency department with Acute upper abdominal pain and met inclusion criteria. 32.5% (N = 132) of patients underwent AUS only, 11.3% (N = 46) underwent HIDA scan only, and 56.2% (N = 228) had both studies performed for workup. 52.7% (N = 214) of patients had histopathologically confirmed Acute Cholecystitis. The sensitivities of AUS, HIDA, and AUS combined with HIDA for Acute Cholecystitis were 73.3% (95% confidence interval [CI] = 66.3%–79.5%), 91.7% (95% CI = 86.2%–95.5%), and 97.7% (95% CI = 93.4%–99.5%), respectively. Although of limited sensitivity, AUS findings of sonographic Murphy sign, gallbladder distension, and gallbladder wall thickening were associated with a diagnosis of Acute Cholecystitis. Conclusions The sensitivity of AUS for diagnosing Acute Cholecystitis in patients with Acute upper abdominal pain is limited. The addition of a HIDA scan in the diagnostic workup significantly improves sensitivity and can add valuable information in the appropriate clinical setting.