Two-Center Prospective Comparison of the Trocar and Seldinger Techniques for Percutaneous Cholecystostomy

OBJECTIVE. The purpose of this study is to compare the safety and efficacy of the bedside ultrasound (US)-guided trocar technique versus the US- and fluoroscopy-guided Seldinger technique for percutaneous cholecystostomy (PC). SUBJECTS AND METHODS. This prospective noninferiority study compared the bedside US-guided trocar technique for PC (the trocar group; 53 patients [28 men and 25 women]; mean [± SD] age, 74.31 ± 16.19 years) with the US- and fluoroscopy-guided Seldinger technique for PC (the Seldinger group; 52 patients [26 men and 26 women], mean age, 79.92 ± 13.38 years) in consecutive patients undergoing PC at two large tertiary university hospitals. The primary endpoints were technical success and procedure-related complication rates. Secondary endpoints included procedural duration, pain assessment, and clinical success after up to 3 months of follow-up. RESULTS. PC was successfully performed for all 105 patients. The clinical success rate was similar between the two study groups (86.8% in the trocar group vs 76.9% in the Seldinger group; p = 0.09). Mean procedural time was significantly lower in the trocar group than in the Seldinger group (1.77 ± 1.62 vs 4.88 ± 2.68 min; p < 0.0001). Significantly more procedure-related complications were noted in the Seldinger group than in the trocar group (11.5% vs 1.9%; p = 0.02). Among patients in the Seldinger group, bile leak occurred in 7.7%, abscess formation in 1.9%, and gallbladder rupture in 1.9%. No procedure-related death was noted. Minor bleeding occurred in one patient (1.9%) in the trocar group, but the bleeding resolved on its own. The mean pain score during the procedure was significantly lower in the Seldinger group than in the trocar group (3.2 ± 1.77 vs 4.76 ± 2.17; p = 0.01). At 12 hours after the procedure, the mean pain score was significantly lower for patients in the trocar group (0.78 ± 1.0 vs 3.12 ± 1.36; p = 0.0001). CONCLUSION. Use of the bedside US-guided trocar technique for PC was equally effective as the Seldinger technique but was associated with fewer procedure-related complications, required less procedural time, and resulted in decreased postprocedural pain, compared with fluoroscopically guided PC using the Seldinger technique.

Timing of percutaneous cholecystostomy tube removal: systematic review

INTRODUCTION

Percutaneous cholecystostomy (PC) is an effective procedure to treat moderate or severe acute cholecystitis (AC) in high-risk patients. The ideal timing of the drainage removal is argued. The aim of this study is to analyze our experience and perform a systematic review about the ideal timing of a percutaneous cholecystostomy (PC) tube removal.

EVIDENCE ACQUISITION

A web-based literature search was performed and studies reporting the length of the catheter maintenance were analyzed. A regression analysis between the timing of tube removal and morbidity, mortality and disease recurrence was performed. Patients who underwent PC as definitive treatment of moderate or severe acute cholecystitis at our institution between 2011 to 2015 were analyzed. Clinical and technical success, morbidity, mortality and recurrence rates were retrospectively retrieved from a perspective database.

EVIDENCE SYNTHESIS

The systematic review yield to analyze 50 studies. None of them focused exclusively on outcome measures in relation to PC tube duration. The timing of the drain removal varied from 2 to 193 days. Regression analyses showed no correlation between length of tube maintenance and the considered outcomes. We studied 35 patients. The median age was 78 (range 52-94) and 88.5% had an ASA score ≥3. P-POSSUM estimated morbidity was 68.7% (range 34.3-99.0) and mortality was 15.8% (range 1.9-80.2). Clinical success was 97.1%. Procedure-related morbidity was 34.3%: 2 abscess, 1 bleeding, 1 biloma and 8 tube dislodgment. Biliary leakage was not observed. The observed 30-day overall mortality was 11.4%. The median follow-up was 16 months. Recurrence rate was 12.1%.

CONCLUSIONS

PC is an effective procedure in high-risk patients with moderate or severe AC. At the moment there is no evidence whether the duration of PC tube may affect outcome.

Ex vivo comparison of the lumen-apposing properties of EUS-specific stents (with video)

BACKGROUND AND AIMS

Several EUS-specific stents have become available. It has been claimed that some of these stents have lumen-apposing properties, but objective data measuring such properties are not available. The aim of this study is to measure the lumen-apposing force (LAF) of these stents.

