Percutaneous Cholecystostomy is an Effective Treatment for High-Risk Patients with Acute Cholecystitis

Abstract

We sought to determine the safety, efficacy, and outcome of percutaneous cholecystostomy (PC) in all patients undergoing the procedure at our institutions. We reviewed 53 consecutive cases of acute cholecystitis seen at our hospitals over 5.5 years in which PC was performed at the initial treatment. Follow-up was obtained by chart review and telephone questionnaire. Acute cholecystitis was the primary admitting diagnosis in 18 cases. In the remaining 35, cholecystitis developed during hospitalization. All patients were considered high surgical risks on the basis of the presence of comorbid conditions. The gallbladder was successfully catheterized under radiologic guidance in all patients and with no immediate procedure-related morbidity. Acute cholecystitis resolved in 44 of 53 patients (83%), whereas nine patients (17%) did not improve clinically after PC and died during the same hospitalization. A total of 33 (62%) eventually survived hospitalization. Elective cholecystectomy was done in 25 patients with no mortality. After cholecystectomy, three of these patients subsequently died of other causes, whereas 22 are alive. Eight patients did not undergo cholecystectomy because of underlying medical conditions or because they had acalculous cholecystitis. These patients remained free of biliary problems after removal of their cholecystostomy tube, but two have subsequently died of nonbiliary conditions. Percutaneous cholecystostomy is a safe, effective treatment for high-risk patients with acute cholecystitis. Cholecystostomy can be followed by elective cholecystectomy at a later time if the patient's condition permits or by expectant conservative management in patients who have had acalculous cholecystitis or have a very high mortality risk with surgery.

Percutaneous Drainage versus Emergency Cholecystectomy for the Treatment of Acute Cholecystitis in Critically Ill Patients: Does it Matter?

“…Percutaneous drainage of the gallbladder has been developed as a less invasive procedure compared to open cholecystectomy in critically ill patients with AC. From a technical point of view, it is a rather uncomplicated procedure with a low complication rate that is reported to range from 3 to 13% [7–21, 32, 33]. The complication rate in this current series was 8.7% with no major complication.…”

“…Since first reported in 1980 [6], several series have demonstrated the feasibility of PD in high-risk patients with AC-related sepsis [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. However, there are only scarce data comparing PD to emergency surgery, i.e., laparoscopic cholecystectomy.…”

Comparison of percutaneous gallbladder aspiration with percutaneous cholecystostomy in acute cholecystostomy patients. Can gall bladder aspiration alone be sufficient?

“…[8] PC has been a successful and effective treatment option in patients who cannot undergo LC due to comorbid diseases and do not respond to conservative treatment. [9][10][11] , they reported that 32 of 45 patients achieved recovery with PA at once. Success was achieved in 11 of the remaining 13 patients following the second application of PA.…”

Management of Cholelithiasis in Cirrhotic Patients

“…In the study reported by Yao et al, all patients undergoing PTC demonstrated clinical improvement within 3 days; this improvement helped these patients transition to surgery with acceptable risks [6]. However, the reported rates of acute cholecystitis recurrence after cholecystostomy in patients with gallstones may range from 25% to 30% [30]. It has been shown in the literature that PTC typically leads to multiple readmissions, extended hospital stays and higher hospital costs [31].…”