Clinical study
Percutaneous Cholecystostomy for Acute Cholecystitis: Ten-Year Experience

https://doi.org/10.1016/j.jvir.2011.09.030Get rights and content

Abstract

Purpose

To review the clinical course of patients with acute cholecystitis treated by percutaneous cholecystostomy, and to identify risk factors retrospectively that predict outcome.

Materials and Methods

A total of 106 patients diagnosed with acute cholecystitis were treated by percutaneous cholecystostomy during a 10-year period. Seventy-one (67%) presented to the emergency department (ED) specifically for acute cholecystitis, and 35 (23%) were inpatients previously admitted for other conditions. Outcomes of the two groups were compared with respect to severity of illness, leukocytosis, bile culture, liver function tests, imaging features, time intervals from onset of symptoms to medical and percutaneous intervention, and whether surgical cholecystectomy was later performed.

Results

Overall, 72 patients (68%) showed an improvement clinically, whereas 34 (32%) showed no improvement or a clinically worsened condition after cholecystostomy. Patients who presented to the ED primarily with acute cholecystitis fared better (84% of patients showed improvement) than inpatients (34% showed improvement; P < .0001). Gallstones were identified in 54% of patients who presented to the ED, whereas acalculous cholecystitis was more commonly diagnosed in inpatients (54%). Patients with sepsis had worse outcomes overall (P < .0001). Bacterial bile cultures were analyzed in 95% of patients and showed positive results in 52%, with no overall effect on outcome. There was no correlation between the time of onset of symptoms until antibiotic therapy or cholecystostomy in either group. Long-term outcomes for both groups were better for those who later underwent cholecystectomy (P < .0001).

Conclusions

Outcomes after percutaneous cholecystostomy for acute cholecystitis are better when the disease is primary and not precipitated by concurrent illness.

Section snippets

Materials and Methods

Between January 2000 and February 2010, 110 patients underwent percutaneous cholecystostomy at a single quaternary-care medical center. Medical records were available for 106 patients, who formed the basis of this retrospective study, which was conducted with the approval of the institutional review board. All data were handled in accordance with the Health Insurance Portability and Accountability Act.

The diagnosis of acute cholecystitis was based on the combination of clinical presentation,

Results

There were 42 women and 64 men (mean age, 66 y; range, 23–96 y; Table 4). There were no significant differences in sex, age, presentation setting (ED vs inpatient), or comorbid conditions (all P > 0.2; Table 5). Seventy-one patients (67%) were outpatients presenting to the ED, and 35 (23%) were inpatients who had been admitted for other reasons.

The average length of time from the onset of symptoms to initiation of antibiotic treatment for all patients was 32 hours (range, 1 h to 9 d), and the

Discussion

Since the first description of a safe technique for percutaneous cholecystostomy published by Radder in 1980 (8), radiologic intervention has proven to be an effective first-line therapeutic procedure for the treatment of acute cholecystitis, particularly when patients are too ill for surgery or when the time course of their illness requires a period of defervescence before cholecystectomy (9, 10, 11). Even for patients assigned to American Society of Anesthesiologists classes III, IV, and V (6

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    None of the authors have identified a conflict of interest.

    This article includes two supplementary tables that are available online at www.jvir.org.

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