scholarly journals Outcomes of Percutaneous Cholecystostomy

2012 ◽  
Vol 1 (1) ◽  
pp. 20-23
Author(s):  
Rahul J Anand ◽  
Laurie Punch ◽  
Amy C Sisley ◽  
Steven b Johnson ◽  
Matthew Lissauer
Keyword(s):  
Acute Cholecystitis ◽  
Retrospective Chart Review ◽  
Acalculous Cholecystitis ◽  
Definitive Treatment ◽  
Percutaneous Cholecystostomy ◽  
Acute Calculous Cholecystitis ◽  
Open Operation ◽  
Biliary Pathology ◽  
Emergency Cholecystectomy ◽  
Calculous Cholecystitis

ABSTRACT Objective Emergency cholecystectomy in patients with severe comorbidities carries up to 30% mortality. Percutaneous cholecystostomy (PC) is accepted as acute management in these patients. This study evaluated outcomes of PC and the need for subsequent cholecystectomy. Methods Retrospective chart review evaluated all patients undergoing PC between June 1, 2005 and January 1, 2010. Results Fifty four patients underwent PC. Indications included acute calculous cholecystitis (44%), acalculous cholecystitis (33%) and other (22%). Twelve patients had PC related complications. Seventeen patients underwent CCY 144 ± 133 days after PC placement. 71% of those procedures were converted to open operation. 15% of patients had PC tube removed successfully without cholecystectomy, 62 ± 53 days after PC. Fifteen patients died in hospital after PC, four likely related to biliary pathology. Patients who underwent subsequent cholecystectomy were more likely to have had a diagnosis of acute cholecystitis (71% vs 33%, p < 0.05). Patients with a diagnosis of acalculous cholecystitis trended toward a higher likelihood of death compared to acute cholecystitis (8 of 18, 44% vs 4 of 24, 17%, p = 0.08). Conclusion PC can be definitive treatment in a minority of patients with acalculous cholecystitis and severe comorbidities. Interval cholecystectomy carries a high complication rate. How to cite this article Ferrada PA, Anand RJ, Punch L, Sisley AC, Johnson SB, Lissauer M . Outcomes of Percutaneous Cholecystostomy. Panam J Trauma Critical Care Emerg Surg 2012;1(1):20-23.

Percutaneous Cholecystectomy in the Intensive Care Patient

1998 ◽  
Vol 13 (2) ◽  
pp. 78-84
Author(s):  
John P. Mcgahan
Keyword(s):  
Intensive Care ◽  
Acute Cholecystitis ◽  
Intensive Care Patient ◽  
Acalculous Cholecystitis ◽  
Care Patient ◽  
Definitive Treatment ◽  
Acute Acalculous Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
Diagnostic Dilemma ◽  
Definitive Therapy

The diagnosis of acute cholecystitis in the intensive care patient is often problematic. While most patients with acute cholecystitis present with fever, increased white count, or symptomatology pertaining to the gallbladder, occasionally these patients may be comatose and often present a diagnostic dilemma. Surgical cholecystectomy is the treatment of choice for acute cholecystitis, but this therapy carries with it a high mortality rate in the desperately ill patient. Thus surgical cholecystostomy has been advocated as a temporizing procedure to be performed until these patients stabilize. More recently percutaneous cholecystostomy, performed at the patient's bedside under ultrasound guidance, has been successfully performed using small-size catheters. This is a low-risk temporizing procedure when performed by well-trained personnel. In fact, percutaneous cholecystostomy has been shown to be a definitive treatment in patients with acute acalculous cholecystitis. Patients with calculous cholecystitis may require more definitive therapy, such as cholecystectomy. Presented is a review of the development and the current applications of percutaneous cholecystostomy in intensive care patients with suspected acute cholecystitis.

scholarly journals Acute Calculous Cholecystitis: What is new in diagnosis and therapy?

