Advertisement

Percutaneous cholecystostomy for severe (Tokyo 2013 stage III) acute cholecystitis

  • F. PolistinaEmail author
  • C. Mazzucco
  • D. Coco
  • M. Frego
Original Article

Abstract

Purposes

To evaluate the impact of percutaneous cholecystostomy (PC) on severe acute cholecystitis (AC).

Methods

According to the ICD-9 classification, we retrospectively retrieved medical records of patients discharged with a diagnosis of AC from January 2007 to December 2016 at our hospital. Patients were then stratified according to the Tokyo 2013 (TG 13) AC severity criteria. Grade III AC was diagnosed according to the TG 13 criteria. Indications for PC were failure of optimal medical treatment within 48 h, worsening of clinical condition within early medical treatment, patients unfit for upfront surgery and patient’s preference. Ascites was considered a contraindication to PC while coagulopathy was considered a minor contraindication. Primary end points were: clinical improvement, morbidity and related mortality. Secondary endpoints were AC recurrences and elective laparoscopic cholecystectomies (LS). Response was evaluated by clinical and blood test improvement. Morbidity was evaluated according to the Dindo–Clavien scale.

Results

A total of 117 eligible patients were diagnosed as grade III AC. Of these, 29 (24.7%) underwent PC. The procedure was completed in all cases. Overall morbidity rate was 20.6%. Main complication was the drainage dislodgement due to involuntary patient’s movement. Overall mortality was 17.2% but no causes of death were dependent upon the procedure. Clinical improvement was reported in 95.5% of surviving patients.

Conclusion

This study confirms that PC is a valuable tool in the treatment of severe AC. Randomized trials are needed to clarify the criteria for patient selection and to optimize the timing for both cholecystostomy and cholecystectomy.

Keywords

Acute cholecystitis Gallbladder abscess Gallstones Percutaneous drainage 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest in the present paper.

