Abstract No. 542 Can cystic duct patency be a reliable indicator in the management of the a cholecystostomy tube?

Abstract

Routinely, cholecystostomy tubes are placed in the septic patent who would otherwise be unfit for surgical management. Classical thought is that the patient should progress to cholecystectomy after recovery from the acute illness. However, with greater attention on outcomes, it seems that cholecystostomy tubes may be remaining in-situ for a longer duration. The goal of this study is to identify if patency of the cystic duct is a viable indicator for the removal of a cholecystostomy tube. We retrospectively reviewed all cholecystostomy tube placements between 2015 to 2016 at our institution. Cases where excluded tube placement was for an obstructing mass, palliative, prior cholecystostomy tube, or lost to follow-up. Data collected include indication for placement, age, duration until cystic duct opening and total tube time in situ, underwent a capping trial and outcome, surgery status, if the tube dislodged, and if died with tube in situ. Data was compared with a Cox Regression survival analysis and descriptive measures. 31 people (45.6% of eligible cholecystostomy tube placements) were identified to have a patent cystic duct during placement or with routine management. Half of the population had patency by 37 days after placement. There was no significance difference in time for the cystic duct to open between acute calculous versus acalculous cholecystitis as the indication for placement. As for outcomes, 45.3% proceeded with cholecystectomy, 12.9% passed with tube in-situ, and 42% where able to have the tube removed. Of those removed, 2 people (15.4%) had a recurrent cholecystitis at a mean of 246 days, who went on to tube replacement and subsequent tube removal at patency of cystic duct. Our analysis suggests that cystic duct patency may be a valid indicator for the management of a cholecystostomy tube without a large proportion of the population having to have re-intervention.