Ultrasound-guided Percutaneous Cholecystostomy Research Articles

Bedside Ultrasound-Guided Percutaneous Cholecystostomy in Critically Ill Patients—Outcomes in 51 Patients

Abstract Purpose The aim of this study was to report technical and clinical success of bedside ultrasound-guided percutaneous cholecystostomy (PC) tube placement in intensive care unit (ICU). Materials and Methods This is a retrospective study of 51 patients (36 males:15 females, mean age: 67 years) who underwent ultrasound-guided PC from May 2015 to January 2020. The indication for cholecystostomy tube placement, comorbidities, imaging finding, technical success, clinical success, timing of surgery post-cholecystostomy tube placement, indwelling catheter time, complications, and follow-up were recorded. Results Indications for cholecystostomy tube placement were acute calculous cholecystitis (n = 43; 84.3%), perforated cholecystitis (n = 5; 9.8%), and emphysematous cholecystitis (n = 3; 5.9%). Most of the patients had multiple comorbidities; these were diabetes mellitus, hypertension, cardiovascular disease, chronic renal disease, underlying malignancy, and multisystem disease with sepsis. All patients had undergone PC through transhepatic approach under ultrasound guidance in ICU. Technical success rate of the procedure was 100%. Clinical success rate was 92.1% (47/51) and among these 44/51 (86.2%) patients underwent definitive elective cholecystectomy, 3/51 (5.9%) patients had elective tube removal. Three of fifty-one (5.9%) patients did not improve; among these two underwent emergency surgery, while there was 1/51 (1.9%) mortality due to ongoing sepsis and multiorgan dysfunction. There were no procedure-related mortalities or procedure-related major complications. One patient had bile leak due to multiple attempts for cholecystostomy placement. Mean tube indwelling time was 13 days (range: 3–45 days). Conclusion Ultrasound-guided PC can be safely performed in ICU in critically ill patients unfit for surgery with high technical and clinical success rates. Early laparoscopic cholecystectomy should be preferred after stabilization of clinical condition following cholecystostomy.

Ultrasound-guided percutaneous cholecystostomy as bridging or definitive treatment in patients with acute cholecystitis grade II or III

BackgroundWe aimed to investigate the extent to which ultrasound (US)-guided percutaneous cholecystostomy (PC) is used as a bridging or definitive therapy for grade II and III acute cholecystitis and whether this treatment causes significant changes in C-reactive protein (CRP) and direct bilirubin (DB) levels in the first 72 h and the first three weeks. MethodsWe included 145 consecutive patients who underwent PC over 17 years. No patient had cirrhosis. PC was performed in the interventional radiology department under US guidance. ResultsUS-guided PC was the definitive treatment for more than half of the patients (51.7%) and decreased DB levels significantly more than CRP levels. ConclusionNo statistically significant correlation between those whose CRP and DB levels normalized within three weeks and those who did not and required a second invasive procedure. Nevertheless, the bridging treatment group was significantly older than the definitive treatment group.

Retrospective comparison of clinical outcomes of ultrasound-guided percutaneous cholecystostomy in patients with and without coagulopathy: a single center's experience.

To compare the complication rate and clinical outcomes for percutaneous cholecystostomy (PC) in patients with or without coagulopathy. We retrospectively reviewed electronic medical chart of patients who underwent ultrasound-guided PC with a 8.5-F drainage tube for acute cholecystitis between November 2003 and March 2017. We divided the patients into two groups: patients with coagulopathy (international normalized ratio > 1.5 or platelet count < 50 × 109/L or with a history of anticoagulant medication in preceding 5days) and patients without coagulopathy. Duration of drainage, duration of hospital stay, 30-day mortality and complication rates were compared between these two groups. Student's t test, Chi-square test or Fisher's exact test was used for bivariate analyses. Age, age-adjusted Charlson Comorbidity Index (ACCI) and sepsis-adjusted complication rates were also compared. In total, 141 patients had PC (mean age was 73.3 years [SD 13.3]; range 33-96 years; 94 men and 47 women). Fifty-two patients (36.9%) had coagulopathy and 89 patients (63.1%) were without any history of coagulopathy. Hemorrhagic complication rate was 3.5% (5 out of 141 patients, including 4 with coagulopathy and 1 without). One patient with coagulopathy died due to the hemorrhage. Duration of drainage was longer in patients with coagulopathy than patients without coagulopathy (20.0days vs. 14.8days; P = 0.033). No significant difference was observed with regard to duration of hospital stay (32.3days vs. 25.6days; P = 0.103) and 30-day mortality (7.7% vs. 1.1%; P = 0.062). The overall complication rate did not significantly differ (9.6% and 11.2%; P = 0.763), nor did age, ACCI or sepsis-adjusted complications. Clinical outcomes and complications rates after PC did not statistically differ between patients with and without coagulopathy, but there was a tendency of higher risk of hemorrhage in coagulopathy patients. Therefore, the indication of this procedure should be carefully determined.