METHODS

The LAF of 3 EUS-specific metallic stents (stents A, N, and S) were compared in an ex vivo setting. Four types of anastomoses were performed with the stents including cholecysto-duodenal, cholecysto-gastric, gastro-gastric, and gastro-jejunal and compared with a hand-sewn (HS) equivalent of the anastomosis. The outcome parameter was the LAF created by each type of stent.

RESULTS

Sixty-four anastomoses were created. The overall mean (standard deviation) LAFs were significantly higher for stents A and S (P < .001). This difference persisted regardless of the type of anastomosis: gastro-gastric (P = .002), gastro-jejunal (P = .005), cholecysto-gastric (P = .002), and cholecysto-jejunal (P = .003). The differences in LAF created by each type of stent across different types of anastomoses were also compared. A trend to significance was observed in the anastomoses created by stent N (P = .064) and stent A (P =.052); a significant difference in LAF was observed among different anastomoses created by stent S (P = .015). The LAF created by HS anastomosis was significantly higher than that for all stents across all anastomoses.

CONCLUSIONS

Stents A and S had a higher LAF. The use of these stents should be considered when performing EUS-guided transmural luminal anastomoses in non-adherent organs. Further studies are required to confirm the clinical efficacies of these EUS-specific stents.

Ultrasound-guided percutaneous cholecystostomy for acute cholecystitis in critically ill patients: one center's experience

BACKGROUND/AIMS

The standard treatment for acute cholecystitis is cholecystectomy; however, cholecystectomy is not an option in some patients who are too high-risk for emergency surgery. Ultrasound-guided percutaneous cholecystostomy is an alternative for such patients. This study presents one center's five-year clinical experience with ultrasound-guided percutaneous cholecystostomy for treatment of acute cholecystitis.

METHODS

In this study the records of all patients (18 total; mean age, 68.2+/-15.4 years; range, 42-91 years) who underwent ultrasound-guided percutaneous cholecystostomy for acute cholecystitis between June 1998 and October 2003 were reviewed. Duration of hospitalization, duration of tube placement, mortality and morbidity after tube placement, complication rates, culture results for aspirated bile, and clinical outcomes were analyzed.

RESULTS

Fourteen patients were diagnosed with acute calculous cholecystitis and four were diagnosed with acalculous cholecystitis. The average hospital stay was 19+/-12.6 days (range, 5-52 days), and the average duration of catheter drainage was 20.5+/-19.1 days (range, 1-75 days). Six patients underwent open cholecystectomy between days 16 and 26 of catheter drainage, and none had postoperative complications.

CONCLUSIONS

Ultrasound-guided percutaneous cholecystostomy is a relatively safe and easy method for treating acute cholecystitis in critically ill patients. The risk of complications is low and the likelihood of success is high.

Percutaneous Cholecystostomy Catheter Removal and Incidence of Clinically Significant Bile Leaks: A Clinical Approach to Catheter Management

OBJECTIVE

We sought to determine the incidence of bile leaks upon removal of small-bore percutaneous cholecystostomy catheters and to evaluate clinical and imaging guidelines to ensure safe catheter removal.

MATERIALS AND METHODS

A retrospective evaluation of all gallbladder drainages performed over a 5-year period revealed 163 patients (range, 7-98 years) who underwent percutaneous cholecystostomy catheter placement. Medical records and imaging studies were reviewed to assess the events at catheter removal (e.g., inadvertent removal, controlled removal with cholangiography without tract imaging, or controlled removal with cholangiography with tract imaging) and the incidence of major and minor bile leaks.

RESULTS

The events at catheter removal were assessed in 66 patients. Group 1 was 45 patients whose catheters were removed after a minimum of approximately 3 weeks with a cholangiogram that established cystic and common duct patency and no imaging of the tract. Catheters were not removed until the patient recovered from acute illnesses that contributed to acalculous cholecystitis. Group 2 was 11 patients managed similarly to group 1 except that tract imaging was performed at catheter removal. Group 3 was 10 patients whose tubes came out inadvertently without cholangiogram or tract imaging. Two major (group 2 and group 3) and two minor (group 2) bile leaks occurred. No bile leaks occurred in group 1 (p = 0.006).

