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Can percutaneous cholecystostomy be a definitive management for acute acalculous cholecystitis?

Yun Hee Chung1, E Ryoung Choi, Kwang Min Kim

  • 1Department of Medicine, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Republic of Korea.

Journal of Clinical Gastroenterology
|August 5, 2011
PubMed

Insights

Percutaneous cholecystostomy is a safe and effective treatment for acute acalculous cholecystitis (AAC), potentially avoiding the need for further surgery in high-risk patients.

Area of Science:

  • Gastroenterology
  • Interventional Radiology
  • Surgical Oncology

Background:

  • Acute acalculous cholecystitis (AAC) primarily affects critically ill patients.
  • Percutaneous cholecystostomy offers a less invasive option for high-risk surgical candidates.
  • The necessity of a subsequent cholecystectomy after percutaneous cholecystostomy remains debated.

Purpose of the Study:

  • To assess the safety, efficacy, and long-term outcomes of percutaneous cholecystostomy as a definitive treatment for AAC.
  • To determine if cholecystectomy is required after initial percutaneous cholecystostomy for AAC.

Main Methods:

  • Retrospective analysis of medical records from 57 patients treated for AAC with percutaneous cholecystostomy between 1995 and 2010.
  • Evaluation of procedural success, complication rates, symptom resolution, mortality, and need for subsequent interventions.

Main Results:

  • 100% technical success rate for percutaneous cholecystostomy with no major complications.
  • Symptom resolution within 4 days in 93% of patients.
  • In-hospital mortality was 21%; 31% underwent elective cholecystectomy.
  • In patients managed non-operatively (n=28), recurrent cholecystitis occurred in 7% after tube removal and a median 32-month follow-up.

Conclusions:

  • Percutaneous cholecystostomy is a highly effective treatment for AAC, especially in patients too ill for immediate surgery.
  • This procedure can serve as a definitive treatment, potentially obviating the need for cholecystectomy in select AAC patients.
  • Recovery from percutaneous cholecystostomy may eliminate the need for further surgical intervention in many cases of AAC.
Abstract

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