S0962 Endoscopic Ultrasound-Guided Gallbladder Drainage vs Percutaneous Cholecystostomy vs Transpapillary Cystic Duct Stenting in Non-Surgical Patients With Acute Cholecystitis: A Large Tertiary Care Center Experience

INTRODUCTION: Cholecystectomy is the treatment of choice for patients with acute cholecystitis (AC). In high-risk non-surgical patients with many comorbidities, endoscopic ultrasound-guided gallbladder drainage (EUS-GB) via a lumen-apposing metal stent (LAMS), percutaneous cholecystostomy (PC), and endoscopic transpapillary cystic duct stenting (CDS) are alternatives to surgical management. However, data comparing the three modalities is limited. Our aim was to study outcomes of EUS-GB vs PC vs CDS in non-surgical patients with AC. METHODS: We retrospectively analyzed data for patients with AC between 2016 and 2020. Diagnosis was established using ICD-9 and ICD-10 codes. Patients with prior cholecystectomy, age < 18 years, and those without routine follow-up were excluded. Outcomes included total fluoroscopy time, post-procedural pain, narcotic use, clinical success, reinterventions, adverse events (AE), hospital length of stay (LOS), and mortality. Characteristics and outcomes were compared using one-way ANOVA or Kruskal-Wallis tests for continuous variable and Pearson’s chi-square or Fisher’s exact tests for categorical variables. Logistic regression models were used to estimate odds ratios and 95% confidence intervals. RESULTS: A total of 5323 patients with AC were reviewed, of which 182 non-surgical patients met our inclusion criteria (Figure 1). Mean age was 76.5 years and 61.2% were males, with 55 patients who underwent EUS-GB, 105 PC, and 23 CDS (Table 1). Baseline characteristics between the groups were similar. Total fluoroscopy time was significantly lower in the EUS-GB patients (1.7 mins) vs PC (3 mins) and CDS (3.9 mins) (P = 0.0002). Post-procedural pain and narcotic use were significantly lower in the EUS-GB and CDS patients compared to PC (P < 0.0001) (Table 2). Patients with EUS-GB and CDS (0% & 17.4%) underwent significantly fewer reinterventions compared to PC (92.4%, P < 0.0001). The EUS-GB (3.6%) and CDS (13%) group had significantly lower AE compared to PC (61%, P < 0.0001). The LOS was significantly lower in EUS-GB and CDS patients vs PC (P = 0.0027). Mortality between all the groups was similar. CONCLUSION: In high-risk non-surgical patients with AC, EUS-GB via LAMS is safer and more effective compared to CDS and PC as it is associated with the significantly shorter fluoroscopy time, less post-procedural pain and narcotic use, fewer AE, and the least recurrence of cholecystitis.Figure 1.: Inclusion and exclusion criteria for final analysis.Table 1.: Outcomes for EUS-GB vs PC vs CDS patientsTable 2.: Odds ratio for developing post-procedural pain and subsequent narcotic use

Should percutaneous cholecystostomy be used in all cases difficult to manage?

Cholecystectomy is the well-accepted management method for acute cholecystitis in patients suitable for surgery. Percutaneous cholecystostomy is planned and used in patients at high surgical risk due to acute symptomatic cholecystitis and/or acute or chronic comorbidity. Percutaneous cholecystostomy can provide permanent treatment, or it may act as a bridge for elective cholecystectomy. We presented the outcomes of 50 patients who initially underwent ultrasound-guided transhepatic percutaneous cholecystostomy and 4-6 weeks later, an interval cholecystectomy. All patients had either impaired gallbladder wall integrity on contrast-enhanced abdominal computed tomography performed during admission or had grade II acute cholecystitis according to the Tokyo Guidelines 13 diagnostic criteria and severity grading of acute cholecystitis or exhibited clinical signs of acute cholecystitis on the fifth day of non-operative treatment. Our results suggest that although percutaneous cholecystostomy is a useful method for alleviation of the emergency clinical condition in acute cholecystitis, it makes the interval cholecystectomy more difficult to perform due to the dense fibrosis developing during the healing process, eventually complicating laparoscopic cholecystectomy. Cholecystostomy may cause fibrosis during the healing process, eventually complicating laparoscopic cholecystectomy. Thus, there is a need for better evaluation during the identification of indications for cholecystostomy.

Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis.

Recent evidence suggests that endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an effective and safe alternative to percutaneous drainage (PT-GBD). We conducted a systematic review and meta-analysis to compare these two procedures in high risk surgical patients with acute cholecystitis. A comprehensive electronic literature search was conducted for all articles published up to October 2017 to identify comparative studies between EUS-GBD and PT-GBD. A meta-analysis was performed on outcomes including technical success, clinical success, post-procedure adverse events, length of hospital stay, unplanned hospital readmission, need for reintervention, recurrent cholecystitis, and disease- or treatment-related mortality for these two procedures. Five comparative studies (206 patients in the EUS-GBD group vs. 289 patients in the PT-GBD group), were included in the final analysis. There were no statistically significant differences in technical success (odds ratio [OR] 0.43, 95 % confidence interval [CI] 0.12 to 1.58; P = 0.21; I 2 = 0 %) and clinical success (OR 1.07, 95 %CI 0.36 to 3.16; P = 0.90; I 2 = 44 %) between the two procedures. EUS-GBD had fewer adverse events than PT-GBD (OR 0.43, 95 %CI 0.18 to 1.00; P = 0.05; I 2 = 66 %). Moreover, patients undergoing EUS-GBD had shorter hospital stays, with pooled standard mean difference of - 2.53 (95 %CI - 4.28 to - 0.78; P = 0.005; I 2 = 98 %), and required significantly fewer reinterventions (OR 0.16, 95 %CI 0.04 to 0.042; P < 0.001; I 2 = 32 %) resulting in significantly fewer unplanned readmissions (OR 0.16, 95 %CI 0.05 to 0.53; P = 0.003; I 2 = 79 %). EUS-GBD was associated with lower rates of post-procedure adverse events, shorter hospital stays, and fewer reinterventions and readmissions compared with PT-GBD in patients with acute cholecystitis who were unfit for surgery.

Acute Cholecystitis Caused by Vancomycin-ResistantEnterococcus faeciumin a Morbidly Obese Patient with Multiple Co-Morbidities

Abstract Background: Vancomycin-resistant Enterococcus faecium (VRE) is a low virulent pathogen. It can cause a variety of infections most commonly in immunosuppressed patients and those with previous exposure to broad-spectrum antibiotics. Case Presentation: A morbidly obese male with multiple comorbidities presented with acute cholecystitis. Because of the high operative risk it was decided to treat the condition with antibiotics and ultrasound-guided percutaneous cholecystostomy tube placement. Cultures of bile revealed VRE and initial therapy consisted of daptomycin. Cultures on day seven after initiation of daptomycin showed continuing growth of VRE and therapy was changed to linezolid and the patient was able to clear VRE from bile and cholecystitis resolved. The tube was removed after six months and interval cholecystectomy was planned after appropriate weight loss. Conclusions: We report the first case of VRE acute cholecystitis in North America. Only two additional cases have been reported thus f...

Inspissated bile syndrome; Safe and effective minimally invasive treatment with percutaneous cholecystostomy in neonates and infants

PurposeInspissated bile syndrome (IBS) is a rare cause of obstructive jaundice in neonates and infants with several treatment options reported. We present our experience with the use of minimally invasive ultrasound-guided percutaneous cholecystostomy drain catheter placement with ongoing saline lavage in neonates and infants. MethodsRetrospective chart review of patients treated with percutaneous cholecystostomy, from February 2010 till June 2015. We reviewed the technical and clinical success along with complications of the procedure. ResultsThere were 6 patients, mean age 17weeks (range 4–40). Most had significant risk factors for IBS presenting with biliary obstruction. A total of 7 procedures performed on the 6 patients, with a technical success rate of 6/7. One patient required cannulation of the intrahepatic biliary system. Drains were flushed for a median of 26days (10–70). Clinical success was achieved in all patients. 3 had displacement of the drain, one of which required re-insertion. Another developed a small sub-hepatic collection post procedure with pyrexia. On long term follow up one was found to have a forme fruste choledochal cyst. ConclusionCenters with suitable interventional radiology services ultrasound-guided percutaneous cholecystostomy drain catheter placement with ongoing saline lavage is a safe and effective minimally invasive treatment for IBS in neonates and infants.