CONCLUSION

Major bile leaks occurred in 3% of patients, and minor leaks occurred with equal frequency. Tract imaging may not be necessary in patients with small-bore gallbladder catheters who have recovered from critical illness, show patent cystic and common ducts, and have had catheters for 3-6 weeks.

Ultrasound-guided percutaneous cholecystostomy: update on technique and clinical applications

Acute cholecystitis is one of the most frequent causes for emergency admissions to General Surgery Departments. Due to the increased morbidity and high-risk of mortality, patients with severe underlying disease or a debilitated general condition are initially treated conservatively by administration of antibiotics, decompression, and drainage of the gallbladder. Percutaneous cholecystostomy (PC) is a minimally invasive method of percutaneous placement of a catheter, under ultrasound guidance, in the gallbladder lumen. PC can be performed at the bed-side and help the patient as well as physicians searching for a site and cause of sepsis. Dynamic ultrasound visualization of the puncture needle and gallbladder is crucial to avoid complications. PC cholecystectomy is an efficacious procedure with reported clinical response rates of 56%-100%. Clinical response is considered when a decrease in white blood cell count, defervescence, and decrease in the need for vasopressors are present. Patients with gallstones and symptoms and signs localized to the right upper quadrant are more likely to respond. Mortality is associated mainly with the underlying medical conditions. Ultrasound-guided PC can be followed by elective cholecystectomy at a later stage if the patient's condition permits, or by expectant or conservative management in those with acalculous cholecystitis.

Measurement of needle-tip bioimpedance to facilitate percutaneous access of the urinary and biliary systems: first assessment of an experimental system

RATIONALE AND OBJECTIVES

Percutaneous access to the renal collecting system or biliary system is most frequently performed under image guidance. However, current techniques lack a feedback mechanism to help confirm successful access. A percutaneous needle system has been developed consisting of a modified 18-gauge percutaneous access needle that measures tissue impedance at its needle tip. Initial results in utilizing this novel system to determine successful access into dilated kidney and gall bladder specimens are reported.

METHODS

Impedance measurements were recorded as the needle was precisely advanced through ex vivo kidney and liver/gall bladder specimens. In an anesthetized porcine model, impedance values were recorded with laparoscopic visualization as the needle was advanced percutaneously through abdominal wall, liver, and into gall bladder.

RESULTS

A characteristic, reproducible drop in impedance was noted with successful entry into ex vivo distended kidney and gall bladder specimens. This feature was also noted during in vivo percutaneous cholecystostomy.

CONCLUSIONS

A measurable, characteristic drop in tissue impedance signifies successful entry into the urinary and biliary systems. This impedance needle system may facilitate current percutaneous access techniques.

Selective use of tube cholecystostomy with interval laparoscopic cholecystectomy in acute cholecystitis

HYPOTHESIS

Tube cholecystostomy followed by interval laparoscopic cholecystectomy is a sale and efficacious treatment option in critically ill patients with acute cholecystitis.

DESIGN

Retrospective cohort study within a 4 1/2%-year period.

SETTING

University hospital.

PATIENTS

Of 324 patients who underwent laparoscopic cholecystectomy, 65 (20%) had acute cholecystitis; 15 of these 65 patients (mean age, 75 years) underwent tube cholecystostomy.

INTERVENTION

Thirteen patients at high risk for general anesthesia because of underlying medical conditions underwent percutaneous tube cholecystostomy with local anesthesia. Laparoscopic tube cholecystostomy was performed on 2 patients during attempted laparoscopic cholecystectomy because of severe inflammation. Interval laparoscopic cholecystectomy was attempted after an average of 12 weeks.

MAIN OUTCOME MEASURES

Technical details and clinical outcome.

RESULTS

Prompt clinical response was observed in 13 (87%) of the patients after tube cholecystostomy. Twelve patients (80%) underwent interval cholecystectomy. Laparoscopic cholecystectomy was attempted in 11 patients and was successful in 10 (91%), with 1 conversion to open cholecystectomy. One patient had interval open cholecystectomy during definitive operation for esophageal cancer and another had emergency open cholecystectomy due to tube dislodgment. Two patients (13%) had complications related to tube cholecystostomy and 2 patients died from sepsis before interval operation. One patient died from sepsis after combined esophagectomy and cholecystectomy. Postoperative minor complications developed in 2 patients. At a mean follow-up of 16.7 months (range, 0.5-53 months), all patients were free of biliary symptoms.

