Abstract No. 573 The role of image-guided percutaneous cholecystostomy as a primary treatment in children

Abstract

To evaluate the indications, technical success, and complications of percutaneous trans-hepatic cholecystostomy in children. A single-center, IRB reviewed and exempted 20 years retrospective study of children who had IR-guided percutaneous trans-hepatic cholecystostomy. Data collected included; patient demographics, tube indication, tube size and type, duration of drainage, complications, and comorbid conditions. Exclusion criteria; drainage catheter exchange for pre-existing surgical tubes. A total of 14 primary trans-hepatic PCT procedures were performed in 14 patients using trans-hepatic access. The median age at intervention was 3.56 years with IQR (0.27–10.6 years), mean weight was 25 kg (range, 3.7–65.5 kg), 6 of whom were infants, and < 10 kg. Indications included; inspissated bile syndrome (50%, n = 7), acalculous cholecystitis (21%, n = 3), tumor-related obstructive jaundice (14%, n = 2), biliary calculi (7%, n = 1), suspected biliary atresia (7%, n = 1). Technical success was 85.7% (N = 12/14), two failed procedures, 2/14 bladder wall perforation followed by surgical drain placement. Catheter size ranged from 5- to 8.5-Fr, with the most common type of catheter being a Dawson-Muller Catheter (58.3%, n = 8/12). Comorbidities including, hematologic malignancies (n = 2), cystic fibrosis (n = 2), congenital heart disease (n = 2), renal transplant, viral congestive heart failure on ECMO, sickle cell disease, primary sclerosing cholangitis, and tracheoesophageal fistula were present in 12/14 patients. The median catheter tube dwell time was 13 days, IQR (6–31 days). Of the successful placements, there were no major complications. Three minor complications, self- limited GB wall perforation in 1 and premature tube dislodgement in 2 infants of the 12 successfully placed drainage tubes. In children, PCT can be used as a primary treatment modality for hepatobiliary disorders with good technical success but this procedure can be challenging, and in this study, failures were reflective of the initial experience.