Korean J Gastroenterol.  2014 Jan;63(1):32-38. 10.4166/kjg.2014.63.1.32.

Percutaneous Cholecystostomy Is Appropriate as Definitive Treatment for Acute Cholecystitis in Critically Ill Patients: A Single Center, Cross-sectional Study

Affiliations
  • 1Digestive Disease Center, Department of Internal Medicine, Cheju Halla General Hospital, Jeju, Korea. drhyo@hotmail.com
  • 2Department of Radiology, Cheju Halla General Hospital, Jeju, Korea.
  • 3Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS
Percutaneous cholecystostomy (PC) is an effective treatment for cholecystitis in high-risk surgical patients. However, there is no definitive agreement on the need for additional cholecystectomy in these patients.
METHODS
All patients who were admitted to Cheju Halla General Hospital (Jeju, Korea) for acute cholecystitis and who underwent ultrasonography-guided PC between 2007 and 2012 were consecutively enrolled in this study. Among 82 total patients enrolled, 35 underwent laparoscopic cholecystectomy after recovery and 47 received the best supportive care (BSC) without additional surgery.
RESULTS
The technical and clinical success rates for PC were 100% and 97.5%, respectively. The overall mean survival was 12.8 months. In the BSC group, mean survival was 5.4 months, and in the cholecystectomy group, mean survival was 22.4 months (p<0.01). However, there was no significant difference between these groups in multivariate analysis (relative risk [RR]=1.92; 95% CI, 0.77-4.77; p=0.16). However, advanced age (RR=1.05; 95% CI, 1.02-1.08; p=0.001) and higher class in the American Society of Anesthesiologists' physical status (RR=3.06; 95% CI, 1.37-6.83, p=0.006) were significantly associated with survival in the multivariate analysis. Among the 47 patients in the BSC group, the cholecystostomy tube was removed in 31 patients per protocol. Recurrent cholecystitis was not observed in either group of patients during the follow-up period.
CONCLUSIONS
In high-risk surgical patients, PC without additional cholecystectomy might be the best definitive management. Furthermore, the cholecystostomy drainage catheter can be safely removed in certain patients.

Keyword

Acute cholecystitis; Cholecystectomy; Comorbidity; Cholecystostomy; Elderly

MeSH Terms

Aged
Aged, 80 and over
Cholecystitis, Acute/mortality/*surgery
Cholecystostomy
Critical Illness
Cross-Sectional Studies
Female
Humans
Laparoscopy
Male
Middle Aged
Odds Ratio
Survival Rate

Figure

  • Fig. 1. Clinical outcomes of 82 patients that underwent percutaneous cholecystostomy in Cheju Halla General Hospital (Jeju, Korea) between 2007 to 2012. BSC, best supportive care.

  • Fig. 2. Flow chart of the post-cho-lecystostomy management protocol devised by Digestive Disease Center in Cheju Halla General Hospital (Jeju, Korea).a Impacted stone, obstructive mass, or sustained radiocontrast media (remaining >3 hours).

  • Fig. 3. Cumulative survival rates of 2 treatment groups (cholecystectomy vs. the best supportive care [BSC]) after percutaneous cholecystostomy.

  • Fig. 4. Cumulative survival rates of remained vs. removed groups after percutaneous cholecystostomy.


