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Müller T, Braden B. Ultrasound-Guided Interventions in the Biliary System. Diagnostics (Basel) 2024; 14:403. [PMID: 38396442 PMCID: PMC10887796 DOI: 10.3390/diagnostics14040403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Ultrasound guidance in biliary interventions has become the standard tool to facilitate percutaneous biliary drainage as well as percutaneous gall bladder drainage. Monitoring of the needle tip whilst penetrating the tissue in real time using ultrasound allows precise manoeuvres and exact targeting without radiation exposure. Without the need for fluoroscopy, ultrasound-guided drainage procedures can be performed bedside as a sometimes life-saving procedure in patients with severe cholangitis/cholecystitis when they are critically ill in intensive care units and cannot be transported to a fluoroscopy suite. This article describes the current data background and guidelines and focuses on specific sonographic aspects of both the procedures of percutaneous biliary drainage and gallbladder drainage.
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Affiliation(s)
- Thomas Müller
- Medizinische Klinik II, St. Josefs-Hospital, Beethovenstraße 20, 65189 Wiesbaden, Germany
| | - Barbara Braden
- Medizinische Klinik B, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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MacCormick A, Jenkins P, Zhong J, Makris GC, Gafoor N, Chan D. Nationwide Outcomes following Percutaneous Cholecystostomy for Acute Calculous Cholecystitis and the Impact of Coronavirus Disease 2019: Results of the Multicentre Audit of Cholecystostomy and Further Interventions (MACAFI study). J Vasc Interv Radiol 2023; 34:269-276. [PMID: 36265818 DOI: 10.1016/j.jvir.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 09/09/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To assess the mortality, readmission rates, and practice variation of percutaneous cholecystostomy (PC) in patients with acute calculous cholecystitis in the United Kingdom (UK). MATERIALS AND METHODS A total of 1,186 consecutive patients (636 men [53.6%]; median age, 75 years; range, 24-102 years) who underwent PC for acute calculous cholecystitis between January 1, 2019, and December 31, 2020, were included from 36 UK hospitals. The exclusion criteria were diagnostic aspirations, absence of acute calculous cholecystitis, and age less than 16 years. The coronavirus disease 2019 (COVID-19) lockdown was declared on March 26, 2020, in the UK, which served to distinguish among groups. RESULTS Most patients (66.3%) underwent PC as definitive treatment, whereas 31.3% underwent PC as a bridge to surgery. The overall 30-day readmission rate was 42.2% (500/1,186), and the 30-day mortality was 9.1% (108/1,186). Centers performing fewer than 30 PCs per year had higher 90-day mortality than those performing more than 60 (19.3% vs 11.0%, respectively; P = .006). A greater proportion of patients presented with complicated acute calculous cholecystitis during the COVID-19 pandemic compared to prior (49.9% vs 40.9%, respectively; P = .007), resulting in more PCs (61.3 vs 37.9 per month, respectively; P < .001). More PCs were performed in tertiary hospitals than in district general hospitals (9 vs 3 per 100 beds, respectively; P < .001), with a greater proportion performed as a bridge to surgery (50.5% vs 22.8%, respectively; P < .001). CONCLUSIONS The practice of PC is highly variable throughout the UK. The readmission rates are high, and there is significant correlation between mortality and PC case volume.
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Affiliation(s)
| | - Paul Jenkins
- Peninsula Radiology Academy, Plymouth, United Kingdom; University Hospitals Plymouth NHS Trust, Plymouth, Department of Interventional Radiology, London, United Kingdom; UK National Interventional Radiology Trainee Research (UNITE) Collaborative.