Ultrasound-guided percutaneous cholecystostomy in acute cholecystitis: case vignette and review of the technique.

Acute cholecystitis is a frequent condition. Although cholecystectomy is the indicated treatment of this entity, it cannot be performed in some high-risk surgery patients, such as critically ill or those with multiple comorbidities. In these non-uncommon scenarios, percutaneous cholecystostomy is the recommended alternative treatment, which allows immediate decompression and drainage of the acutely inflamed gallbladder and thus reducing the patient's symptoms and the systemic inflammatory response. Ultrasound is the imaging method of choice to guide the percutaneous cholecystostomy procedure due to its real-time guidance, lack of ionizing radiation and portability, avoiding the need to transfer unhealthy patients to the radiology department. We will review the ultrasound-guided percutaneous cholecystostomy procedure, of special interest for radiologists, surgeons, and also intensive care and emergency physicians.

Ultrasound-guided double-tract percutaneous cholecystostomy combined with choledochoscopic gallbladder-preserving cholecystolithotomy for elderly patients with acute calculous cholecystitis

Objective To investigate the clinical efficacy of ultrasound-guided double-tract percutaneous cholecystostomy combined with choledochoscopic gallbladder-preserving cholecystolithotomy for the elderly patients with acute calculous cholecystitis. Methods The clinical data of 35 elderly patients with cholecystolithiasis who were admitted to the General Hospital of Chengdu Military Command from January 2012 to December 2013 were retrospectively analyzed. All the 35 patients received ultrasound-guided double-tract percutaneous drainage, and then received choledochoscopic gallbladder-preserving cholecystolithotomy. The long-term oral use of anti-inflammatory and cholagogue medications after operation reduced recurrence of cholecystolithiasis. All the patients were followed up by telephone interview and outpatient examination till June 30, 2014. Results All the 35 patients undergoing successfully the ultrasound-guided double-tract percutaneous cholecystostomy. Of the 35 patients, 1 patient with the puncture bleeding was cured successfully by symptomatic treatment, 1 patient was treated by cholecystectomy due to the unformed sinus tract under costal margin, and other 34 patients underwent successfully cholecystolithotomy. The follow-up was carried out for 4 to 24 months and 1 patient was diagnosed as with recurrence of cholecystolithiasic. Conclusion Ultrasound-guided double-tract percutaneous cholecystostomy combined with choledochoscopic gallbladder-preserving cholecystolithotomy for elderly patients with acute calculous cholecystitis is safe and feasible, with an advantage of promotional value. Key words: Cholecystolithiasis; Elderly patients; Gallbladder-preserving cholecystolithotomy; Cholecystostomy

Ultrasound-guided double-tract percutaneous cholecystostomy combined with a choledochoscope for performing cholecystolithotomies in high-risk surgical patients

Cholecystolithiasis is the most common disease treated by general surgery, with an incidence of about 0.15-0.22%. The most common therapies are open cholecystectomy (OC) or laparoscopic cholecystectomy (LC). However, with a greater understanding of the function of the cholecyst, more and more patients and surgeons are aware that preserving the functional cholecyst is important for young patients, as well as patients who would not tolerate anesthesia associated with either OC or LC. Based on these considerations, we have introduced a notable, minimally invasive treatment for cholecystolithotomy. We performed a retrospective review of patients with cholecystolithiasis who were unable to tolerate surgery or who insisted on preserving the functional cholecyst. Our particular approach can be simply described as ultrasound-guided percutaneous cholecystostomy combined with a choledochoscope for performing a cholecystolithotomy under local anesthesia. Ten patients with cholecystolithiasis were treated via this approach. All except one patient had their gallbladder stones totally removed under local anesthesia, without the aggressive procedures associated with OC or LC. The maximum number of gallbladder stones removed was 16, and the maximum diameter was 13 mm without lithotripsy. After the minimally invasive surgery, the cholecyst contractile functions of all patients were normal, confirmed via ultrasound after a high-fat diet. Complications such as bile duct injury, biliary fistula, and bleeding occurred significantly less often than with OC and LC. The recurrence rates for each of 2 post-operative years were about 11.11% (1/9, excluding a failure case) with uncertainty surrounding recurrence or residue, and 22.22% (2/9, including one non-recurrence patient with follow-up time of 22 months), respectively. Ultrasound-guided percutaneous cholecystostomy combined with choledochoscope is a safe, efficient, and minimally invasive cholecystolithotomy method. We recommend this technique for the management of small stones (less than 15 mm) in high-risk surgical patients.

