4:03 PM Abstract No. 168 Results of percutaneous cholecystostomy tube placement in 324 patients

Abstract

Determine the technical success and clinical outcome of cholecystostomy tube placement along with removal rate after placement. A database search was performed from January 2010 to September 2017 for the term “cholecystostomy tube” yielding 1,160 patients. Patients with no indication for cholecystostomy (n = 625; 53.9%) or an outside hospital placed cholecystostomy (n = 211; 18%) were excluded. 324 (27.9%) patients with cholecystostomy tubes were included in the analysis. 312 (96.2%) tubes were placed by interventional radiology and 12 (3.8%) intraoperatively by surgery. Indication for cholecystostomy tube placement, ultrasound findings, initial lab studies, candidacy for surgery, comorbidities, access route, tube size, dwell time, bile culture results, reason for tube removal, follow-up, and complications were recorded. The indications for cholecystostomy tube placement included: acute cholecystitis (n = 270; 83.3%), perforated cholecystitis (n = 22; 6.8%), and emphysematous cholecystitis (n = 18; 5.6%). Ultrasound findings included: wall thickening (n = 208; 64.2%), calculi (n = 187; 57.7%), and pericholecystic fluid (n = 143; 44.1%). 297 (91.7%) patients were not surgical candidates. The most frequent reason for removal was cholecystectomy (n = 96; 29.6%). 36 (11.1%) had a patent cystic duct on follow-up, 19 (5.9%) had cholecystoscopy and stone removal, 15 (4.6%) underwent double J stent placement, and 3 (0.01%) had liver transplants. 94 patients died (29%), 33 (10.2%) had tubes migrate or fall out. 256 (79%) had transhepatic and 56 (17.2%) had transperitoneal tubes. Mean tube size was 7-French. Mean dwell time was 89 days (range, 0-586 days). 45 (13.9%) patients had tubes at the end of study period, and 19 (4.2%) were lost to follow-up, 13 (28.9%) had ongoing tube changes, 8 (17.8%) scheduled cholecystectomy, and 4 (8.9%) getting downsized with plans for removal. 321 (99%) of patients had no major adverse events, 2 (0.006%) had bile leak, and 1 (0.001%) developed septic shock. Cholecystostomy tube placement was possible in all patients and clinical symptoms resolved after placement in all cases. A majority of patients were able to have their tubes removed.