328 Local Delays in Tubogram Completion for Biliary Patency – Why the Wait?

Abstract

Abstract Aim Despite the CHOCOLATE Study (CS Loozen et al 2018) recommending laparoscopic cholecystectomy even in high-risk patients, we are completing more cholecystostomies than ever to manage acute cholecystitis, particularly during the COVID pandemic. Fluoroscopic tubogram can be performed to check biliary patency post intervention, this can potentially definitive treatment or discharge. We locally assessed the time delay in accessing tubograms. Method Audit of all local tubograms completed of the biliary system (September 2020-2022). All tubogram procedures (not just biliary) within the North West Mersey Region over the same period also quantified. Results 397 tubograms were conducted in the NW; 51 locally. 26/51 were for post IR drain & 1 for biliary t-tube assessment from 26 patients (av. age 73, range 59-90yrs). 19 were as inpatient, 8 outpatients. Assessing working days between expected completion and actual completion in both groups: 73.7% of inpatient tubograms were completed within 3 or less days (av. 3.6, range 0-17 days). 37.5% of outpatient tubograms were completed within 5 days of less (av. 7.9, range 0-23 days). There was 1 true complication (tube slippage & removal), 3 extravasations & 1 abandoned procedure. 4 (15%) patients had died at the time of data assessment. Conclusions With the rise of cholecystostomy, there has been an increase in biliary tubograms. These are a specialist procedure; there is a time delay in obtaining them and they do not come without risk. Provision of tubograms needs to be assessed, or a move back to traditional initial surgical management considered.