CONCLUSIONS

Tube cholecystostomy allowed for resolution of sepsis and delay of definitive surgery in selected patients. Interval laparoscopic cholecystectomy was safely performed once sepsis and acute infection had resolved in this patient group at high risk for general anesthesia and conversion to open cholecystectomy. Just as catheter drainage of acute infection with interval appendectomy is accepted in patients with periappendiceal abscess, tube cholecystostomy with interval laparoscopic cholecystectomy should have a role in the management of selected patients with acute cholecystitis.

[Method of punction transcutaneous cholecystostomy and device for accomplishment]

The author has developed a mode of punctional transcutaneous cholecystostomy--under ultrasound scanning control and the device for its accomplishment. The mode and the device provide increase of safety of the operation and the possibility of usage of ultrasound scanning without special punctional transducer. The results of clinical application of the developed method and the device in patients with acute cholecystitis are effective.

[Gallbladder puncture and drainage as therapy of acute cholecystitis]

PATIENTS AND METHODS

An ultrasound-guided, percutaneous puncture (n = 30) and cholecystostomy (n = 10) was performed on 40 high-risk patients aged between 38 and 99 (mean age 78 years old) suffering from acute lithogenic cholecystitis or acalculous stress cholecystitis on account of general inoperability. Two catheter dislocations and in 3 cases a slight bile leakage were observed as complications.

RESULTS

The puncture and drainage led to a dramatic alleviation of pain for all patients, the involution of a paralytic subileus and improvement of the general condition. Eighteen patients underwent a laparoscopic or open interval cholecystectomy in a stabilised condition. There was no recurrence of inflammation in 22 patients over a follow-up period of up to 5 years, so that one can assume a cicatrised healing of the acute choleycstitis.

CONCLUSIONS

Ultrasound-guided, percutaneous puncture and cholecystostomy are effective, low-risk, and only slightly invasive procedures which can be employed for risk patients with acute cholecystitis as a life-saving, and in some cases definitive treatment. On account of pathogenic considerations, they should be included in the diagnostic and therapeutic concept at an early stage, particularly for acute, acalculous stress cholecystitis.

Percutaneous cholecystectomy for patients with acute cholecystitis and an increased surgical risk

PURPOSE

To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk.

METHODS

Thirty-three patients with acute cholecystitis (calculous, n = 22; acalculous, n = 11) underwent percutaneous cholecystostomy by means of a transhepatic (n = 21) or transperitoneal (n = 12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy.

RESULTS

All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decrease in body temperature (n = 13), normalization of the white blood cell count (n = 3), or both (n = 6). There were 6 (18%) minor-moderate complications (transhepatic access, n = 3; transperitoneal access, n = 3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n = 9) and percutaneous and endoscopic stone removal (n = 3). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n = 2) and gallbladder ablation (n = 2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related.

CONCLUSIONS

Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary.

The role of percutaneous transhepatic cholecystostomy in the management of acute cholecystitis in high-risk patients

A method recently developed that may be an appropriate solution for high-risk patients with acute cholecystitis is percutaneous sonography-guided cholecystostomy. We report our experience in 10 high-risk elderly patients with clinical and sonographic diagnosis of acute cholecystitis. Immediate regression and resolution of septic symptoms was achieved in all cases. One patient was operated on as soon as his clinical condition stabilized, with uneventful postoperative recovery. The other nine were considered inoperable; of these, two were readmitted within a few months with recurrence of symptoms who underwent surgery, with a long and complicated postoperative course. The only complication we observed was temporary septicemia in one patient immediately after completion of the procedure. In view of these findings, we consider percutaneous transhepatic cholecystostomy an effective and safe method of treatment for acute cholecystitis in critically ill patients. However, this procedure should be regarded as a preliminary measure only, to render the patient more suitable for a formal cholecystectomy. We report our results and discuss technical and principal matters concerning percutaneous transhepatic cholecystostomy in the light of the current literature.