Reference

References

1. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology. 1999; 117:632–639.
Article
2. Kalliafas S, Ziegler DW, Flancbaum L, Choban PS. Acute acalculous cholecystitis: incidence, risk factors, diagnosis, and outcome. Am Surg. 1998; 64:471–475.
3. Kiviluoto T, Sirén J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet. 1998; 351:321–325.
Article
4. Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998; 227:461–467.
Article
5. Koo KP, Thirlby RC. Laparoscopic cholecystectomy in acute cholecystitis. What is the optimal timing for operation? Arch Surg. 1996; 131:540–544.
Article
6. Lujan JA, Parrilla P, Robles R, Marin P, Torralba JA, Garcia-Ayllon J. Laparoscopic cholecystectomy vs open cholecystectomy in the treatment of acute cholecystitis: a prospective study. Arch Surg. 1998; 133:173–175.
Article
7. Houghton PW, Jenkinson LR, Donaldson LA. Cholecystectomy in the elderly: a prospective study. Br J Surg. 1985; 72:220–222.
Article
8. Frazee RC, Nagorney DM, Mucha P Jr. Acute acalculous cholecystitis. Mayo Clin Proc. 1989; 64:163–167.
Article
9. Weiss CA 3rd, Lakshman TV, Schwartz RW. Current diagnosis and treatment of cholecystitis. Curr Surg. 2002; 59:51–54.
Article
10. Vogelzang RL, Nemcek AA Jr. Percutaneous cholecystostomy: diagnostic and therapeutic efficacy. Radiology. 1988; 168:29–34.
Article
11. Hultman CS, Herbst CA, McCall JM, Mauro MA. The efficacy of percutaneous cholecystostomy in critically ill patients. Am Surg. 1996; 62:263–269.
12. Welschbillig-Meunier K, Pessaux P, Lebigot J, et al. Percutaneous cholecystostomy for high-risk patients with acute cholecystitis. Surg Endosc. 2005; 19:1256–1259.
Article
13. Byrne MF, Suhocki P, Mitchell RM, et al. Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center. J Am Coll Surg. 2003; 197:206–211.
Article
14. Hirota M, Takada T, Kawarada Y, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14:78–82.
15. Meyer S. Grading of patients for surgical procedures. Anesthesiology. 1941; 2:281–284.
16. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982; 5:649–655.
Article
17. Hatzidakis AA, Prassopoulos P, Petinarakis I, et al. Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment. Eur Radiol. 2002; 12:1778–1784.
Article
18. Escarce JJ, Shea JA, Chen W, Qian Z, Schwartz JS. Outcomes of open cholecystectomy in the elderly: a longitudinal analysis of 21,000 cases in the prelaparoscopic era. Surgery. 1995; 117:156–164.
Article
19. Morse BC, Smith JB, Lawdahl RB, Roettger RH. Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy. Am Surg. 2010; 76:708–712.
Article
20. McKay A, Abulfaraj M, Lipschitz J. Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Surg Endosc. 2012; 26:1343–1351.
Article
21. Granlund A, Karlson BM, Elvin A, Rasmussen I. Ultrasound-guided percutaneous cholecystostomy in high-risk surgical patients. Langenbecks Arch Surg. 2001; 386:212–217.
Article
22. Ha JP, Tsui KK, Tang CN, Siu WT, Fung KH, Li MK. Cholecystectomy or not after percutaneous cholecystostomy for acute calculous cholecystitis in high-risk patients. Hepatogastroenterology. 2008; 55:1497–1502.
23. Leveau P, Andersson E, Carlgren I, Willner J, Andersson R. Percutaneous cholecystostomy: a bridge to surgery or definite management of acute cholecystitis in high-risk patients? Scand J Gastroenterol. 2008; 43:593–596.
Article
24. Bakkaloglu H, Yanar H, Guloglu R, et al. Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention. World J Gastroenterol. 2006; 12:7179–7182.
Article
25. Koebrugge B, van Leuken M, Ernst MF, van Munster I, Bosscha K. Percutaneous cholecystostomy in critically ill patients with a cholecystitis: a safe option. Dig Surg. 2010; 27:417–421.
Article
26. Chok KS, Chu FS, Cheung TT, et al. Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis. ANZ J Surg. 2010; 80:280–283.
Article
27. Griniatsos J, Petrou A, Pappas P, et al. Percutaneous cholecystostomy without interval cholecystectomy as definitive treatment of acute cholecystitis in elderly and critically ill patients. South Med J. 2008; 101:586–590.
Article
Full Text Links
  • KJG
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr