Percutaneous cholecystostomy is safe and effective option for acute calculous cholecystitis in select group of high-risk patients

Bala, Miklosh; Mizrahi, Ido; Mazeh, Haggi; Yuval, Jonathan B.; Eid, Ahmed; Almogy, Gideon

doi:10.1007/s00068-015-0601-1

Cited by 20 publications

(16 citation statements)

References 20 publications

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“…Percutaneous cholecystostomy (PC) has been used as a useful alternative treatment for these AC patients unfit for surgery. In recent years, PC has become an alternative treatment strategy for AC patients, especially in high‐risk patients …”

Section: Introductionmentioning

confidence: 99%

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Long‐term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis

Park

Yang

et al. 2019

J of Gastro and Hepatol

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Background and Aim Percutaneous cholecystostomy (PC) has been frequently used as an alternative treatment for acute cholecystitis in seriously ill patients unfit for surgery. The aim of this study was to investigate the recurrence rate and risk factors of recurrence. Methods Medical records of 102 patients who were followed up for more than 1 year after PC tube removal among 716 patients who underwent PC for acute cholecystitis treatment were retrospectively analyzed. Results The recurrence rate of acute cholecystitis after PC tube removal was 20.6% (21/102), and the mean time to recur was 660 days. Underlying cancer (odds ratio [OR]: 3.369; 95% confidence interval [CI]: 1.006–11.282; P = 0.0489), PC duration shorter than 44 days (OR: 5.596; 95% CI: 1.35–23.201; P = 0.0176), and the presence of common bile duct stone in initial imaging studies (OR: 24.393; 95% CI: 2.696–220.746; P = 0.0045) were positively correlated with recurrence. Tubogram before PC tube removal did not significantly lower the recurrence. However, PC tube clamping for several days significantly lowered the recurrence (OR: 0.108; 95% CI: 0.015–0.794; P = 0.0288). Fifty‐nine (57.8%) had acalculous cholecystitis. Calculous cholecystitis was negatively correlated with recurrence (OR: 0.267; 95% CI: 0.074–0.967; P = 0.0444). Receiver operating characteristic curve of the prediction model for recurrence verified its accuracy (area under the curve: 0.8475). Conclusion We should try to keep PC more than 6 weeks and clamp for 1–2 weeks before removal. For those with the presence of common bile duct stones, calculous cholecystitis, and underlying malignancy, we should keep PC for longer duration and carefully observe symptoms and signs of recurrence.

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Section: Introductionmentioning

confidence: 99%

“…In recent years, PC has become an alternative treatment strategy for AC patients, especially in high-risk patients. 4,5 Percutaneous cholecystostomy in critically ill patients with AC was first reported by Radder in 1980. 6 It has been mainly used in bridging procedure followed by interval cholecystectomy after stabilization.…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis

Park

Yang

et al. 2019

J of Gastro and Hepatol

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“…However, the Tokyo guidelines base management decisions on the severity of cholecystitis and do not factor in baseline patient comorbidities beyond the acute physiologic changes associated with the disease process. Conversely, U.S. studies evaluating outcomes after cholecystostomy tube placement place more emphasis on patient comorbidities or contraindications to surgery as the indication for cholecystostomy tube placement rather than severity of disease; 3–11 these studies do not incorporate the TG13 grading of cholecystitis or address management based on the Tokyo guidelines for cholecystostomy tube placement. In the U.S., significant controversy remains regarding management of these critically ill patients, including the decision to place a cholecystotomy tube as well as the decision for subsequent cholecystectomy.…”

Section: Introductionmentioning

confidence: 99%

Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis

Dimou

Adhikari

Mehta

et al. 2017

Journal of the American College of Surgeons

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Background The Tokyo guidelines recommend initial cholecystostomy tube drainage, antibiotics, and delayed cholecystectomy in patients with grade III cholecystitis. Study Design We used Medicare data (1996–2010) to identify patients ≥66 years admitted with grade III acute cholecystitis. We evaluated adherence to the Tokyo guidelines and compared mortality, readmission, and complication rates with and without cholecystostomy tube placement in a propensity-matched (1:3) cohort of patients with grade III cholecystitis. Results 8,818 patients were admitted with grade III cholecystitis; 565 patients (6.4%) had a cholecystostomy tube placed. Cholecystostomy tube placement increased from 3.9% to 9.7% over the study period. Compared to 1,689 propensity-matched controls, patients with cholecystostomy tube placement had higher 30-day (HR 1.26, 95% CI 1.05–1.50), 90-day (HR 1.26, 95% CI 1.08–1.46) and 2-year mortality (HR 1.19, 95% CI 1.04–1.36) and were less likely to undergo cholecystectomy in the 2-years after initial hospitalization (33.4% vs. 64.4%, HR 0.26, 95% CI 0.21–0.31). Readmissions were also higher at 30 days (HR 2.93, 95% CI 2.12–4.05), 90 days (HR 3.48, 95% CI 2.60–4.64), and 2 years (HR 3.08, 95% CI 2.87–4.90). Conclusions Since introduction of the Tokyo Guidelines (2007), use of cholecystostomy tubes in patients with grade III cholecystitis has increased, but the majority of patients do not get cholecystostomy tube drainage as first line therapy. Cholecystostomy tube placement was associated with lower rates of definitive treatment with cholecystectomy, higher mortality and higher readmission rates. These data suggest a need for further evaluation and refinement of the Tokyo guidelines.

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“…[16] Furthermore, PC was reported to have lower complication rate, and 96% of cases had symptomatic relief after the procedure in a retrospective study conducted with 104 patients. PC alone was the only definitive treatment for 70% of the cases.…”

Section: Discussionmentioning

confidence: 98%

Percutaneous Cholecystostomy: A Curative Treatment Modality In Elderly & High ASA Score Acute Cholecystitis Patients.

Tolan

Semiz-Oysu²,

Başak³

et al. 2016

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Acute cholecystitis (AC) is a common emergency seen by general surgeons. Optimal treatment is laparoscopic cholecystectomy (LC); however, in cases where surgery cannot be performed due to high risk of morbidity and mortality, such as in elderly patients with comorbid diseases, other treatment modalities may be used. Percutaneous cholecystostomy (PC) is one alternative method to treat AC. PC can be used to provide drainage of the gall bladder and control infection. Subsequently, interval cholecystectomy can be performed when there are better conditions. Presently described is experience and results with PC in high risk, elderly patients with AC.

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Percutaneous cholecystostomy is safe and effective option for acute calculous cholecystitis in select group of high-risk patients

Abstract: High operative risk due to older age and CAD preclude LC in more than one-third of patients following PC especially presenting with sepsis and elevated ALK-P. This study suggests that PC could be a safe treatment option in this select group of high-risk patients.

Cited by 20 publications

References 20 publications

Long‐term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis

Long‐term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis

Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis

Percutaneous Cholecystostomy: A Curative Treatment Modality In Elderly & High ASA Score Acute Cholecystitis Patients.

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