Percutaneous Cholecystostomy: Long-Term Outcomes in 324 Patients.

Abstract

To report technical success and clinical outcome of cholecystostomy tube placement along with timing-and method-of tube removal. A retrospective review of cholecystostomy tubes placed from January 2010 to September 2017 was performed at a single academic center. This search yielded 1160 patients. Of these patients, 324 (27.9%) met inclusion criteria for cholecystostomy placement, 199 (61.4%) males and 125 (38.6%) females, with mean age of 67years (range 6-101years). The indication for cholecystostomy tube placement, technical success, surgical candidacy, medical comorbidities, clinical outcome, tube indwelling time, complications, and follow-up were recorded. Indications for cholecystostomy tube placement included: acute cholecystitis (n=270; 83.3%), perforated cholecystitis (n=22; 6.8%), emphysematous cholecystitis (n=18; 5.6%), and other (n=14; 4.3%). Technical success was 100%. Many patients had multiple medical comorbidities including (most commonly): debilitation (n=211; 65.1%), cardiovascular disease (n=194; 59.9%), multisystem disease (n=181; 55.9%), and malignancy (n=131; 40.4%). After tube placement, 96 (29.6%) patients underwent definitive cholecystectomy, 94 expired (29.0%), 36 (11.1%) had a patent cystic duct on follow-up cholangiogram and subsequent cholecystostomy removal, 14 (4.3%) underwent cholecystoscopy with stone removal, and 3 (0.9%) had liver transplantation. Forty-five (13.9%) patients had indwelling tubes at the end of the study period. Mean tube indwelling time was 89days (range 0-586days). Technical success for cholecystostomy tube placement was 100% with all patients having clinical resolution of acute cholecystitis. Many patients were able to have tubes subsequently removed.