| | - Jim Zhong
- UK National Interventional Radiology Trainee Research (UNITE) Collaborative; St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Harehills, Leeds, and Department of Interventional Radiology
| | - Gregory C Makris
- UK National Interventional Radiology Trainee Research (UNITE) Collaborative; Department of Interventional Radiology, St Thomas' Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom; St Thomas' Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Nelofer Gafoor
- University Hospitals Plymouth NHS Trust, Plymouth, Department of Interventional Radiology, London, United Kingdom
| | - David Chan
- University Hospitals Plymouth NHS Trust, Department of Upper GI Surgery
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- UK National Interventional Radiology Trainee Research (UNITE) Collaborative
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Cruz-Centeno N, Jovet-Toledo G, Ramirez-Tanchez C. What happens after percutaneous cholecystostomy tube for acute calculous cholecystitis? SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Hess GF, Sedlaczek P, Haak F, Staubli SM, Muenst S, Bolli M, Zech CJ, Hoffmann MH, Mechera R, Kollmar O, Soysal SD. Persistent acute cholecystitis after cholecystostomy - increased mortality due to treatment approach? HPB (Oxford) 2022; 24:963-973. [PMID: 34865990 DOI: 10.1016/j.hpb.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Percutaneous cholecystostomy (PC) is a treatment option for acute cholecystitis (AC) in cases where cholecystectomy (CCY) is not feasible due to limited health conditions. The use of PC remains questionable. The aim was to retrospectively analyse the outcome of patients after PC. METHODS All patients who underwent PC for AC at a tertiary referral hospital over 10 years were included. Descriptive statistics, analysed mortality with and without CCY after PC, and a multivariable logistic regression for potential confounder and a landmark sensitivity analysis for immortal time bias were used. RESULTS Of 158 patients, 79 were treated with PC alone and 79 had PC with subsequent CCY. Without CCY, 48% (38 patients) died compared to 9% with CCY. In the multivariable analysis CCY was associated with 85% lower risk of mortality. The landmark analysis was compatible with the main analyses. Direct PC-complications occurred in 17% patients. Histologically, 22/75 (29%) specimens showed chronic cholecystitis, and 76% AC. CONCLUSION Due to the high mortality rate of PC alone, performing up-front CCY is proposed. PC represents no definitive treatment for AC and should remain a short-term solution because of the persistent inflammatory focus. According to these findings, almost all specimens showed persistent inflammation.
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Affiliation(s)
- Gabriel F Hess
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Philipp Sedlaczek
- University of Basel, Faculty of Medicine, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Fabian Haak
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Sebastian M Staubli
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Simone Muenst
- Institute of Medical Genetics and Pathology, University Hospital Basel, Schönbeinstrasse 40, 4056, Basel, Switzerland
| | - Martin Bolli
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Christoph J Zech
- Institute of Radiology, University Hospital Basel, Petersgraben 4, 4051, Basel, Switzerland
| | - Martin H Hoffmann
- Institute of Radiology, St. Clara Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Robert Mechera
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Otto Kollmar
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Savas D Soysal
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland.
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5
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Ben Yehuda A, Markov E, Jeroukhimov I, Lavy R, Hershkovitz Y. Should cholangiography be part of the management of every patient with percutaneous cholecystostomy? Am J Surg 2022; 224:987-989. [PMID: 35501188 DOI: 10.1016/j.amjsurg.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/19/2022]
Affiliation(s)
- A Ben Yehuda
- Division of Surgery Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel
| | - E Markov
- Division of Surgery Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel
| | - I Jeroukhimov
- Trauma Unit Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel
| | - R Lavy
- Division of Surgery Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel
| | - Y Hershkovitz
- Trauma Unit Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel.
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Chen SY, Huang R, Kallini J, Wachsman AM, Van Allan RJ, Margulies DR, Phillips EH, Barmparas G. Outcomes Following Percutaneous Cholecystostomy Tube Placement for Acalculous Versus Calculous Cholecystitis. World J Surg 2022; 46:1886-1895. [DOI: 10.1007/s00268-022-06566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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Hung YL, Sung CM, Fu CY, Liao CH, Wang SY, Hsu JT, Yeh TS, Yeh CN, Jan YY. Management of Patients With Acute Cholecystitis After Percutaneous Cholecystostomy: From the Acute Stage to Definitive Surgical Treatment. Front Surg 2021; 8:616320. [PMID: 33937313 PMCID: PMC8083985 DOI: 10.3389/fsurg.2021.616320] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Percutaneous cholecystostomy (PC) has become an important procedure for the treatment of acute cholecystitis (AC). PC is currently applied for patients who cannot undergo immediate laparoscopic cholecystectomy. However, the management following PC has not been well-reviewed. The efficacy of PC tubes has already been indicated, and compared to complications of other invasive biliary procedures, complications related to PC are rare. Following the resolution of AC, patients who can tolerate anesthesia and the surgical risk should undergo interval cholecystectomy to reduce the recurrence of biliary events. For patients unfit for surgery, whether owing to comorbidities, anesthesia risks, or surgical risks, expectant management may be applied; however, a high incidence of recurrence has been noted. In addition, several interesting issues, such as the indications for cholangiography via the PC tube, removal or maintenance of the PC catheter before definitive treatment, and timing of elective surgery, are all discussed in this review, and a relevant decision-making flowchart is proposed. PC is an effective and safe intervention, whether as expectant treatment or bridge therapy to definitive surgery. High-level evidence of post-PC care is still necessary to modify current practices.