Complication Rate of Ultrasound-Guided Percutaneous Cholecystostomy in Patients With Coagulopathy

The purpose of this article is to compare the complication rate for ultrasound-guided percutaneous cholecystostomy in patients with coagulopathy to the rate in patients with normal coagulation. We performed a database search for patients who underwent ultrasound-guided percutaneous cholecystostomy from January 2000 through December 2010. Patients were divided into those with normal coagulation and those with coagulopathy, as documented by abnormal laboratory values (international normalized ratio ≥ 1.5 and platelet count ≤ 50 × 10(9)/L) or history of anticoagulant medication in the preceding 5 days. Medical records were reviewed, and complication rates and subsequent treatment was recorded. Statistical analysis was performed using the Fisher exact and chi-square tests. Two hundred forty-two patients underwent ultrasound-guided percutaneous cholecystostomy (132 men and 110 women; mean [± SD] age, 73.9 ± 15.9 years; range, 22-104 years). One hundred thirty-two patients were coagulopathic and 110 had normal coagulation. Major complications related to ultrasound-guided percutaneous cholecystostomy were rare (4/242 cases [1.7%]) and included hemorrhage requiring transfusion (n = 1), death directly related to the procedure (n = 1), sepsis related to the procedure (n = 1), and abscess or biloma formation (n = 1). All of these occurred in the group with normal coagulation. Fourteen additional deaths (5.8%) that occurred within 30 days of the procedure were related to comorbidities. Minor catheter-related complications (15/242 [6.2%]) were due to catheter dislodgement (n = 11 [4.5%]), failure of placement (n = 1 [0.4%]), and hemorrhage not requiring transfusion (n = 3 [1.2%]). Two of the minor hemorrhagic complications were seen in the coagulopathic group and one in the normal coagulation group (p = 0.599). There is no difference in the complication rate for ultrasound-guided percutaneous cholecystostomy in patients who are coagulopathic compared with those who have normal coagulation.

Percutaneous cholecystostomy (PC) in the management of acute cholecystitis in high risk patients.

To determine the role of ultrasound-guided percutaneous cholecystostomy (PC) regarding complications and outcome in the management of acute cholecystitis in patients high risk for surgery and anaesthesia and not responding to conservative management. Observational case series. The study was carried out at The Aga Khan University Hospital, Karachi, from January 2003 to December 2007. The study included patients admitted with acute cholecystitis considered unfit for immediate surgery but not responding to conservative management. Percutaneous cholecystostomy was conducted under ultrasound guidance. The studied variables included patients' demographics, co-morbid, ultrasound findings of biliary tree, indication for percutaneous cholecystostomy, its route, complication during or after procedure, patient's clinical outcome (upto 48 hours) and 30 days follow-up. Those with incomplete medical record and follow-up were excluded. Data were analyzed and results compiled using SPSS 16.0 version. Mean and standard deviation for quantitative variable like age was derived. Proportions were computed for complications and patient's clinical outcome. Forty one patients with complete medical record were studied including 15 (37%) males and 26 (63%) females. Mean age was 65 +/-13.5 years. Indications for PC included calculus cholecystitis in 25, acalculous cholecystitis in 10, empyema in 04 and gallbladder perforation in 02 patients. No complication was seen during or after procedure in 31 (75%) patients. Complications occurred in 10 (25%) patients including vagal reaction, pain during procedure, tube blockage, catheter dislodgement and bile leakage. Favourable clinical response (improvement in clinical symptoms) was noted in 34 (83%) patients. Seven (17%) patients did not show any improvement in clinical condition after the procedure. On 30 days follow-up, 9 patients had undergone cholecystectomy, 5 (12%) patients expired due to underlying clinical conditions and the rest were settled without requiring an immediate cholecystectomy. There was no direct procedure-related mortality. Imaging guided PC is a safe and effective procedure for immediate management of non-resolving acute cholecystitis in patients high risk for surgery and anaesthesia and not responding to conservative management.

