The Role of Ultrasound in Cholecystitis

• ClinicalTrials.gov Identifier: NCT03470220
• Recruitment Status: Completed
• First Posted: March 19, 2018
• Last Update Posted: February 26, 2019
• Sponsor: Karolinska Institutet
• Information provided by (Responsible Party): Camilla Gustafsson, Karolinska Institutet

Study Description

Brief Summary:

The aim of this study is:

1. To describe the natural course of acute cholecystitis, by performing repeated ultrasound examinations from day of admission to hospital until day of surgery or discharge.
2. To investigate if there is anything in the ultrasound picture that can predict a difficult operation.

Patients will be prospectively enrolled. The ultrasound picture (ultrasound variables: gallbladder volume, gallbladder wall thickness, and presence of oedema in the gallbladder wall), will be compared to clinical variables (tenderness in right upper quadrant, WBC, CRP and temperature) and to the time (hours) from onset of symptoms. Statistical analyses will be made to see if statistically significant, and clinically relevant, associations between variables exist.

Furthermore, for participants receiving acute surgery, an upper GI surgeon will evaluate the operation as easy, intermediate or difficult. In extension, investigators will look at associations between difficult surgery and all the variables previously mentioned (both ultrasound variables, clinical variables and time).

Condition or disease
Cholecystitis, Acute

Detailed Description:

Patients admitted to Stockholm South General Hospital's Surgery Department, with a confirmed diagnosis of acute cholecystitis (according to the Tokyo Guidelines 2013) will be considered eligible for the study and asked to participate. Informed consent will be obtained from all participants. Participants will be examined with ultrasound of the gallbladder daily, while receiving regular care for acute cholecystitis, which means either waiting for acute surgery or being treated conservatively for as long as inpatient care is needed.

The ultrasound examinations will be performed by a radiologist or a specialised certified ultrasound trained nurse as well as by an ultrasound trained surgeon. Measures of gallbladder volume (measured in cm3), gallbladder wall thickness (measured in mm:s) and presence of oedema in the gallbladder wall (noted as a binomial variable 'yes/no') are recorded in a case report form (no.1) together with body temperature, labs and information about onset of symptoms.

The operating surgeon (a specialist in surgery) will evaluate the operation and grade it from easy to difficult and fill in a case report form (no.2).

Data will be collected from the forms and analysed using a regression model (generalised estimated equation or a mixed model).

Study Design

• Study Type: Observational
• Actual Enrollment: 120 participants
• Observational Model: Cohort
• Time Perspective: Prospective
• Official Title: The Role of Ultrasound in Cholecystitis
• Actual Study Start Date: October 23, 2017
• Actual Primary Completion Date: November 30, 2018
• Actual Study Completion Date: November 30, 2018

Groups and Cohorts

Group/Cohort
Ultrasound; All included patients will be examined with ultrasound

Outcome Measures

Primary Outcome Measures :

1. Does the gallbladder wall thickness in acute cholecystitis change over time? [ Time Frame: Through study completion, one year ]
   Measurement of the gallbladder wall thickness in mm will be measured daily. Association between the gallbladder wall thickness and time from onset of symptoms (hours) will be analyzed.

Secondary Outcome Measures :

1. Does the gallbladder volume in acute cholecystitis change over time? [ Time Frame: Through study completion, one year ]
   Measurement of the gallbladder volume, in cm3 will be measured daily. Association between the gallbladder volume and time from onset of symptoms (hours) will be analyzed.
2. Does the presence of oedema in the gallbladder wall change over time? [ Time Frame: Through study completion, one year ]
   The presence of oedema in the gallbladder wall will be examined and noted daily.

Other Outcome Measures:

1. Does any of the ultrasound variables contribute to predict difficult surgery in acute cholecystitis? [ Time Frame: Through study completion, one year ]

   Patients with acute cholecystitis who undergo surgery at the same admission will be included for further analysis.

   The operating surgeon (a specialist in general surgery) will classify the operation as easy, intermediate or difficult.

   Associations between difficult surgery, all the above listed variables and time from onset of symptoms will be calculated using a regression model (GEE or mixed model).

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes
• Sampling Method: Probability Sample

Study Population

Patients admitted to the hospital, with confirmed acute cholecystitis according to the Tokyo Guidelines 2013 will be asked to participate in the study

Criteria

Inclusion Criteria:

• Acute cholecystitis according to the Tokyo Guidelines 2013 criteria

Exclusion Criteria:

• Difficulties to communicate

Contacts and Locations

Locations

Sweden

Södersjukhuset

Stockholm, Stockholms LAN, Sweden, S-11883

Sponsors and Collaborators

Karolinska Institutet

Investigators

• Study Director: Anders Sonden, Docent; Karolinska Instistutet Södersjukhuset

More Information

Publications:

Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan AC, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG; Tokyo Guidelines Revision Committee. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013 Jan;20(1):35-46. doi: 10.1007/s00534-012-0568-9.

Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Yoshida M, Miura F, Yamashita Y, Okamoto K, Gabata T, Hata J, Higuchi R, Windsor JA, Bornman PC, Fan ST, Singh H, de Santibanes E, Gomi H, Kusachi S, Murata A, Chen XP, Jagannath P, Lee S, Padbury R, Chen MF, Dervenis C, Chan AC, Supe AN, Liau KH, Kim MH, Kim SW; Tokyo Guidelines Revision Committee. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2013 Jan;20(1):24-34. doi: 10.1007/s00534-012-0561-3.

Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gomi H, Yoshida M, Mayumi T, Miura F, Gouma DJ, Garden OJ, Büchler MW, Kiriyama S, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Gabata T, Higuchi R, Okamoto K, Hata J, Murata A, Kusachi S, Windsor JA, Supe AN, Lee S, Chen XP, Yamashita Y, Hirata K, Inui K, Sumiyama Y; Tokyo Guidelines Revision Committee. TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013 Jan;20(1):1-7. doi: 10.1007/s00534-012-0566-y.

• Responsible Party: Camilla Gustafsson, M.D. Principal Investigator, Karolinska Institutet
• ClinicalTrials.gov Identifier: NCT03470220
• Other Study ID Numbers: 2017/1222-31/2
• First Posted: March 19, 2018
• Last Update Posted: February 26, 2019
• Last Verified: February 2019

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

Cholecystitis; Acalculous Cholecystitis; Cholecystitis, Acute; Gallbladder Diseases; Biliary Tract Diseases; Digestive System Diseases