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Affiliation(s)
- Yu-Liang Hung
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Mu Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Outcomes of Patients Treated With Upfront Cholecystostomy for Severe Acute Cholecystitis. Surg Laparosc Endosc Percutan Tech 2020; 30:79-84. [PMID: 31876887 DOI: 10.1097/sle.0000000000000747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Percutaneous cholecystostomy tube (PCT) placement is a treatment method for acute cholecystitis, both in adult patients unsuitable for surgery and those failing to improve with conservative management. The purpose of this study was to assess the outcomes of patients undergoing cholecystostomy. MATERIALS AND METHODS A review of consecutive patients who underwent PCT insertion over a 10-year period was performed. Outcomes assessed included cholecystostomy dwell time, tubogram requirement, cholecystostomy reinsertion, cholecystectomy, bile leaks, and mortality. RESULTS One hundred eight patients (77 male individuals, 31 female individuals) were included. The mean age was 70 years (range: 29 to 93 y). A total of 89 transhepatic and 19 transperitoneal PCTs were inserted. Fifty-nine patients (55%) had a subsequent tubogram to assess cystic duct patency or catheter position. Mean catheter dwell time was 17 days (range: 1 to 154 d). Eleven (10%) required PCT reinsertion. Time to reinsertion ranged from 2 to 163 days (mean=38 d). Fifty-three patients (50%) had no further biliary intervention after removal of the cholecystostomy catheter. One patient required subsequent drainage of a hepatic abscess, and another developed a biloma. Thirty-two patients (30%) underwent cholecystectomy (66% laparoscopic, 34% open). Thirty-day mortality after PCT insertion was 8.3%. Twenty patients (19%) died of non-cholecystostomy-related illness during the 10-year follow-up period. CONCLUSIONS Cholecystostomy is an important treatment method of acute cholecystitis as a bridge to cholecystectomy or as an alternative definitive treatment option in those unsuitable for surgery. A tubogram is not always necessary before tube removal. Cholecystostomy tubes can be removed safely with little risk of bile leak if patients are clinically well, and clean-appearing bile is draining.
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Hung YL, Chen HW, Fu CY, Tsai CY, Chong SW, Wang SY, Hsu JT, Yeh TS, Yeh CN, Jan YY. Surgical outcomes of patients with maintained or removed percutaneous cholecystostomy before intended laparoscopic cholecystectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:461-469. [PMID: 32281739 DOI: 10.1002/jhbp.740] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/11/2020] [Accepted: 03/02/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Percutaneous cholecystostomy (PC) followed by definitive cholecystectomy is an alternative treatment for acute cholecystitis (AC). We retrospectively investigated the impact of PC tube removal before definitive cholecystectomy on surgical outcomes. METHODS From 2012 to 2017, 942 AC patients underwent PC at a single institute. Eligible patients were selected according to inclusion criteria. Demographic data, clinical and laboratory parameters, and treatment outcomes were extracted from medical records. Categorization of patients and subsequent subgroup analysis were based on cholangiography. RESULTS The rate of emergent cholecystectomy in the PC tube removal group was higher than that in the PC tube preserved group (OR = 2.969, 95% CI 1.334-6.612, P = 0.008). In subgroup analysis of patients with patent bile flow under cholangiography, the rate of emergent cholecystectomy was higher in the PC tube removal group (OR = 3.173, 95% CI 1.182-8.523, P = 0.022), though the incidence of complications was higher in the PC tube preserved group (P = 0.012). In addition, routine preoperative cholangiography had no clinical impact on surgical outcome. CONCLUSION Percutaneous cholecystostomy tube can be removed before subsequent LC to avoid postoperative complications, though removal of the PC tube is associated with an increased likelihood of emergent cholecystectomy.
