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Management algorithm of acute cholecystitis after percutaneous cholecystostomy catheter placement based on outcomes
Abdulrahman Masrani1, Daniel Young2, John P Karageorgiou3
1Mallinckrodt Institute of Radiology at Washington University, St Louis, MO, USA. a_masrani@me.com.
Insights
Percutaneous cholecystostomy (PC) is effective for acute cholecystitis (AC) treatment, offering a low complication rate. This procedure can serve as a bridge to definitive therapy, with a proposed management algorithm to guide post-PC care.
Area of Science:
- Interventional Radiology
- Hepatobiliary Surgery
- Gastroenterology
Background:
- Acute cholecystitis (AC) is a common surgical emergency.
- Percutaneous cholecystostomy (PC) is an alternative treatment for AC, especially in high-risk patients.
- Management strategies following PC for AC require clear guidelines.
Purpose of the Study:
- To evaluate the outcomes of percutaneous cholecystostomy (PC) catheter placement in patients with acute cholecystitis (AC).
- To propose a management algorithm for AC following PC catheter placement based on study outcomes.
Main Methods:
- Retrospective study of 419 patients who underwent PC between July 2010 and September 2016 for AC.
- Exclusion of patients undergoing PC for indications other than AC.
- Analysis of primary outcomes (definitive AC treatment) and secondary outcomes (catheter removal, death).
Main Results:
- 100% technical success rate for PC in 377 AC patients, with low complication rates (2.4% major, 1.6% minor).
- Definitive treatment achieved in 31% (cholecystectomy) and 16% (percutaneous cholecystolithotomy).
- Catheter removal without surgery occurred in 20%; 13% died with catheters in place due to comorbidities.
Conclusions:
- Percutaneous cholecystostomy (PC) is a safe and effective option for acute cholecystitis (AC) management.
- PC serves as a valuable bridge to definitive treatment with a low complication profile.
- The proposed management algorithm can guide clinical decision-making for AC patients post-PC placement.
Purpose:
To report outcomes of percutaneous cholecystostomy (PC) catheter placement in patients with acute cholecystitis (AC) and propose management algorithm of AC after PC catheter placement based on the outcomes.
Method And Materials:
Retrospective study was performed. 419 patients who underwent PC between July 2010 and September 2016 were included. Patients who underwent PC for indication other than AC were excluded. The primary outcome was definitive treatment of AC following PC, including cholecystectomy or percutaneous cholecystolithotomy. Secondary outcomes include removal of drainage catheter without further management or death with catheter in place. Based on outcomes, we proposed management algorithm of AC after PC catheter placement.
Results:
377 of 419 patients underwent PC for treatment of AC (median age, 66 years; range 18-100 years). Technical success rate was 100% with 2.4% major complications rate and 1.6% minor complications rate. Following PC, 118 patients (31%) underwent definitive treatment with cholecystectomy. Sixty-one patients (16%) underwent definitive treatment with percutaneous cholecystolithotomy with removal of catheters. Seventy-four patients (20%) had their catheters removed upon resolution of cholecystitis without undergoing surgery or stone removal. Fifty patients (13%) died with catheters in place due to other comorbidities. Five patients (1%) still had their catheters in place at the end of the study.
Conclusion:
PC remains a viable option for treatment of AC with low complication rate and can be used as bridge to definitive therapy. Our proposed management algorithm can be a guideline for the management of AC after PC catheter placement.
