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Retrospective Analysis of Outcomes Following Percutaneous Cholecystostomy for Acute Cholecystitis
L L Kuan1,2, T Oyebola3, A Mavilakandy3
1Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, NHS Trust, Gwendolen Road, Leicester, LE5 4PW, United Kingdom. kuan.lilian@gmail.com.
Insights
Percutaneous cholecystostomy (PC) offers a safe alternative for high-risk patients with acute cholecystitis. This procedure is effective for managing gallbladder inflammation and can be a valuable temporary measure before definitive treatment.
Area of Science:
- Hepatobiliary surgery
- Interventional radiology
- Gastroenterology
Background:
- Percutaneous cholecystostomy (PC) is a key intervention for acute cholecystitis in patients deemed too high-risk for surgical cholecystectomy.
- This retrospective study evaluates the outcomes of PC in a high-risk patient cohort over a five-year period.
Purpose of the Study:
- To assess the reasons for choosing PC over immediate surgery.
- To determine the subsequent management and outcomes for patients treated with PC.
- To identify the incidence of common bile duct stones (CBDS), PC-related complications, and 30-day mortality.
Main Methods:
- Retrospective analysis of 96 patients undergoing PC for acute cholecystitis between January 2010 and December 2015.
- Data collected from electronic databases, clinical notes, and imaging reports.
- Evaluation of reasons for PC, definitive management, CBDS incidence, complications, and 30-day mortality.
Main Results:
- 28.1% of patients had common bile duct stones (CBDS); 12.5% detected during PC cholangiogram.
- High American Society of Anaesthesiologists (ASA) score (49%) and gallbladder empyema (29.1%) were primary indications for PC.
- 25% of patients underwent interval cholecystectomy, and the 30-day in-hospital mortality rate was 16.7%.
Conclusions:
- PC is a safe and effective salvage therapy for elderly, high-risk patients with comorbidities.
- PC serves as a valuable temporizing measure, facilitating definitive treatment in high-risk individuals.
- Vigilance for CBDS is crucial, necessitating further imaging (MRCP or check cholangiogram) to prevent recurrent sepsis in this vulnerable population.
Background:
Percutaneous cholecystostomy (PC) is often performed for patients with acute cholecystitis who are too high risk for cholecystectomy. The purpose of this retrospective study was to evaluate the outcomes of this cohort of patients over a 5-year period.
Methods:
A retrospective analysis of all patients treated with PC for acute cholecystitis in a tertiary centre teaching hospital was conducted. The study period ranged from January 2010 to December 2015. Clinical data were extracted from the hospitals' electronic database system, as well as reviewing clinical notes and imaging reports. The aims of this study were to detect the reason PC was undertaken as opposed to surgery, the subsequent definitive management of patients initially treated with PC, the incidence of common bile duct stones (CBDS), the complications from PC, and the 30-day mortality.
Results:
A total of 96 patients were identified. The total number of patients with CBDS was 27 (28.1%). Fourteen (14.6%) patients were shown to have CBDS on initial imaging. CBDS was detected in 12 patients (12.5%) at cholangiogram during their PC procedure. One patient had CBDS detected during a check cholangiogram at 6 weeks, which was not seen on initial imaging. Twenty-eight patients (29.2%) underwent an endoscopic retrograde cholangiopancreatography (ERCP), during their index admission. The main reasons for PC were a high American Society of Anaesthesiologists (ASA) score (49%), sepsis requiring organ support (19.8%), empyema of the gallbladder (29.1%), failed external biliary drainage for biliary obstruction (2.1%), and concomitant palliative malignancy (5.2%). Interval cholecystectomy was performed in 24 patients (25%). The total 30-day in-hospital mortality was 16.7%.
Conclusion:
PC is an effective and safe alternative as salvage therapy in high-risk elderly patients who have multiple comorbidities. It is valuable as a temporising measure before definitive treatment in high-risk patients. A high index of suspicion for CBDS (and further imaging with MRCP or a check cholangiogram) is warranted to detect missed CBDS. This is particularly relevant in this vulnerable group of patients where CBDS may represent a future source of recurrent sepsis.
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