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Affiliation(s)
- Yu-Liang Hung
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Wu Chen
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Yi Tsai
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sio-Wai Chong
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Kuan LL, Oyebola T, Mavilakandy A, Dennison AR, Garcea G. Retrospective Analysis of Outcomes Following Percutaneous Cholecystostomy for Acute Cholecystitis. World J Surg 2020; 44:2557-2561. [DOI: 10.1007/s00268-020-05491-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Morales-Maza J, Rodríguez-Quintero J, Santes O, Hernández-Villegas A, Clemente-Gutiérrez U, Sánchez-Morales G, Mier y Terán-Ellis S, Pantoja J, Mercado M. Percutaneous cholecystostomy as treatment for acute cholecystitis: What has happened over the last five years? A literature review. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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12
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Morales-Maza J, Rodríguez-Quintero JH, Santes O, Hernández-Villegas AC, Clemente-Gutiérrez U, Sánchez-Morales GE, Mier Y Terán-Ellis S, Pantoja JP, Mercado MA. Percutaneous cholecystostomy as treatment for acute cholecystitis: What has happened over the last five years? A literature review. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2019; 84:482-491. [PMID: 31521405 DOI: 10.1016/j.rgmx.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 01/04/2023]
Abstract
Acute cholecystitis is one of the most frequent diseases faced by the general surgeon. In recent decades, different prognostic factors have been observed, and effective treatments described, to improve the results in patients with said pathology (lower morbidity and mortality, shorter hospital stay, and minimum conversion of laparoscopic to open procedures). In general, laparoscopic cholecystectomy is the standard treatment for acute cholecystitis, but it is not exempt from complications, especially in patients with numerous comorbidities or those that are critically ill. Percutaneous cholecystostomy emerged as a less invasive alternative for the treatment of acute cholecystitis in patients with organ failure or a prohibitive surgical risk. Even though it is an effective procedure, its usefulness and precise indications are subjects of debate. In addition, there is little evidence on cholecystostomy catheter management. We carried out a review of the literature covering the main aspects physicians involved in the management of acute cholecystitis should be familiar with.
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Affiliation(s)
- J Morales-Maza
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - J H Rodríguez-Quintero
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - O Santes
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - A C Hernández-Villegas
- Departamento de Radiología Intervencionista, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - U Clemente-Gutiérrez
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - G E Sánchez-Morales
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - S Mier Y Terán-Ellis
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - J P Pantoja
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - M A Mercado
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México.
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Successful Cholecystectomy After Endoscopic Ultrasound Gallbladder Drainage Compared With Percutaneous Cholecystostomy, Can it Be Done? J Clin Gastroenterol 2019; 53:231-235. [PMID: 29697498 DOI: 10.1097/mcg.0000000000001036] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided gallbladder drainage (EGBD) with a lumen apposing metal stent is becoming a widely accepted alternative to percutaneous gallbladder drainage (PTGD) for patients who are not candidates for cholecystectomy (CCY). In some patients, medical comorbidites can improve, allowing them to undergo CCY. We compare feasibility and outcomes of interval CCY after EGBD versus PTGD. METHODS We conducted a multicentered international cohort study of patients who underwent EGBD or PTGD and then underwent interval CCY. Baseline patient demographics, procedural details, and follow-up data were recorded and compared. RESULTS In total, 34 patients were included. Thirteen patients underwent EGBD followed by CCY (mean age, 53.77±17.27, 46.15% male), and 21 patients underwent PTGD followed by CCY (mean age, 62.14±13.06, 61.9% male). There was no statistically significant difference in mean Charlson Comorbidity Index (P=0.12) or etiology of cholecystitis (P=0.85) between the 2 groups. All patients had a technically successful CCY. There was no difference between rates of open versus laparoscopic CCY (P=1). In addition, there was no difference in postsurgical adverse events (P=0.23). CONCLUSIONS Surgical CCY after EGBD with lumen apposing metal stent is safe and feasible for the management of cholecystitis. If patient's underlying medical conditions improve, previous EUS-GLB drainage should not preclude patients from undergoing CCY as part of standard of care.
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