Percutaneous cholecystostomy results of 136 acute cholecystitis patients: A retrospective cohort study
Keywords:Acute cholecystitis, Comorbidities, Percutaneous cholecystostomy, Recurrence
Background/Aim: Percutaneous cholecystostomy (PC) is an alternative procedure to surgery in selected patients with acute cholecystitis (AC). This study aimed to review the clinical and surgical results of patients who underwent percutaneous cholecystostomy. Methods: The records of patients who underwent PC for AC were evaluated for age, gender, comorbidities, survey, catheterization timing, complications, control, removal timing, operation type, interval time, pathology, C-reactive protein (CRP) level and white blood cell count (WBC), ultrasonography (USG) and computed tomography (CT) results. Results: One hundred and thirty-six AC patients who underwent PC were included in the study. The median age was 73 (32-96) years and 57.3% of the patients were male. Out of the 136, 106 (78%) had an American Society of Anesthesiologists (ASA) classification score of 3 or 4. The median Charlson’s comorbidity index (CCI) score was 5 (0-13). The median timing of catheterization was 23 (20-144) hours and length of hospital stay (LOS) was 3 (1-25) days. Dislocation was the most common complication of PC, and 7.4% (n=10) had recurrent AC. The median time until tube removal was 26.5 (1-238) days. Among all, 41.2% (n=56) of the patients underwent interval cholecystectomy, which equates to 76.8% of the those performed laparoscopically. The median time until the operation was 100 (1-264) days. Chronic cholecystitis was the most common pathology of cholecystectomy after PC. Bacterial bile cultures were analyzed in 36 of the patients and showed positive results in 66.7%, with no overall effect on the outcome. Nine patients (6.6%) died. Conclusion: The importance of PC in AC increased with the Covid19 pandemic. PC was performed especially for old patients with ASA ≥3, and CCI ≥5 due to lower complication and recurrence rates. PC could be the final treatment for selected AC patients. Interval cholecystectomies performed after 8 weeks had a shorter LOS and a lower rate of complication.
Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002 Sep 21;325(7365):639-43. doi: 10.1136/bmj.325.7365.639.
Halpin V. Acute cholecystitis. BMJ Clin Evid. 2014 Aug 20;2014:0411. PMID: 25144428.
Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):41-54. doi: 10.1002/jhbp.515.
Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, et al. Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):87-95. doi: 10.1002/jhbp.504.
Morales-Maza J, Rodríguez-Quintero JH, Santes O, et al. Percutaneous cholecystostomy as treatment for acute cholecystitis: What has happened over the last five years? A literature review. Rev Gastroenterol Mex. 2019 Oct-Dec;84(4):482-91. English, Spanish. doi: 10.1016/j.rgmx.2019.06.004.
Somuncu E, Kara Y, Kızılkaya MC, Bozdağ E, Yıldız ZB, Özkan C, et al. A. Percutaneous cholecystostomy instead of laparoscopy to treat acute cholecystitis during the COVID-19 pandemic period: single center experience. Ulus Travma Acil Cerrahi Derg. 2021 Jan;27(1):89-94. English. doi: 10.14744/tjtes.2020.69804.
Chou CK, Lee KC, Chan CC, Perng CL, Chen CK, Fang WL, et al. Early Percutaneous Cholecystostomy in Severe Acute Cholecystitis Reduces the Complication Rate and Duration of Hospital Stay. Medicine (Baltimore). 2015 Jul;94(27):e1096. doi: 10.1097/MD.0000000000001096.
Masrani A, Young D, Karageorgiou JP, Mani NB, Picus DD, Kim SK. Management algorithm of acute cholecystitis after percutaneous cholecystostomy catheter placement based on outcomes from 377 patients. Abdom Radiol (NY). 2020 Apr;45(4):1193-7. doi: 10.1007/s00261-020-02449-y.