HPB Surgery ◽  
1992 ◽  
Vol 6 (2) ◽  
pp. 69-78 ◽  
Author(s):  
Dirk J. Gouma ◽  
Huug Obertop
Keyword(s):  
Acute Cholecystitis ◽  
Ultrasound Guidance ◽  
Gallbladder Wall ◽  
Percutaneous Cholecystostomy ◽  
Endoscopic Retrograde ◽  
Extensive Experience ◽  
Acute Calculous Cholecystitis ◽  
First Choice ◽  
Prospective Trials ◽  
Calculous Cholecystitis

The management of patients with acute calculous cholecystitis has changed during recent years. The etiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant since bile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonography is first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneous puncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Early cholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to be superior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patients younger than 70–80 years of age, but a high mortality has been reported in octogenerians. Selective intraoperative cholangiography is now generally accepted and no advantage of routine cholangiography was shown in clinical trials. Percutaneous cholecystostomy can be successfully performed under ultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis. Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensive experience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder by introduction of a catheter in the cystic duct is feasible but data are still scarce.

scholarly journals Percutaneous cholecystostomy as an alternative to cholecystectomy in high risk patients with biliary sepsis: a district general hospital experience

2012 ◽  
Vol 94 (2) ◽  
pp. 99-101 ◽  
Author(s):  
W Al–Jundi ◽  
T Cannon ◽  
R Antakia ◽  
U Anoop ◽  
R Balamurugan ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Improvement ◽  
Acalculous Cholecystitis ◽  
Definitive Treatment ◽  
Bridge To Surgery ◽  
Percutaneous Cholecystostomy ◽  
Emphysematous Cholecystitis ◽  
Acute Calculous Cholecystitis ◽  
High Risk Patients ◽  
Risk Patients

INTRODUCTION Cholecystectomy is the standard treatment for patients with acute cholecystitis. However, percutaneous cholecystostomy (PC) is an alternative for patients at high risk for surgery. We present our five-year clinical experience with the aim of evaluating the efficacy of PC in high risk patients. METHODS A retrospective review was performed on 30 consecutive patients who underwent PC at our institution. The indications for cholecystostomy, route of insertion, technical success, clinical improvement, length of hospitalisation, in-hospital or 30-day mortality, complications, subsequent admissions and performance of interval cholecystectomy were recorded. The median follow-up period was 25 months (range: 1–52 months). RESULTS Thirty-two PCs were performed in thirty patients (mean age: 76.1 years; range: 52–90 years). The indications for PC were acute calculous cholecystitis (29/32), acalculous cholecystitis (1/32) and emphysematous cholecystitis (2/32). The route of insertion was transperitoneal for 22/32 PCs (68.8%) and transhepatic for 10/32 (31.2%). The procedure was technically successful in all patients although 2/22 transperitoneal drains (9.1%) were dislodged subsequently. Twenty-seven PCs (84.4%) resulted in clinical improvement within five days. The in-hospital or 30–day mortality rate was 16.7% (5/30). Eleven patients (36.7%) had a subsequent cholecystectomy: 6 were laparoscopic and 5 converted to open procedures at a median interval of 58 days (range: 1–124 days). CONCLUSIONS PCs are straightforward with few complications. Most patients improve clinically and the procedure can therefore be used as a definitive treatment in unfit patients or as a bridge to surgery in those who might subsequently prove fit for a definitive operation.

scholarly journals Percutaneous Cholecystostomy as an Alternative to Cholecystectomy in High-Risk Patients with Acute Cholecystitis

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Salih Tosun ◽  
Oktay Yener ◽  
Ozgur Ekinci ◽  
Aman Gapbarov ◽  
Murat Asik ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Clinical Improvement ◽  
Length Of Hospital Stay ◽  
Acalculous Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
Safe Alternative ◽  
Acute Calculous Cholecystitis ◽  
High Risk Patients ◽  
Risk Patients

Background: Cholecystectomy is the standard treatment for patients with acute cholecystitis. On the other hand, percutaneous cholecystostomy (PC) is an alternative for patients at high-risk for surgery. The aim of this study was to evaluate the clinical outcomes of PC. Methods: Surgically high-risk patients with acute cholecystits having undergone PC at our institution between January 2014 – January 2017 were evaluated. Data including the indications for PC, route of insertion, technical success, clinical improvement, length of hospital stay, mortality rates, procedure related complications, subsequent admissions and performance of interval cholecystectomy were recorded and analyzed. Results: The study group consisted of 30 patients with a mean age of 75.3 ( range: 49–99) years. The indications for PC were acute calculous cholecystitis in 28 (93.3%) and acalculous cholecystitis in 2 (6.7%) patients.  All procedures were performed via the transhepatic route. Twenty-five PCs (84.4%) resulted in clinical improvement within five days. A repeated PC was performed in two (6.7%) patients.  Seven (23.3%) patients underwent a subsequent cholecystectomy after 6 weeks. An emergent cholecystectomy was performed in one (3.3%) patient. Five (16.7%) patients died from underlying comorbid diseases, unrelated to the biliary system, during the follow-up. Conclusions: Patients with acute cholecystitis were promptly relieved from their symptoms following PC. There were only minor complications following the procedure and an interval cholecystectomy was necessary in only 23.3% of the patients. PC is a safe alternative to choecystectomy in high-risk patients with acute cholecystitis with satisfactory results.

