Percutaneous Cholecystostomy is an Effective Definitive Treatment Option for Acute Acalculous Cholecystitis

Kirkegård, Jakob; Horn, Torben; Christensen, Steffen; Larsen, Lone; Knudsen, Aage; Mortensen, Frank Viborg

doi:10.1177/1457496914564107

Cited by 55 publications

(31 citation statements)

References 26 publications

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“…However, Davis et al [35] recommended that in high-risk surgical patients with cholecystitis treated with PC that once the precipitating disorder has been controlled the cholecystostomy tube can be removed and removal of the gallbladder in the absence of stones is not needed. Additionally, Kirkegård et al [36] concluded that PC may be a successful definitive treatment for those with AAC and is associated with low mortality and need for subsequent cholecystectomy. However, results of this study suggest PC was used as a bridging therapy for interval cholecystectomy in at least four patients.…”

Section: Discussionmentioning

confidence: 99%

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Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

et al. 2017

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Background: Acute acalculous cholecystitis (AAC) accounts for 5-10% of cases of acute cholecystitis. The advantage of interval cholecystectomy for patients with AAC is unclear. Therefore, a retrospective analysis of patients diagnosed with AAC at our institution was performed over a 5-year period. Methods: Patients were identified via hospital coding using the keywords “acalculous cholecystitis, cholecystostomy and gall bladder perforation.” Follow-up data was obtained by performing a retrospective review of the patients' hospital records. Results: A total of 33 patients with AAC were identified and followed for a median period of 18 months. The median age at presentation was 70 (10-96) and American Society of Anesthesiologists (ASA) grade was 3 (1-5). Twenty-three patients (70%) were treated with antibiotics alone, 7 patients (21%) with percutaneous cholecystostomy and 3 patients (9%) with laparoscopic cholecystectomy. The 90-day mortality rate was 30% with significant correlation to comorbid status, as all deaths occurred in ASA grade 3-5 individuals (p = 0.020). Two patients (6%) developed recurrent AAC and were managed non-operatively. Conclusion: Antibiotics and cholecystostomy were the mainstay of AAC management, and comorbid status influenced related mortality. Our results suggest that it appears safe to avoid interval cholecystectomy in patients who recover from AAC, as they are typically high-risk surgical candidates.

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Section: Discussionmentioning

confidence: 99%

“…However, results of this study suggest PC was used as a bridging therapy for interval cholecystectomy in at least four patients. The rationale or indication for interval surgery was not clear [36].…”

Section: Discussionmentioning

confidence: 99%

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

et al. 2017

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“…Some clinicians may justify ongoing suspicion for gallstone-related complications following PC for acute acalculous cholecystitis based on the fact that right upper quadrant ultrasound is only 84% sensitive (95% confidence interval 76–92%) in detecting cholelithiasis, such that a substantial proportion of patients diagnosed with acalculous cholecystitis do in fact have gallstones (15). Regardless, many authors consider PC to be definitive therapy for patients with acalculous cholecystitis (4, 16–18) due to low rates or recurrent cholecystitis. Conversely, about one in four patients with acute calculous cholecystitis may develop recurrent cholecystitis within two to three months of PCT placement (3, 5, 7, 19–22).…”

Section: Discussionmentioning

confidence: 99%

“…Although PC has no apparent survival advantage over cholecystectomy, it does provide temporizing therapy while the patient recovers from an acute insult (1–3). Management of the PC tube remains controversial; decisions regarding drain management vary widely across institutions (4–8). In particular, the diagnostic and therapeutic yield of performing surveillance cholangiography by injecting contrast through the PC tube is unclear.…”

Section: Introductionmentioning

confidence: 99%

Routine surveillance cholangiography after percutaneous cholecystostomy delays drain removal and cholecystectomy

