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Percutaneous Cholecystostomy Versus Conservative Treatment for Acute Cholecystitis: a Cohort Study
Stine Ydegaard Turiño1, Daniel Mønsted Shabanzadeh2, Nethe Malik Eichen2
1Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark. stineydegaard@gmail.com.
Insights
Percutaneous cholecystostomy for acute calculous cholecystitis did not show long-term benefits or complications. This study suggests reconsidering non-operative management due to high gallstone readmission rates.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Medical Interventions
Background:
- Acute calculous cholecystitis often requires intervention for patients unfit for surgery.
- Percutaneous cholecystostomy is a common non-operative approach.
- Long-term outcomes of this procedure for gallstone morbidity and mortality are not well-established.
Purpose of the Study:
- To compare the long-term outcomes of percutaneous cholecystostomy versus conservative treatment for acute calculous cholecystitis.
- To evaluate gallstone-related readmissions, recurrent cholecystitis, and overall mortality.
Main Methods:
- A cohort study included 201 patients with acute calculous cholecystitis from 2006-2015.
- 97 patients underwent percutaneous cholecystostomy; the remainder received conservative treatment.
- Endpoints included gallstone-related readmissions, recurrent cholecystitis, and overall mortality over a median follow-up of 1.6 years.
Main Results:
- Percutaneous cholecystostomy had a 3.1% complication rate and 3.5% in-hospital mortality.
- Long-term, 38.6% experienced gallstone-related readmissions and 25.3% had recurrent cholecystitis.
- No significant differences in readmissions, recurrence, or mortality were found between groups.
Conclusions:
- Percutaneous cholecystostomy for acute calculous cholecystitis offers no significant long-term benefits or harm.
- High rates of gallstone-related readmissions observed.
- Rethinking indications for non-operative management, including percutaneous cholecystostomy, is suggested given current perioperative improvements.
Background:
Percutaneous cholecystostomy is frequently used as a treatment option for acute calculous cholecystitis in patients unfit for surgery. There is sparse evidence on the long-term impact of cholecystostomy on gallstone-related morbidity and mortality in patients with acute calculous cholecystitis. This study describes the long-term outcome of acute calculous cholecystitis following percutaneous cholecystostomy compared to conservative treatment.
Methods:
This was a cohort study of patients admitted at our institution from 2006 to 2015 with acute calculous cholecystitis without early or delayed cholecystectomy. Endpoints were gallstone-related readmissions, recurrent cholecystitis, and overall mortality.
Results:
The investigation included 201 patients of whom 97 (48.2%) underwent percutaneous cholecystostomy. Patients in the cholecystostomy group had significantly higher age, comorbidity level, and inflammatory response at admission. The median duration of catheter placement in the cholecystostomy group was 6 days. The complication rate of cholecystostomy was 3.1% and the mortality during the index admission was 3.5%. The median follow-up was 1.6 years. The rate of gallstone-related readmissions was 38.6%, and 25.3% had recurrence of cholecystitis. Cox regression analyses revealed no significant differences in gallstone-related readmissions, recurrence of acute calculous cholecystitis, and overall mortality in the two groups.
Conclusions:
Percutaneous cholecystostomy in the treatment of acute calculous cholecystitis was neither associated with long-term benefits nor complications. Based on the high gallstone-related readmission rates of this study population and todays perioperative improvements, we suggest rethinking the indications for non-operative management including percutaneous cholecystostomy in acute calculous cholecystitis.
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