Is percutaneous cholecystostomy acceptable as a bridge treatment for acute cholecystitis in high risk patients who has a biliary problem?

Abstract Background Cholecystostomy offers an alternative method for patients unfit to undergo immediate cholecystectomy. Nevertheless, the role of cholecystostomy in the clinical management of high-risk surgical patients remains unclear. One of the main problems concerning the therapeutic effect in critically ill patients with acute cholecystitis is the lack of validated, well-established scoring systems to stratify the severity of patient disease states. APACHE IV scoring system was useful to estimate the hospital mortality for high-risk patients. We try to evaluate the performance of the APACHE IV scoring system in patients over 65 years of age with acute cholecystitis and the therapeutic effect of percutaneous cholecystostomy. Methods 597 patients over 65 years of age with acute cholecystitis between January 2011 and December 2018 were retrospectively analyzed with the APACHE IV scores. Results Among the 597 patients, 52 successfully underwent cholecystectomy (2 died, 3.85%), 65 underwent percutaneous cholecystostomy (1 died, 1.54%), and 480 received conservative therapy (27 died, 5.63%). The fitness of the APACHE IV score prediction is good with the area under the ROC curve of 0.894. The APACHE IV models were well-calibrated (with the Hosmer-Lemeshow statistic). Using the method of binary regression analysis, for the patients whose estimated mortality rate was more than 10%, cholecystostomy was an important factor for prognosis (P = 0.048). The estimated mortality of PC patients before and after operation was compared, which indicated that the estimated mortality after puncture was significantly decreased, either in the whole patient group (P = 0.004) or in the group with an estimated mortality greater than 10% (P = 0.008). Conclusion The APACHE IV scoring system showed that cholecystostomy was a safe and effective treatment for elderly high-risk patients with acute cholecystitis.

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Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients

Surgical Endoscopy ◽

10.1007/s00464-011-2035-0 ◽

2011 ◽

Vol 26 (5) ◽

pp. 1343-1351 ◽

Cited By ~ 97

Author(s):

Andrew McKay ◽

Moaz Abulfaraj ◽

Jeremy Lipschitz

Keyword(s):

High Risk ◽

Acute Cholecystitis ◽

Percutaneous Cholecystostomy ◽

Long Term Outcomes ◽

High Risk Patients ◽

Risk Patients ◽

Short And Long Term

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Percutaneous Cholecystostomy for Severe Acute Cholecystitis: A Useful Procedure in High-Risk Patients for Surgery

Scandinavian Journal of Surgery ◽

10.1177/1457496918798209 ◽

2018 ◽

Vol 108 (2) ◽

pp. 124-129 ◽

Cited By ~ 1

Author(s):

S. Aroori ◽

C. Mangan ◽

L. Reza ◽

N. Gafoor

Keyword(s):

High Risk ◽

Acute Cholecystitis ◽

Open Cholecystectomy ◽

Length Of Hospital Stay ◽

Acalculous Cholecystitis ◽

Percutaneous Cholecystostomy ◽

High Risk Patients ◽

Risk Patients ◽

Physiological Reserve ◽

American Society

Background: Acute cholecystitis has the potential to cause sepsis and death, particularly in patients with poor physiological reserve. The gold standard treatment of acute cholecystitis (cholecystectomy) is often not safe in high-risk patients and recourse is made to percutaneous cholecystostomy as either definite treatment or temporizing measure. The aim of this study is to evaluate early and late outcomes following percutaneous cholecystostomy in patients with acute cholecystitis treated at our institution. Methods: All patients who underwent percutaneous cholecystostomy for acute cholecystitis (excluding patients with malignancy) between January 2005 and September 2014 were included in the study. Results: A total of 53 patients (22 female, median age, 74 years; range, 27–95 years) underwent percutaneous cholecystostomy during the study period. In total, 12 patients (22.6%) had acalculous cholecystitis. The main indications for percutaneous cholecystostomy were significant co-morbidities (n = 28, 52.8%) and patients too unstable for surgery (n = 21, 39.6%). The median time to percutaneous cholecystostomy from diagnosis of acute cholecystitis was 3.6 days (range, 0–45 days). The median length of hospital stay was 27 (range, 4–87) days. The overall 90-day mortality was 9.3% with two further deaths at 12-month follow up. The mortality was significantly higher in patients with American Society of Anesthesiology grade 4–5 (18% vs 0% in American Society of Anesthesiology grade 2–3, p = 0.026) and in patients with acalculous cholecystitis (25% vs 4.5%, p = 0.035). The overall readmission rate was 18%. A total of 24 (45.2%) patients had surgery: laparoscopic cholecystectomy, n = 11; laparoscopic converted to open, n = 5; open total cholecystectomy, n = 5; open cholecystectomy, n = 1; laparotomy and washout, n = 1; laparotomy partial cholecystectomy and closure of perforated small intestine and gastrostomy, n = 1. Conclusion: Percutaneous cholecystostomy is a useful temporary or permanent procedure in patients with acute cholecystitis of both calculous and acalculous origin, who are unfit for surgery.

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