References

  1. 1.
    Strasberg SM. Acute calculous cholecystitis. N Engl J Med. 2008;358:2804–11.  https://doi.org/10.1056/NEJMcp0800929.CrossRefGoogle Scholar
  2. 2.
    Al-Jundi W, Cannon T, Antakia R, et al. Percutaneous cholecystostomy as an alternative to cholecystectomy in high risk patients with biliary sepsis: a district general hospital experience. Ann R Coll Surg Engl. 2012;94(2):99–101.  https://doi.org/10.1308/003588412X13171221501302.CrossRefGoogle Scholar
  3. 3.
    Edlund G, Ljungdahl M. Acute cholecystitis in the elderly. Am J Surg. 1990 Apr;159(4):414–6 (discussion 416).CrossRefGoogle Scholar
  4. 4.
    Gurusamy KS, Rossi M, Davidson BR. Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database Syst Rev 2013;8:CD007088.  https://doi.org/10.1002/14651858.CD007088.pub2.Google Scholar
  5. 5.
    Kim SY, Yoo KS. Efficacy of preoperative percutaneous cholecystostomy in the management of acute cholecystitis according to severity grades. Korean J Intern Med. 2017.  https://doi.org/10.3904/kjim.2016.209 (PMID: 28063415).Google Scholar
  6. 6.
    Okamoto K, Suzuki K, Takada T, et al. Tokyo Guidelines 2018 flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2017.  https://doi.org/10.1002/jhbp.516 (PMID: 29045062).Google Scholar
  7. 7.
    Radder RW. Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging. 1980;49(6):330–3.Google Scholar
  8. 8.
    Miura F, Takada T, Strasberg SM, et al. Tokyo Guidelines Revision Comittee. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20(1):47–54.  https://doi.org/10.1007/s00534-012-0563-.CrossRefGoogle Scholar
  9. 9.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240(2): 205–13.  https://doi.org/10.1097/01.sla.0000133083.54934.ae.CrossRefGoogle Scholar
  10. 10.
    Ansaloni L, Pisano M, Coccolini F, et al. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg. 2016;11:25.  https://doi.org/10.1186/s13017-016-0082-5.CrossRefGoogle Scholar
  11. 11.
    Society of American Gastrointestinal and Endoscopic Surgeons. Guidelines for the clinical application of laparoscopic biliary tract surgery. 2017. http://www.sages.org/publications/guidelines/guidelines-for-the-clinical-application-of-laparoscopic-biliary-tract-surgery/. Accessed 7 Jan 2017.
  12. 12.
    Society for Surgery of the Alimentary Tract. SSAT patient care guidelines. Treatment of gallstone and gallbladder disease. 2017. http://www.ssat.com/cgi-bin/chole7.cgi. Accessed 7 Jan 2017.
  13. 13.
    Cooper S, Donovan M, Grieve DA. Outcomes of percutaneous cholecystostomy and predictors of subsequent cholecystectomy. ANZ J Surg. 2017.  https://doi.org/10.1111/ans.14251 (PMID: 29052940).Google Scholar
  14. 14.
    Zeren S, Bayhan Z, Koçak C, Kesici U, Korkmaz M, Ekici MF, Algın MC, Yaylak F. Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis: Percutaneous cholecystostomy. Ulus Travma Acil Cerrahi Derg. 2017;23(6):501–6.  https://doi.org/10.5505/tjtes.2017.63668 (PMID: 29115653).Google Scholar
  15. 15.
    Gulaya K, Desai SS, Sato K. Percutaneous cholecystostomy: evidence-based current clinical practice. Semin Interv Radiol. 2016;33(4):291–6.  https://doi.org/10.1055/s-0036-1592326 (review).CrossRefGoogle Scholar
  16. 16.
    Simorov A, Ranade A, Parcells J, et al. Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study. Am J Surg. 2013;206(6):935–40.  https://doi.org/10.1016/j.amjsurg.2013.08.019 (discussion 940–1).CrossRefGoogle Scholar
  17. 17.
    Pang KW, Tan CH, Loh S, Chang KY, et al. Outcomes of percutaneous cholecystostomy for acute cholecystitis. World J Surg. 2016;40(11):2735–44.  https://doi.org/10.1007/s00268-016-3585-z.CrossRefGoogle Scholar
  18. 18.
    Boules M, Haskins IN, Farias-Kovac M, et al. What is the fate of the cholecystostomy tube following percutaneous cholecystostomy? Surg Endosc. 2016.  https://doi.org/10.1007/s00464-016-5161-x.Google Scholar
  19. 19.
    Popowicz A, Lundell L, Gerber P, et al. Cholecystostomy as bridge to surgery and as definitive treatment or acute cholecystectomy in patients with acute cholecystitis. Gastroenterol Res Pract. 2016;2016:3672416.  https://doi.org/10.1155/2016/3672416.CrossRefGoogle Scholar
  20. 20.
    Horn T, Christensen SD, Kirkegård J, et al. Percutaneous cholecystostomy is an effective treatment option for acute calculous cholecystitis: a 10-year experience. HPB (Oxford). 2015;17(4):326–31.  https://doi.org/10.1111/hpb.12360.CrossRefGoogle Scholar
  21. 21.
    Hsieh YC, Chen CK, Su CW, et al. Outcome after percutaneous cholecystostomy for acute cholecystitis: a single-center experience. J Gastrointest Surg. 2012;16(10):1860–8.  https://doi.org/10.1007/s11605-012-1965-8.CrossRefGoogle Scholar
  22. 22.