scholarly journals Percutaneous cholecystostomy: a nonsurgical therapeutic option for acute cholecystitis in high-risk and critically ill patients

2003 ◽  
Vol 121 (6) ◽  
pp. 260-262 ◽  
Author(s):  
Guilherme de Castro Dabus ◽  
Sérgio San Juan Dertkigil ◽  
Jamal Baracat
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Option ◽  
Invasive Procedure ◽  
Acalculous Cholecystitis ◽  
Definitive Treatment ◽  
Distinct Advantage ◽  
Percutaneous Cholecystostomy

Percutaneous cholecystostomy offers a potentially important type of therapy for critically ill patients with acute cholecystitis who present high risk when undergoing laparotomy or laparoscopy under general anesthesia. It offers a distinct advantage for these kinds of patients by avoiding the risks of the surgical intervention. Percutaneous cholecystostomy is a safe and effective minimally invasive procedure with a high success rate and low procedure-related complications. It should be considered not only in temporary management of calculous cholecystitis, but also in definitive treatment in cases of acalculous cholecystitis.

Percutaneous Cholecystostomy Without Interval Cholecystectomy as Definitive Treatment of Acute Cholecystitis in Elderly and Critically Ill Patients

2008 ◽  
Vol 101 (6) ◽  
pp. 586-590 ◽  
Author(s):  
John Griniatsos ◽  
Athanasios Petrou ◽  
Paris Pappas ◽  
Konstantinos Revenas ◽  
Ioannis Karavokyros ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Definitive Treatment ◽  
Percutaneous Cholecystostomy

Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1)

Gut ◽  
2020 ◽  
Vol 69 (6) ◽  
pp. 1085-1091 ◽  
Author(s):  
Anthony Y B Teoh ◽  
Masayuki Kitano ◽  
Takao Itoi ◽  
Manuel Pérez-Miranda ◽  
Takeshi Ogura ◽  
...  
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Acute Cholecystitis ◽  
Clinical Success ◽  
Controlled Trial ◽  
Definitive Treatment ◽  
Percutaneous Cholecystostomy ◽  
Gallbladder Drainage ◽  
Pain Scores ◽  
Very High

ObjectiveThe optimal management of acute cholecystitis in patients at very high risk for cholecystectomy is uncertain. The aim of the current study was to compare endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) to percutaneous cholecystostomy (PT-GBD) as a definitive treatment in these patients under a randomised controlled trial.DesignConsecutive patients suffering from acute calculous cholecystitis but were at very high-risk for cholecystectomy were recruited. The primary outcome was the 1-year adverse events rate. Secondary outcomes include technical and clinical success, 30-day adverse events, pain scores, unplanned readmissions, re-interventions and mortalities.ResultsBetween August 2014 to February 2018, 80 patients were recruited. EUS-GBD significantly reduced 1 year adverse events (10 (25.6%) vs 31 (77.5%), p<0.001), 30-day adverse events (5 (12.8%) vs 19 (47.5%), p=0.010), re-interventions after 30 days (1/39 (2.6%) vs 12/40 (30%), p=0.001), number of unplanned readmissions (6/39 (15.4%) vs 20/40 (50%), p=0.002) and recurrent cholecystitis (1/39 (2.6%) vs 8/40 (20%), p=0.029). Postprocedural pain scores and analgesic requirements were also less (p=0.034). The technical success (97.4% vs 100%, p=0.494), clinical success (92.3% vs 92.5%, p=1) and 30-day mortality (7.7% vs 10%, p=1) were statistically similar. The predictor to recurrent acute cholecystitis was the performance of PT-GBD (OR (95% CI)=5.63 (1.20–53.90), p=0.027).ConclusionEUS-GBD improved outcomes as compared to PT-GBD in those patients that not candidates for cholecystectomy. EUS-GBD should be the procedure of choice provided that the expertise is available after a multi-disciplinary meeting. Further studies are required to determine the long-term efficacy.Trial registration numberNCT02212717

Sign in / Sign up

Export Citation Format

Share Document