[Laparoscopic Y-Roux anastomosis]

In order to circumvent laparotomy in patients with biliary obstruction due to inoperable carcinoma of the pancreatic head, we evaluated the feasibility of a bypass operation using minimal invasive measures. A technique of laparoscopic cholecystojejunostomy was developed in adult pigs with a previous clip occlusion of the distal common bile duct to imitate choledochal obstruction. Complete biliary bypass was restored with a cholecystojejunostomy via a Roux-en-Y loop using two circular staplers (21, 25 or 29 mm diameter), introduced through a 33-mm-diameter trocar, to perform the proximal and distal anastomoses. 12 pigs operated in this way, recovered easily with normal weight gain and without technical complications. Contrast radiography of the biliary bypass at autopsy on day 28 demonstrated patent and leak-free anastomoses and functional bypass. We conclude that laparoscopic cholecystojejunostomy with Roux-en-Y loop is a feasible technique resulting in an uncomplicated postoperative course and a biliary bypass with optimal function. Endoscopic application of circular staplers to perform laparoscopic entero-biliary and entero-enteral anastomosis is practical and safe.

Technique of laparoscopic cholecystojejunostomy with a Roux-en-Y loop

In order to avoid laparotomy in patients with biliary obstruction due to inoperable carcinoma of the pancreatic head, we evaluated the feasibility of a bypass operation using minimal invasive measures. A technique of laparoscopic cholecystojejunostomy was tested in adult pigs who had undergone clip occlusion of the distal common bile duct to imitate choledochal obstruction. Complete biliary bypass was restored with a cholecystojejunostomy via a Roux-en-Y loop using two circular staplers (21, 25, or 29 mm diameter), introduced through a prototype 33-mm-diameter trocar, used to effect the proximal and distal anastomoses. Seven pigs operated on in this way recovered easily, with normal weight gain and without technical complications. Contrast radiography of the biliary bypass at autopsy on day 28 confirmed patent and leak-free anastomoses and functional bypass. We conclude that laparoscopic cholecystojejunostomy with a Roux-en-Y loop is a feasible technique and results in an uncomplicated postoperative course and a biliary bypass with optimal function. Endoscopic application of circular staplers for laparoscopic enterobiliary and enteroenteral anastomosis is practical and safe.

Percutaneous cholecystostomy for suspected acute cholecystitis in the hospitalized patient

PURPOSE

The authors evaluated the outcome of 49 hospitalized patients with sepsis and possible acute cholecystitis in whom emergency percutaneous cholecystostomy was attempted on 50 occasions.

PATIENTS AND METHODS

All cholecystostomy procedures were performed with ultrasound (US) guidance by using either the trocar (n = 35) or the Seldinger (n = 15) technique. Forty of the 50 cholecystostomies (80%) were attempted at the patients' bedside, and 49 of the 50 catheters (98%) were placed successfully.

RESULTS

Twenty-five of these patients eventually died of other causes (51%), but there was clinical improvement in 31 of the 49 patients (63%) based on a 72-hour decrease of temperature to less than 37.3 degrees C, normalization of white blood cell count, and/or resolution of abdominal pain. US findings were correlated with clinical response. Clinical improvement occurred most frequently after cholecystostomy in patients with either a distended gallbladder (74%), pericholecystic fluid (80%), or gallstones (92%). Forty-three of the 49 patients underwent cholecystostomy alone (88%), and six required further procedures (12%). There were six complications (12%) including catheter dislodgment (n = 3), hematoma (n = 1), and severe pain (n = 2). No deaths were directly attributed to percutaneous cholecystostomy.

CONCLUSION

Percutaneous cholecystostomy performed in septic hospitalized patients is a low-risk procedure that may be helpful in the treatment of some patients with suspected acute cholecystitis.

Biliary extracorporeal shock wave lithotripsy: the efficacy and safety of concomitant catheter cholecystostomy during biliary lithotripsy

The major limitations of biliary extracorporeal shock wave lithotripsy (ESWL) relate to adequate stone fragmentation and clearance of the stone fragments. We hypothesized the removal of small fragments with concomitant catheter cholecystostomy during ESWL would improve its efficacy. ESWL with aspiration or flushing through three different cholecystostomy catheters was performed on pigs with surgically implanted gallstones. Twenty-two percent and 46% of the pre-ESWL stone weight were aspirated through the 10 and 12 French catheters respectively. The clearance, size, and visualization of fragments was not significantly different between any of the groups. No significant post-mortem tissue or catheter damage was found. Catheter aspiration is a safe and effective method of removing gallstone fragments during biliary ESWL, but it does not improve stone fragmentation, stone clearance, or visualization of other fragments.

