Safe and effective short-time percutaneous cholecystostomy: A retrospective observational study

Abstract

The introduction of percutaneous cholecystostomy (PCT) has shifted the paradigm in treatment of acute calculous and acalculous cholecystitis. PCT has high success and low complication rates, but there are still unresolved issues regarding the duration of the procedure. The aim of our study is to determine the characteristics and outcome of patients treated with short-term PCT drainage. Patients who were admitted to the Department of gastroenterology and the Department of Abdominal Surgery at the University Hospital Center Split under the diagnosis of acute cholecystitis and who were treated with the PCT, in a period between January 2015 and January 2020, were retrospectively included in the study. During that timeframe we identified 92 patients and have analyzed their characteristics and clinical outcomes. The statistical analysis included the Kaplan-Meier method for calculating survival curves for grades 2 and 3, the log-rank test for testing the difference between survival rates of grade 2 and 3 patients, and logistic regression to determine variables that affected the outcome of our patients. According to the Tokyo guidelines, most of the patients (74, 80.43%) met the criteria for grade 2 cholecystitis, and the minority had grade 1 (9, 9.78%) and grade 3 (9, 9.78%) cholecystitis. The average drainage duration was 10.1 ± 4.8 (3-28) days. We identified mild complications in 6 cases. Nine patients (10%) had lethal outcome. The mortality in the largest group of patients with grade 2 cholecystitis was 5.48% and as high as 71.43% in patients with grade 3 cholecystitis. The complication rate was 6.5%. One quarter of gallbladder aspirates showed a ciprofloxacin resistance. Short-time PCT lasting approximately 10 days can be used safely and effectively for the treatment of patients with acute cholecystitis.

Assessment of Gallbladder Drainage Methods in the Treatment of Acute Cholecystitis: A Literature Review

“…Only 1% of patients had mild complications, and the reported long-term mortality rate was 6.8% [33]. Contrary, Simunic et al performed a retrospective study that included 92 patients treated with PGBD from 2015 until 2020 with a significantly shorter average drainage duration of 10.1 ± 4.8 (3-28) days, complication rate of 6.5%, and intrahospital mortality of 10% [34]. In order to compare these strategies, Di Martino et al conducted a retrospective comparative study on 151 patients who were separated into two groups depending on the PGBD duration (median 52 vs. 8 days) with no difference in complication rates, but a significantly higher risk of recurrent disease and readmissions in the group with the early drain removal [35].…”

“…Prolonged PGBD results in longer hospitalization, is related to a higher risk of PGBD dysfunction, and therefore, inevitably leads to higher expenses, not to neglect the patient discomfort [34]. We propose the early drain removal as soon as the clinical status and laboratory tests indicate the inflammation withdrawal but with the recommendation of the earliest possible cholecystectomy in all the surgically fit patients due to a high risk of recurrent disease or other potentially detrimental biliary complications such as acute pancreatitis, cholangitis, or biliary sepsis.…”

“…The reported incidence of PGBD-related adverse events varies significantly between the studies and is reported in a wide range (2.5-69%). However, the most commonly reported are mild complications with a rate of 5-15% [12,17,34,[39][40][41] and include catheter dislodgement or obstruction, minor bleeding, bile leakage, and vasovagal reaction [18].…”

“…Severe complications such as major bleeding, bowel perforation, pneumothorax, or death are rarely reported [17,20,24,30,34,36,42,43]. Catheter dislodgement is usually caused by respiratory movement and feeding-related gallbladder contractions, while bleeding might be caused by a fragile and inflamed gallbladder wall or intrahepatic vascular trauma [37].…”

“…Published studies have reported a short-term mortality rate of 5.4-35.8%, which is generally related to patient comorbidities and not the procedure itself [24,28,[30][31][32][33][34][44][45][46]. Predictions of worse outcomes include high Acute Physiology and Chronic Health Evaluation score II (APACHE II) and Charlson comorbidity index (CCI), as well as late procedure timing, as shown in one retrospective analysis [40].…”