Cholecystostomy: Are we using it correctly?

Area of Science:

• Interventional Radiology
• Gastroenterology
• Surgical Oncology

Background:

• Percutaneous cholecystostomy tubes (PCT) are a common treatment for acute cholecystitis in non-surgical candidates.
• Concerns exist regarding the overuse and prolonged use of PCT, potentially burdening patients.
• This study aimed to identify predictors for interval cholecystectomy versus long-term PCT placement.

Purpose of the Study:

• To identify independent predictors differentiating patients who undergo interval cholecystectomy from those managed with destination PCT.
• To evaluate the outcomes and complication rates associated with interval cholecystectomy following PCT placement.

Main Methods:

• Retrospective analysis of 165 patients with cholecystitis treated with PCT from 2014 to 2017.
• Data collected included demographics, laboratory values, Tokyo Grade, comorbidity indices (Charlson, ASA), and complication data.
• Statistical analysis involved descriptive statistics, univariable, and multivariable Poisson regression.

Main Results:

• 61% of patients proceeded to interval cholecystectomy; 4 complications and 27.9% mortality were reported.
• Higher Tokyo Grade and Charlson Comorbidity Score were associated with *no* interval cholecystectomy (IRR 0.454, p=0.042; IRR 0.890, p=0.026).
• Higher serum albumin levels were associated with undergoing interval cholecystectomy (IRR 1.580, p=0.011).

Conclusions:

• Patients not undergoing interval cholecystectomy were older, had more comorbidities, and higher initial Tokyo Grade and liver function test values.
• Interval cholecystectomy demonstrated a low complication rate.
• Current practice may be overly conservative, leading to prolonged PCT use in some patients.