Percutaneous transhepatic cholecystostomy followed by mini-laparotomy cholecystectomy for acute obstructive cholecystitis in the high-risk elderly

Objective To study the use of ultrasound-guided percutaneous transhepatic cholecystostomy (PTGD) followed by selective minilaparotomy cholecystectomy (MC) for acute obstructive cholecystitis in the high-risk elderly.Method A retrospective study was conducted on 120 patients who received ultrasound-guided PTGD followed by selective MC from January 2008 to December 2010.Results PTGD+ MC were performed successfully on 120 patients with acute severe obstructive chole cystitis.In all the patients,the abdominal pain was relieved within 2-3 h of operation,and the temperature decreased to normal from 24- 48 h after operation.The average time of drainage was 10 days.In 97 patients MC was performed 1 week after PTGD,and in 23 patients 2 weeks after PTGD.Bleeding from gallbladder bed occurred in 1 patient.No patient suffered from bile leak.There was no major complication or death after PTGD+ MC.Conclusion PTGD followed by selective MC is a simple,efficacious and minimally invasive treatment for high-risk elderly patients with acute obstructive cholecystitis. Key words: Cholecystitis; Elderly; Minimally invasive

Percutaneous Transhepatic Cholecystostomy for Choledocholithiasis with Acute Cholangitis in High-Risk Patients

To evaluate the safety and feasibility of percutaneous transhepatic cholecystostomy for choledocholithiasis with acute cholangitis in high-risk patients. Six high-risk patients of choledocholithiasis complicated with moderate to severe acute cholangitis underwent percutaneous transhepatic cholecystostomy and subsequent interval open surgery from January, 2008 to October 2010. These patients, who were not suitable for both endoscopic and transhepatic biliary drainage, were reviewed retrospectively. Percutaneous transhepatic cholecystostomy was performed uneventfully. One patient developed hemoperitoneum which was successfully controlled by conservative treatment. Biliary peritonitits occurred in two patients, one ceased to leak spontaneously, the other developed a biloma which was cured by repuncture. No procedure-related death occurred. Sepsis was relieved completely 3 to 4 days after procedure. Two patients underwent interval open exploration of the common bile duct. One patient who recovered from sepsis succumbed on day 12 post-cholecystostomy because of an acute cardiac infarct. The other 3 patients were cured of sepsis and discharged without further treatment. The results showed that ultrasound-guided percutaneous transhepatic cholecystostomy is a safe and effective procedure for choledocholithiasis with moderate to severe acute cholangitis in highly selected high-risk surgical patients. It may deserve to become a definitive therapy for subsequent surgical management. Larger controlled studies are needed to further confirm our findings.

Ultrasound-guided percutaneous cholecystostomy in critically ill patients: preliminary results with clinical outcome

Ultrasound-guided percutaneous cholecystostomy in critically ill patients: preliminary results with clinical outcome

Ultrasound-guided percutaneous cholecystostomy in high-risk surgical patients.

In critically ill patients, cholecystectomy is associated with a high mortality rate. The aim of this study was to evaluate the safety, efficacy and long-term outcome of ultrasound-guided percutaneous cholecystostomy (USGPC) in critically ill patients with acute cholecystitis. Clinical records of 51 patients, all considered high-risk surgical patients, with acute cholecystitis treated with USGPC between 1987 and 1999, were retrospectively reviewed. Response was defined as improvement in clinical symptoms and signs, and/or reduction in c-reactive protein and white blood count levels within 72 h. Long-term results were evaluated by means of clinical records and written correspondence. Gallbladder stones were seen in 28 patients whereas 23 had acalculous cholecystitis. Ninety percent showed clinical improvement after USGPC. Cholecystectomy was performed in 16%, of which 6% after recurrent cholecystitis. Recurrence of cholecystitis occurred in 22%. Hospital mortality was 16%. None of the deaths was procedure related or related to acute cholecystitis alone. Major complications relating to the USGPC were rare (4%), while minor catheter-related complications were quite common. USGPC is a procedure with few complications and a high success rate. In patients with acalculous cholecystitis as well as in many patients with calculous cholecystitis, no further treatment was needed.