Gulaya K, Desai SS, Sato K. Percutaneous Cholecystostomy: Evidence-Based Current Clinical Practice. Semin Intervent Radiol. 2016 Dec;33(4):291-6. doi: 10.1055/s-0036-1592326
Bundy J, Srinivasa RN, Gemmete JJ, Shields JJ, Chick JFB. Percutaneous Cholecystostomy: Long-Term Outcomes in 324 Patients. Cardiovasc Intervent Radiol. 2018 Jun;41(6):928-34. doi: 10.1007/s00270-018-1884-5.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. doi: 10.1016/0021-9681(87)90171-8.
Elsharif M, Forouzanfar A, Oaikhinan K, Khetan N. Percutaneous cholecystostomy… why, when, what next? A systematic review of past decade. Ann R Coll Surg Engl. 2018 Oct 5;100(8):1-14. doi: 10.1308/rcsann.2018.0150.
Dvorak P, Hoffmann P, Renc O, Dusek T, Rejchrt S, Slezak O, Vyroubal P. Percutaneous cholecystostomy in the management of acute cholecystitis - 10 years of experience. Wideochir Inne Tech Maloinwazyjne. 2019 Dec;14(4):516-25. doi: 10.5114/wiitm.2019.84704.
Luk SW, Irani S, Krishnamoorthi R, Wong Lau JY, Wai Ng EK, Teoh AY. Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis. Endoscopy. 2019 Aug;51(8):722-32. doi: 10.1055/a-0929-6603.
Anderson JE, Chang DC, Talamini MA. A nationwide examination of outcomes of percutaneous cholecystostomy compared with cholecystectomy for acute cholecystitis, 1998-2010. Surg Endosc. 2013 Sep;27(9):3406-11. doi: 10.1007/s00464-013-2924-5.
Karakaş DO, Yeşiltaş M. Validity of the Glasgow prognostic score and modified systemic inflammation score in predicting complicated cholecystitis. Hippokratia. 2020 Jan-Mar;24(1):15-20.
Bakkaloglu H, Yanar H, Guloglu R, Taviloglu K, Tunca F, Aksoy M, et al. Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention. World J Gastroenterol. 2006 Nov 28;12(44):7179-82. doi: 10.3748/wjg.v12.i44.7179.
Hsieh YC, Chen CK, Su CW, Chan CC, Huo TI, Liu CJ, et al. Outcome after percutaneous cholecystostomy for acute cholecystitis: a single-center experience. J Gastrointest Surg. 2012 Oct;16(10):1860-8. doi: 10.1007/s11605-012-1965-8.
Peters R, Kolderman S, Peters B, Simoens M, Braak S. Percutaneous cholecystostomy: single centre experience in 111 patients with an acute cholecystitis. JBR-BTR. 2014 Jul-Aug;97(4):197-201. doi: 10.5334/jbr-btr.101.
Boules M, Haskins IN, Farias-Kovac M, Guerron AD, Schechtman D, Samotowka M, et al. What is the fate of the cholecystostomy tube following percutaneous cholecystostomy? Surg Endosc. 2017 Apr;31(4):1707-12. doi: 10.1007/s00464-016-5161-x.
Khasawneh MA, Shamp A, Heller S, Zielinski MD, Jenkins DH, Osborn JB, et al. Successful laparoscopic cholecystectomy after percutaneous cholecystostomy tube placement. J Trauma Acute Care Surg. 2015 Jan;78(1):100-4. doi: 10.1097/TA.0000000000000498.
Gulaya K, Desai SS, Sato K. Percutaneous Cholecystostomy: Evidence-Based Current Clinical Practice. Semin Intervent Radiol. 2016 Dec;33(4):291-96. doi: 10.1055/s-0036-1592326.
Carrafiello G, D'Ambrosio A, Mangini M, Petullà M, Dionigi GL, Ierardi AM, et al. Percutaneous cholecystostomy as the sole treatment in critically ill and elderly patients. Radiol Med. 2012 Aug;117(5):772-9. doi: 10.1007/s11547-012-0794-2.
Sureka B, Rastogi A, Mukund A, Thapar S, Bhadoria AS, Chattopadhyay TK. Gangrenous cholecystitis: Analysis of imaging findings in histopathologically confirmed cases. Indian J Radiol Imaging. 2018 Jan-Mar;28(1):49-54. doi: 10.4103/ijri.IJRI_421_16.
