WTP3.3 Percutaneous cholecystostomy: an intervention requiring re-admission and re-intervention?

Abstract

Abstract Aims A national database study reported a 723% increase in cholecystostomy procedures in England between 2000 and 2019 (Lunevicius, 2022). We aimed to evaluate short and long-term clinical outcomes following percutaneous cholecystostomy for acute cholecystitis (AC) at our centre. Methods A single-centre, retrospective cohort study was conducted utilising data from a tertiary centre database, 2012–2020. Tokyo guidelines were used to grade AC severity. Outcomes were evaluated. Results Seventy-six patients were included. The median age was 76 (IQR 67.5-83.3). The M:F ratio was 1.1:1. Twenty-nine patients (38.2%) had Tokyo Grade 3 AC. The remaining 47 patients (61.8%) had Tokyo Grade 2 AC. Forty-seven patients (61.8%) experienced at least one post-cholecystostomy complication. During index admission, seven patients (9.2%) required admission to ITU, seven patients (9.2%) died, and six (7.9%) required emergency cholecystectomy. The median length of stay was 12 days (IQR 9.33-17.0). Of the 69 patients who were discharged, 23 (33.3%) required emergency readmission due to AC recurrence; 12 of these (17.4%) were readmitted within 30 days. Eleven patients (15.9%) had recurrence of AC whilst the gallbladder catheter remained in-situ, and a further 15 patients (21.7%) had recurrence of AC after catheter removal. Twenty patients (29.0%) required additional percutaneous drainage, of which 11 (15.9%) received repeat cholecystostomy. Twelve patients (17.4%) underwent elective cholecystectomy, with a median interval between PC and elective cholecystectomy of 62.5 days (IQR 20.3-118). Conclusions PC is associated with high post-procedure mortality and morbidity. Clinicians should be discerning in patient selection criteria for PC.