DOI: http://dx.doi.org/10.18203/2349-2902.isj20185455

Short-term outcomes in percutaneous cholecystostomies: a retrospective cohort study

Owain Jones, Hayley Fowler, Gian Abbott, Shopon Saha, Jim Evans, David Monk

Abstract


Background: Elderly patients account for over 50% of patients presenting with acute cholecystitis. High risk surgical candidates are often treated with a percutaneous cholecystostomy (PC) as an alternative to acute surgery. This study aims to determine whether any factor during the index admission with acute calculus cholecystitis treated with PC determines whether a delayed cholecystectomy is performed, in addition to whether there are any predictive factors for the presence of ductal stones or recurrent biliary morbidity.

Methods: A single-centred retrospective cohort study on radiologically inserted PCs for calculous cholecystitis between 2011-2017. Patient, radiological, biochemical and microbiological data were collected during the index admission. Primary outcome was whether the patient underwent a cholecystectomy and secondary outcomes included readmission with a further biliary morbidity or ductal stones necessitating an ERCP within 120days of the index cholecystostomy.

Results: 32 patients (median age 77years, median Charlson Index 5) underwent PC with a median follow up of 151 days (range 27-1113). PC drain-related morbidity was 58% with no 30-days or in-hospital mortality. Patient age (p=0.007), Charlson Index (p=0.015) and a positive bile culture (p=0.032) were associated with a delayed cholecystectomy (38.7% of patients). There were no predictive variables for recurrent biliary morbidity within 90days (38.7%). CRP (p=0.045), ALP (p=0.035) and ALT (p=0.047) were predictive of the need for an ERCP for CBD stones (32.3%).

Conclusions: PC is a safe procedure and is effective in overcoming the acute pathology in this comorbid population. However, the near-term prevalence of CBD stones and risk of further biliary morbidity remains significant suggesting that definitive surgery should be considered in suitable cases.


Keywords


Acute cholecystitis, Cholecystectomy, Choledocholithiasis, gallstones, Percutaneous cholecystostomy

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References


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