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Postinsertion Management of Cholecystostomy Tubes for Acute Cholecystitis: A Systematic Review
Andrea Spota1, Ali Shahabi1, Emma Mizdrak1
1Departments of Surgery.
Insights
Management of percutaneous gallbladder drainage (PGD) tubes lacks a standard protocol. This review synthesizes common practices for follow-up imaging, tube management, and timing for delayed cholecystectomy in acute cholecystitis patients.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Surgical Management
Background:
- Percutaneous gallbladder drainage (PGD) treats high-risk acute cholecystitis patients.
- Increasing PGD use due to aging population and comorbidities.
- Lack of consensus on post-procedure management of drainage tubes.
Purpose of the Study:
- Synthesize common protocols for PGD tube management.
- Describe optimal timing for follow-up imaging and tube removal.
- Determine ideal interval from PGD to delayed cholecystectomy.
Main Methods:
- Systematic review of studies from 2000-2023.
- Included adult patients with acute cholecystitis undergoing PGD.
- Searched MEDLINE, Embase, Cochrane; applied NHLBI quality assessment.
Main Results:
- Analyzed 22,349 patients from 94 studies (fair quality).
- Most studies (92.7%) used imaging for PGD follow-up.
- Tube removal averaged >4 weeks; delayed cholecystectomy often occurred after 5 weeks.
Conclusions:
- Standardized PGD management is difficult to establish from current evidence.
- Reliance on common existing protocols is necessary.
- Further research needed to define optimal post-PGD care pathways.
Background:
Percutaneous gallbladder drainage (PGD) is indicated to treat high-risk patients with acute cholecystitis. Trends suggest increasing use of PGD over time as the population ages and lives longer with multiple comorbidities. There is no consensus on the management of cholecystostomies tube once inserted. This review aims to synthesize and describe the most common protocols in terms of the need and timing of follow-up imaging, management of a destination tube, timing of tube removal, and optimal interval time from tube positioning to delayed cholecystectomy.
Methods:
The study protocol has been registered on the International Prospective Register of Systematic Reviews-PROSPERO. Studies on adult patients diagnosed with acute cholecystitis who underwent a PGD from 2000 to November 2023 were included. The databases searched were MEDLINE, Embase, and Cochrane. The quality assessment tools provided by the NHLBI (National Heart, Lung, and Blood Institute) were applied and descriptive statistics were performed.
Results:
We included 22,349 patients from 94 studies with overall fair quality (6 prospective and 88 retrospective). In 92.7% of papers, the authors checked by imaging all patients with a PGD (41 studies included). Depending on protocol time, 30% of studies performed imaging within the first 2 weeks and 35% before tube removal (40 studies included). In the case of a destination tube, 56% of studies reported removing the tube (25 studies included). In the case of tube removal, the mean time after insertion was more than 4 weeks in 24 of the 33 included studies (73%). Interval cholecystectomies are more frequently performed after 5 weeks from PGD (32/38 included studies, 84%). Limitations included high clinical heterogeneity and prevalent retrospective studies.
Conclusions:
A standard management for percutaneous cholecystostomy after insertion is difficult to define based on existing evidence, and currently we can only rely on the most common existing protocols.
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