Loftus

Brakenridge

Moore

et al. 2017

Journal of Trauma and Acute Care Surgery

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Introduction Percutaneous cholecystostomy (PC) is often performed for patients with acute cholecystitis who are at high risk for operative morbidity and mortality. However, the necessity for routine cholangiography following PC remains unclear. We hypothesized that routine surveillance cholangiography (RSC) following PC would provide no benefit compared to on-demand cholangiography (ODC) triggered by signs or symptoms of biliary pathology. Methods We performed a three-year retrospective cohort analysis of patients managed with PC for acute cholecystitis at two tertiary care hospitals. Patients who had routine surveillance cholangiography (RSC, n=43) were compared to patients who had on-demand cholangiography (ODC, n=41) triggered by recurrent biliary disease. Results RSC and ODC groups were similar by severity of acute cholecystitis, presence of gallstones, systemic inflammatory response syndrome (SIRS) criteria at the time of PC, SIRS criteria 72 hours following PC, and hospital length of stay. Two patients in the ODC group developed clinical indications for cholangiography. All 44 RSC patients had cholangiography, and 67 total cholangiograms were performed in this group. Surveillance cholangiography identified six patients (14%) with cystic duct filling defect and seven patients (16%) with a common bile duct filling defect, all of whom were asymptomatic. Fifteen patients (35%) in the RSC group had 32 ERCP procedures; five patients (12%) in the ODC group had 7 ERCPs (p = 0.021). The ODC group had fewer days to drain removal (35 vs. 61, p < 0.001) and days to cholecystectomy (39 vs. 81, p = 0.005). Rates of recurrent cholecystitis, cholangitis, gallstone pancreatitis, drain removal, and cholecystectomy were similar between groups. Conclusion RSC following PC for acute cholecystitis identified biliary pathology in asymptomatic patients and propagated further testing, but did not provide clinical benefit. ODC was associated with earlier drain removal, earlier cholecystectomy, and decreased resource utilization. Level of Evidence Prognostic study - level III, therapeutic study - level IV

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“…The morbidity and mortality rate in these subgroups may reach up to 30 % [1][2][3]. Therefore, more appropriate treatment modalities for high-risk patients with AC should be considered [4]. At respect, management with antibiotics and decompression of the gallbladder with percutaneous cholecystostomy (PC) is often used in treating this group of patients [3,4].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided percutaneous cholecystostomy in acute cholecystitis: case vignette and review of the technique

Blanco

Pico

2015

J Ultrasound

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Acute cholecystitis is a frequent condition. Although cholecystectomy is the indicated treatment of this entity, it cannot be performed in some high-risk surgery patients, such as critically ill or those with multiple comorbidities. In these non-uncommon scenarios, percutaneous cholecystostomy is the recommended alternative treatment, which allows immediate decompression and drainage of the acutely inflamed gallbladder and thus reducing the patient's symptoms and the systemic inflammatory response. Ultrasound is the imaging method of choice to guide the percutaneous cholecystostomy procedure due to its real-time guidance, lack of ionizing radiation and portability, avoiding the need to transfer unhealthy patients to the radiology department. We will review the ultrasound-guided percutaneous cholecystostomy procedure, of special interest for radiologists, surgeons, and also intensive care and emergency physicians.Keywords Acute cholecystitis Á Interventional radiology Á Ultrasonography Á Cholecystostomy Sommario La colecistiti acuta é una malattia frequente. Benché la colecistectomia laparotomica sia una procedura validata essa non è idonea nella popolazione ad alto rischio, quali i pazienti critici o quelli con elevate comorbiditá. In tali categorie il trattamento percutaneo é la procedura suggerita consentendo di decomprimere la colecisti e ridurre i sintomi sirs correlati. La metodica eco assistita real time e la procedura di scelta in considerazione della assenza di radiazioni e la facilitádi esecuzione in ambiti extra radiologici. Descriveremo di seguito la tecnica di colecistostomia eco guidata di interesse radiologico, chirurgico e rianimatorio.

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Percutaneous Cholecystostomy is an Effective Definitive Treatment Option for Acute Acalculous Cholecystitis

Cited by 55 publications

References 26 publications

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

Routine surveillance cholangiography after percutaneous cholecystostomy delays drain removal and cholecystectomy

Ultrasound-guided percutaneous cholecystostomy in acute cholecystitis: case vignette and review of the technique

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