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Percutaneous Transhepatic Gallbladder Intervention as a Bridge to Cholecystectomy: Aspiration or Drainage?

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Abstract

Background

Percutaneous transhepatic gallbladder aspiration (PTGBA) and percutaneous transhepatic gallbladder drainage (PTGBD) are often the first-line treatments for acute cholecystitis, instead of surgical cholecystectomy. This retrospective study aimed to compare the treatment outcomes of PTGBA and PTGBD and evaluate the risks of treatment failure among patients undergoing PTGBA before surgical cholecystectomy.

Methods

We retrospectively reviewed 99 patients who underwent PTGBA or PTGBD as the first-line treatment before surgical cholecystectomy, between January 2014 and December 2019. Patient characteristics, computed tomography (CT) findings, and post-treatment outcomes were compared between the PTGBA and PTGBD groups. Additionally, risk factors, including CT findings for PTGBA failure, were assessed using multivariate univariate analysis with a backward selection model.

Results

Acute cholecystitis was not controlled in 21 of 47 (44.7%) patients in the PTGBA group and one of 52 patients (1.9%) in the PTGBD group (P < .001). Subsequent multiple logistic regression analysis identified the contrast effect of the gallbladder bed in the arterial phase of contrast-enhanced CT (odds ratio [OR] 9.17, 95% confidence interval [CI] 2.08–40.4, P = 0.003) and onset within 3 days (odds ratio [OR] 6.29, 95% confidence interval [CI] 1.37–29.0, P = 0.018) as independent risk factors for PTGBA failure.

Conclusions

PTGBA is more prone to failure than PTGBD; however, it is a simpler gallbladder drainage treatment method without the need for X-ray fluoroscopy and catheter management after the procedure. Evaluating the risk of PTGBA failure using CT findings and onset date would help us choose a drainage approach more effectively.

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Abbreviations

CRP:

C-reactive protein

PTGBA:

Percutaneous transhepatic gallbladder aspiration

PTGBD:

Percutaneous transhepatic gallbladder drainage

PTGBI:

Percutaneous transhepatic gallbladder intervention

TG:

Tokyo guidelines

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Acknowledgments

The authors are grateful to Hiroshi Imamura for supporting the statistical research.

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Authors and Affiliations

  1. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan

    Yuki Nakamura, Mai Kuwahara, Kyoji Ito, Fuyuki Inagaki, Fuminori Mihara, Nobuyuki Takemura & Norihiro Kokudo

Authors
  1. Yuki Nakamura
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  2. Mai Kuwahara
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  3. Kyoji Ito
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  4. Fuyuki Inagaki
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  5. Fuminori Mihara
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  6. Nobuyuki Takemura
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  7. Norihiro Kokudo
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Corresponding author

Correspondence to Nobuyuki Takemura.

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This study was approved by the National Center for Global Health and Medicine Research Ethics Committee/Institutional Review Board (approval number: NCGM-G-004109–00).

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Nakamura, Y., Kuwahara, M., Ito, K. et al. Percutaneous Transhepatic Gallbladder Intervention as a Bridge to Cholecystectomy: Aspiration or Drainage?. World J Surg 47, 1721–1728 (2023). https://doi.org/10.1007/s00268-023-06987-6

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  • DOI: https://doi.org/10.1007/s00268-023-06987-6

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