Percutaneous Cholecystostomy Versus Conservative Treatment for Acute Cholecystitis: a Cohort Study
Percutaneous cholecystostomy is frequently used as a treatment option for acute calculous cholecystitis in patients unfit for surgery. There is sparse evidence on the long-term impact of cholecystostomy on gallstone-related morbidity and mortality in patients with acute calculous cholecystitis. This study describes the long-term outcome of acute calculous cholecystitis following percutaneous cholecystostomy compared to conservative treatment.
This was a cohort study of patients admitted at our institution from 2006 to 2015 with acute calculous cholecystitis without early or delayed cholecystectomy. Endpoints were gallstone-related readmissions, recurrent cholecystitis, and overall mortality.
The investigation included 201 patients of whom 97 (48.2%) underwent percutaneous cholecystostomy. Patients in the cholecystostomy group had significantly higher age, comorbidity level, and inflammatory response at admission. The median duration of catheter placement in the cholecystostomy group was 6 days. The complication rate of cholecystostomy was 3.1% and the mortality during the index admission was 3.5%. The median follow-up was 1.6 years. The rate of gallstone-related readmissions was 38.6%, and 25.3% had recurrence of cholecystitis. Cox regression analyses revealed no significant differences in gallstone-related readmissions, recurrence of acute calculous cholecystitis, and overall mortality in the two groups.
Percutaneous cholecystostomy in the treatment of acute calculous cholecystitis was neither associated with long-term benefits nor complications. Based on the high gallstone-related readmission rates of this study population and todays perioperative improvements, we suggest rethinking the indications for non-operative management including percutaneous cholecystostomy in acute calculous cholecystitis.
KeywordsCholecystostomy Acute Cholecystitis Elderly
Stine Ydegaard Turiño, Daniel Mønsted Shabanzadeh, Lars Tue Sørensen, Lars Nannestad Jørgensen: Conception or design of the work.
Stine Ydegaard Turiño, Daniel Mønsted Shabanzadeh, Nethe Malik Eichen, Stine Lundgaard Jørgensen: Acquisition, analysis of the work.
Stine Ydegaard Turiño, Daniel Mønsted Shabanzadeh, Lars Nannestad Jørgensen: Interpretation of data for the work.
Stine Ydegaard Turiño, Daniel Mønsted Shabanzadeh, Nethe Malik Eichen, Stine Lundgaard Jørgensen, Lars Tue Sørensen, Lars Nannestad Jørgensen: Drafting the work or revising it critically for important intellectual content.
Stine Ydegaard Turiño, Daniel Mønsted Shabanzadeh, Nethe Malik Eichen, Stine Lundgaard Jørgensen, Lars Tue Sørensen, Lars Nannestad Jørgensen: Final approval of the version to be published.
Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Stine Ydegaard Turiño, Daniel Mønsted Shabanzadeh, Nethe Malik Eichen, Stine Lundgaard Jørgensen, Lars Tue Sørensen, Lars Nannestad Jørgensen.
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