Cholecystostomy tube outcomes: A radiological perspective

Abstract

Purpose: The use of a percutaneous image guided cholecystostomy in the management of severe acute cholecystitis is a well-recognized alternative to acute cholecystectomy. The purpose of this study was to document our outcomes for these patients and compare to existing literature. We will also aim to identify any radiological factors that influence these outcomes. Methods and Materials: A retrospective analysis of hospital records at Nambour General Hospital between 2012 and 2016 was conducted. Data relating to indications, demographics, imaging findings, technique used, complications and outcomes was recorded. Results: 30 patients (20 male, 10 female) who had a percutaneous cholecystostomy (PC) tube were identified, with a mean age of 77 years (range 46-93). Twenty-seven PC were performed for calculus cholecystitis and 3 for acalculus cholecystitis. All were inserted using image guidance; 24 (80%) utilizing ultrasound guidance and 6 (20%) using CT. Similarly, 24 (80%) were inserted using a transhepatic approach and the other 6 (20%) inserted trans-peritoneal. Seven patients (23%) had pre-procedure imaging indicating complicated cholecystitis. Complications of tube insertion occurred in 17 patients (57%) with 12 (71%) of these complications being unintentional dislodgement or removal of the tube. The other 5 complications were mild, not requiring subsequent intervention, and no deaths occurred as a result of PC tube insertion. Twenty-six patients (87%) improved with PC and were discharged from hospital; the readmission rate with biliary pathology was 19% (5/26). Seventeen patients (57%) were alive at completion of data collection. Of the 13 patients that were deceased mean time to death from tube insertion was 387 days (range 27-1260 days) and 10 (77%) of the deceased patients died from causes other than gall bladder pathology. The rate of unintentional removal of tubes was higher in those had died (8/13, 62%) compared to those who were alive (4/17, 24%) however this was not statistically significant. Younger age and the progression to cholecystectomy proved significant predictors of survival. (p = 0.03 and p < 0.01) Conclusion: Our initial and long-term success rates, as well as the absence of serious complications, was inline with published literature and therefore supports the safety and efficacy of PC in the management of acute cholecystitis. (1,2) Our high rate of unintentional removal indicates the need for further investigation into more effective tube fixation techniques.L618977062 <br />