Laparoscopic cholecysto-jejunostomy for obstructing pancreatic cancer: technique and report of two cases

Laparoscopic cholecysto-jejunostomy was performed on two patients with obstructive jaundice due to a mass in the head of the pancreas. Diagnostic studies included CT scan, ERCP, arteriogram, and percutaneous needle aspiration cytology. Both patients recovered without event and were discharged after 4 days.

Percutaneous ultrasound guided cholecystostomy with double bubble catheter

We have used a prototype double bubble cholecystostomy catheter in four very ill patients. This has been done under local anaesthetic using a Seldinger technique, ultrasound guidance, and a trans-peritoneal approach to the gallbladder. The catheter provides drainage, cholangiography, and is intended to allow instrumentation of the biliary tract at a later stage.

[Diagnostic and therapeutic laparoscopy in acute cholecystitis in middle and old age]

Laparoscopic decompression of the gallbladder in elderly and senile patients having acute cholecystitis and in patients with severe coexistent diseases allows arresting the acute inflammatory process in the gallbladder, reducing the amount of forced operations which are extremely dangerous for this contingent of patients. Sanitation of the gallbladder with the electrolytic silver solution and irradiation of the bladder mucosa with laser is highly effective. Microcholecystostoma performed with a catheter having a diameter not less than 2.5 mm maintains adequate decompression of bile ducts and allows performing complete examination of them.

Experimental laparoscopic cholecystotomy

This instrument set for a single puncture technique of laparoscopic cholecystotomy was developed in 100 phantom tests with pig gallbladders and was later evaluated in 12 animal experiments. No complications were observed. After clinical development, treatment on an outpatient basis under local anaesthesia seems possible. For the patient this would mean avoiding general anaesthesia, shorter hospitalization, pain reduction and good cosmetic results, while reducing expenditure for the public health authorities at the same time. To avoid recurrent stones, diet and low-dose drug therapy should be considered. Because the procedure is minimally invasive, repetition of the laparoscopic procedure seems justified if stones recur.

[The choice of the procedure for endoscopic decompression in obstruction of the distal choledochus]

The employment of endoscopic methods in 399 patients for preoperative decompression of the biliary system in mechanical jaundice was analyzed. Positive and negative aspects of each of the methods were established and indications for using them were determined.

Porcine model for the development of interventional techniques in the gallbladder

A technique that permits repeated access to the porcine gallbladder through a surgically placed 18 French latex catheter is described and experience with this system in 22 swine is discussed. This porcine gallbladder model produces a reliable and reproducible means for studying clinically applicable interventional procedures.

Percutaneous subhepatic cholecystostomy with removable anchor

Percutaneous subhepatic cholecystostomy is preferable to the transhepatic technique because it spares the liver from unnecessary trauma and possible sepsis. In order to prevent gallbladder wall invagination and intraperitoneal bile leakage, the fundus is first secured to the abdominal wall with a removable anchoring device that is introduced through a 17-gauge needle system under sonographic and fluoroscopic control. With this technique, the gallbladder was drained in seven patients with possible empyema, and stones were extracted from the gallbladder in three patients who were poor risks for cholecystectomy. None of the patients had hypotension, bile leakage, peritonitis, or bleeding. Subhepatic cholecystostomy was done safely in 10 patients after temporarily anchoring the fundus to the abdominal wall.

Percutaneous cholecystostomy: diagnostic and therapeutic efficacy

Percutaneous cholecystostomy was performed in 32 patients for treatment of suspected cholecystitis (16 patients), decompression of biliary obstruction (six patients), or performance of diagnostic cholangiography (ten patients). The gallbladder was successfully catheterized in 32 of 32 patients (100%), and therapeutic or diagnostic benefit was achieved in 29 of 32 patients (91%). There were no major complications and no procedure-related deaths. There were four minor complications. In the 14 patients with severe cholecystitis there was substantial clinical improvement in 13. Five patients underwent catheter withdrawal after stabilization or long-term drainage. In biliary obstruction, hyperbilirubinemia was successfully treated with percutaneous cholecystostomy in five of six patients, and associated cholangitis was successfully treated in four of four. Ten patients underwent transcholecystic cholangiography; diagnostic visualization was achieved in all, including seven who underwent percutaneous cholecystostomy-assisted transhepatic biliary drainage. Percutaneous cholecystostomy is a safe and effective procedure in diagnosis and treatment of biliary tract problems.