Bhatt MN, Ghio M, Sadri L, Sarkar S, Kasotakis G, Narsule C, et al. Percutaneous Cholecystostomy in Acute Cholecystitis-Predictors of Recurrence and Interval Cholecystectomy. J Surg Res. 2018 Dec;232:539-46. doi: 10.1016/j.jss.2018.06.051.
Park JK, Yang JI, Wi JW, Park JK, Lee KH, Lee KT, et al. Long-term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis. J Gastroenterol Hepatol. 2019 Apr;34(4):784-90. doi: 10.1111/jgh.14611.
Macchini D, Degrate L, Oldani M, Leni D, Padalino P, Romano F, et al. Timing of percutaneous cholecystostomy tube removal: systematic review. Minerva Chir. 2016 Dec;71(6):415-26.
Nitzan O, Brodsky Y, Edelstein H, Hershko D, Saliba W, Keness Y, et al. Microbiologic Data in Acute Cholecystitis: Ten Years' Experience from Bile Cultures Obtained during Percutaneous Cholecystostomy. Surg Infect (Larchmt). 2017 Apr;18(3):345-9. doi: 10.1089/sur.2016.232.
Hung YL, Chen HW, Fu CY, Tsai CY, Chong SW, Wang SY, et al. Surgical outcomes of patients with maintained or removed percutaneous cholecystostomy before intended laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci. 2020 Aug;27(8):461-9. doi: 10.1002/jhbp.740.
Sakran N, Kopelman D, Dar R, Abaya N, Mokary SE, Handler C, et al. Outcome of Delayed Cholecystectomy after Percutaneous Cholecystostomy for Acute Cholecystitis. Isr Med Assoc J. 2018 Oct;20(10):627-31.
Woodward SG, Rios-Diaz AJ, Zheng R, McPartland C, Tholey R, Tatarian T, et al. Finding the Most Favorable Timing for Cholecystectomy after Percutaneous Cholecystostomy Tube Placement: An Analysis of Institutional and National Data. J Am Coll Surg. 2021 Jan;232(1):55-64. doi: 10.1016/j.jamcollsurg.2020.10.010.
Limaiem F, Sassi A, Talbi G, Bouraoui S, Mzabi S. Routine histopathological study of cholecystectomy specimens. Useful? A retrospective study of 1960 cases. Acta Gastroenterol Belg. 2017 Jul-Sep;80(3):365-70.
Frountzas M, Schizas D, Liatsou E, Economopoulos KP, Nikolaou C, Apostolou KG, et al. Presentation and surgical management of xanthogranulomatous cholecystitis. Hepatobiliary Pancreat Dis Int. 2021 Apr;20(2):117-27. doi: 10.1016/j.hbpd.2021.01.002.
Stanek A, Dohan A, Barkun J, Barkun A, Reinhold C, Valenti D, et al. Percutaneous cholecystostomy: A simple bridge to surgery or an alternative option for the management of acute cholecystitis? Am J Surg. 2018 Sep;216(3):595-603. doi: 10.1016/j.amjsurg.2018.01.027.
Fleming CA, Ismail M, Kavanagh RG, Heneghan HM, Prichard RS, Geoghegan J, et al. Clinical and Survival Outcomes Using Percutaneous Cholecystostomy Tube Alone or Subsequent Interval Cholecystectomy to Treat Acute Cholecystitis. J Gastrointest Surg. 2020 Mar;24(3):627-32. doi: 10.1007/s11605-019-04194-0.
Kuan LL, Oyebola T, Mavilakandy A, Dennison AR, Garcea G. Retrospective Analysis of Outcomes Following Percutaneous Cholecystostomy for Acute Cholecystitis. World J Surg. 2020 Aug;44(8):2557-61. doi: 10.1007/s00268-020-05491-5.
Altieri MS, Yang J, Yin D, Brunt LM, Talamini MA, Pryor AD. Early cholecystectomy (≤ 8 weeks) following percutaneous cholecystostomy tube placement is associated with higher morbidity. Surg Endosc. 2020 Jul;34(7):3057-63. doi: 10.1007/s00464-019-07050-z.
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