Cholécystostomie percutanée dans les cholécystites aiguëschez les patients à haut risque

Aim of the study: The aim of this retrospective study was to report the results of percutaneous cholecystostomy in a selected group of high-risk patients with contraindications of general anesthesia. Patients and methods: From October 1995 to December 1999, a percutaneous cholecystostomy was performed in 29 patients with acute cholecystitis. There were 20 women and nine men with a mean age of 80.6 years (range: 59 to 95 years). All the patients were ASA III ( N = 23) or ASA IV ( N = 6). Ultrasound-guided percutaneous cholecystostomy was performed in 24 cases and computed tomography-guided cholecystostomy in five cases. Results: Percutaneous cholecystostomy was easily performed in 28 cases; there was one failed procedure. The drainage was not efficient in three patients who were operated on with one postoperative death of a patient who had a necrotic cholecystitis. There was no mortality in relation with cholecystostomy. One patient died at day 15 from myocardic infarction. The morbidity rate was 3.4% (one case). Postoperative length of hospital stay was 13 days (range: 7–30 days). The duration of the entire procedure ranged from 9 to 60 days (mean: 20 days). The mean follow-up of patients was 17 months (range: 4–40 months). One patient had recurrent acute cholecystitis and another one had angiocholitis; two patients underwent delayed elective laparoscopic cholecystectomy; 20 patients remained asymptomatic and 16 were still alive at the time of this study (13 with biliary stones and three without). Conclusion: Percutaneous cholecystostomy is a valuable alternative procedure for high-risk patients with acute cholecystitis. It’s a safe and usually effective procedure without mortality and with a low morbidity. Whenever possible, percutaneous cholecystostomy should be followed by laparoscopic cholecystectomy.

Ultrasound-Guided Percutaneous Cholecystostomy as an Initial Treatment for Acute Cholecystitis in Elderly Patients

Background/Aims: Acute cholecystitis may atypically present itself in the elderly, thus causing diagnostic and therapeutic problems, and it is well recognized as a high-risk condition for morbidity. The outcome has been attributed to the presence of servere co-morbid disease. In an attempt to minimize the postoperative morbidity and mortality, we performed ultrasound-guided percutaneous transhepatic cholecystostomy (PC) on elderly patients with acute cholecystitis for both initial treatment and subsequent diagnosis of their biliary tract disorders. Methods: Those being more than 70 years old, had acute episode of cholecystitis for more than 48 h and still had positive Murphy’s signs and distended gallbladders were candidates for ultrasound-guided PC. Results: Forty-two elderly patients underwent ultrasound-guided PC. Once the condition of each patient showed signs of improvement and stability, cholangiography was performed via PC tube. The results of the cholangiography showed 20 patients with gallbladder stones, 16 with common bile duct stones and 6 with acalculous cholecystitis. Once stable enough, 32 patients underwent definite surgery, 18 having cholecystectomies, 14 having cholecystectomies and choledocholithotomies. The 6 patients with acalculous cholecystitis had the PC tube removed 3 weeks later, without further surgery. Two patients had gallbladder stones removed by choledochofiberscope. Two patients had common bile duct stone removed by endoscopic sphincteroplasty. Although postoperative complications occurred in 5 patients (11.9%), no instance of operative mortality was found. Conclusion: Our findings lead us to conclude that the use of PC in the early treatment of acute cholecystitis in elderly patients can decrease postoperative morbidity and mortality.

Percutaneous cholecystostomy treatment of acute cholecystitis in pregnancy

Medical treatment of acute cholecystitis in pregnancy may lead to prolonged management and recurrent hospitalizations, whereas surgical management predisposes the mother and fetus to the inherent risks of surgery and general anesthesia. Although percutaneous cholecystostomy has been proven to be an efficacious treatment in critically ill and general surgery patients who are at high risk for surgery, this technique has not been used routinely as a treatment for acute cholecystitis in pregnancy. We report two women (at 30 and 32 weeks' gestation, respectively) who presented with acute calculus cholecystitis. The first patient was a 33-year-old female who failed endoscopic retrograde cholangiopancreatography and papillotomy and had multiple return visits for nausea and vomiting. The second patient was a 23-year-old female with three previous admissions for cholecystitis during the pregnancy. These two patients underwent emergency ultrasound-guided percutaneous transhepatic cholecystostomy. Percutaneous cholecystostomy provided adequate biliary decompression for the remainder of the pregnancy; the patients delivered healthy infants and underwent successful uncomplicated elective laparoscopic cholecystectomy within 3 months of delivery. Percutaneous cholecystostomy may provide a safe and effective alternative for the palliation of acute cholecystitis in pregnancy until a postpartum cholecystectomy can be performed.