    Melloul E, Denys A, Demartines N, et al. Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: does it matter? World J Surg. 2011;35(4):826–33.  https://doi.org/10.1007/s00268-011-0985-y.CrossRefGoogle Scholar
  23. 23.
    Viste A, Jensen D, Angelsen J, et al. Percutaneous cholecystostomy in acute cholecystitis; a retrospective analysis of a large series of 104 patients. BMC Surg. 2015;15:17.  https://doi.org/10.1186/s12893-015-0002-8.CrossRefGoogle Scholar
  24. 24.
    Wang CH, Wu CY, Yang JC, et al. Long-term outcomes of patients with acute cholecystitis after successful percutaneous cholecystostomy treatment and the risk factors for recurrence: a decade experience at a single center. PLoS One. 2016;11(1):e0148017.  https://doi.org/10.1371/journal.pone.0148017.CrossRefGoogle Scholar
  25. 25.
    Sanjay P, Mittapalli D, Marioud A, et al. Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB (Oxford). 2013;15(7):511–6.  https://doi.org/10.1111/j.1477-2574.2012.00610.x.CrossRefGoogle Scholar
  26. 26.
    Li M, Li N, Ji W, et al. Percutaneous cholecystostomy is a definitive treatment for acute cholecystitis in elderly high-risk patients. Am Surg. 2013;79(5):524–7 (PMID:23635589).Google Scholar
  27. 27.
    Gurusamy K, Samraj K, Gluud C, et al. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010;97(2):141–50.  https://doi.org/10.1002/bjs.6870.CrossRefGoogle Scholar
  28. 28.
    Asai K, Watanabe M, Kusachi S, et al. Evaluating the timing of laparoscopic cholecystectomy for acute cholecystitis in an experienced center based on propensity score matching. Asian J Endosc Surg. 2017.  https://doi.org/10.1111/ases.12353.Google Scholar
  29. 29.
    Suzuki K, Bower M, Cassaro S, et al. Tube cholecystostomy before cholecystectomy for the treatment of acute cholecystitis. JSLS. 2015;19(1):e2014.00200.  https://doi.org/10.4293/JSLS.2014.00200.CrossRefGoogle Scholar
  30. 30.
    Terho PM, Leppäniemi A, Mentula PJ. Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications. World J Emerg Surg. 2016;11:54.  https://doi.org/10.1186/s13017-016-0111-4.CrossRefGoogle Scholar
  31. 31.
    Bickel A, Hoffman RS, Loberant N, et al. Timing of percutaneous cholecystostomy affects conversion rate of delayed laparoscopic cholecystectomy for severe acute cholecystitis. Surg Endosc. 2016;30(3):1028–33.  https://doi.org/10.1007/s00464-015-4290-y.CrossRefGoogle Scholar
  32. 32.
    Karakayali FY, Akdur A, Kirnap M, et al. Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis. Hepatobiliary Pancreat Dis Int. 2014;13(3):316–22 (PMID:24919616).CrossRefGoogle Scholar
  33. 33.
    Cheng WC, Chiu YC, Chuang CH, et al. Assessing clinical outcomes of patients with acute calculous cholecystitis in addition to the Tokyo grading: a retrospective study. Kaohsiung J Med Sci. 2014;30(9):459–65.  https://doi.org/10.1016/j.kjms.2014.05.005.CrossRefGoogle Scholar
  34. 34.
    Flexer SM, Peter MB, Durham-Hall AC, et al. Patient outcomes after treatment with percutaneous cholecystostomy for biliary sepsis. Ann R Coll Surg Engl 2014;96(3):229–33.  https://doi.org/10.1308/003588414X13814021679799.CrossRefGoogle Scholar
  35. 35.
    Winbladh A, Gullstrand P, Svanvik J, et al. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HBP. 2009;11(3):183–93.Google Scholar
  36. 36.
    Papis D, Khalifa E, Bhogal R, Nair A, Khan S, Hamady Z, Ahmed J, Marangoni G. Is percutaneous cholecystostomy a good alternative treatment for acute cholecystitis in high-risk patients? Am Surg. 2017;83(6):623–7 (PMID: 28637565).Google Scholar
  37. 37.
    Zarour S, Imam A, Kouniavsky G, Lin G, Zbar A, Mavor E. Percutaneous cholecystostomy in the management of high-risk patients presenting with acute cholecystitis: Timing and outcome at a single institution. Am J Surg. 2017;214(3):456–61.  https://doi.org/10.1016/j.amjsurg.2017.01.030 (PMID: 28237047).CrossRefGoogle Scholar
  38. 38.
    Hall BR, Armijo PR, Krause, et al. Emergent cholecystectomy is superior to percutaneous cholecystostomy tube placement in critically ill patients with emergent calculous cholecystitis. Am J Surg. 2017.  https://doi.org/10.1016/j.amjsurg.2017.11.002 (PMID: 29128102).Google Scholar
  39. 39.
    Tolan HK, Semiz Oysu A, Başak F, Atak İ, Özbağrıaçık M, Özpek A, Kaskal M, Ezberci F, Baş G. Percutaneous cholecystostomy: a curative treatment modality for elderly and high ASA score acute cholecystitis patients. Ulus Travma Acil Cerrahi Derg. 2017;23(1):34–8.  https://doi.org/10.5505/tjtes.2016.26053 (PMID: 28261768).Google Scholar
  40. 40.
    Chou CK, Lee KC, Chan CC, et al. Early percutaneous cholecystostomy in severe acute cholecystitis reduced the complication rate and duration of hospital stay. Medicine. 2015;94(27):1–7.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General SurgeryMonselice HospitalMonseliceItaly

Personalised recommendations