Korean J Gastroenterol.  1997 Jul;30(1):81-89.

Nonsurgical Cholecystic Drainage in Acute Cholecystitis

Abstract

BACKGROUND AND AIMS: Acute cholecystitis is the most common biliary emergency and until now, the choice of the treatment of this disease is surgical operation. But, the. Mortality and morbidity associated with surgical cholecystostomy in those patients are relatively high. Recently, PTCCD and ENGBD were developed as a useful method of nonsurgical cholecystic drainage in high surgical risk group of acute cholecystitis. The purpose of this study was tn assess the usefulness of nonsurgical cholecystic drainage such as PTCCD and ENCrBD in the patients with acute cholecystitis.
METHODS
Of 59 patients with acute cholecystitis treated with nonsurgical cholecystic drainage, 47 were calculous cholecystitis and 12 were acalculous cholecystitis. Nonsurgical chole-cystic drainages were successful in all 59 cases: PTCCD in 45 patients, ENGBD in rernaining 14 patients. 39 patients were treated with nonsurgical cholecystic drainages due to high surgical risk. In remaining 20 patients there were cholangiocarcinoma in 5 patients, netastatic heptna in 2, gallstone pancreatitis in 1, advanced gastric cancer in 2, refusal of surgery in 10.
RESULTS
The prompt clinical recovery were achieved in 42 patients (93.3%) with PTCCD and cornpletely in all 2 cases with ENGBD. In the group with 35 calculous cholecystitis performed PTCCD, 28 under-went PTCCS-L, 4 elective surgery and 3 died because of the underlying condition, In the group with 10 acalculous cholecystitis performed PTC (""D, 8 patients need nr further treatment except drainage and remaining 2 patients underwent elective surgery. Jn the group with 12 calculous cholecystitis treated by ENGBD, 10 underwent elective surgery, l F.SWI. And I gallstone dissolution with MTBE. In 2 acalculous cholecystitis treated by ENGBD, the one patient took no further treatment and the other underwent elective surgery. Complications related to PT (CD occurred in 10 of 45 patients, but there was no mortality related to this procedure. No complications were noted related to ENGBD.
CONCLUSIONS
We conclude that nonsurgical cholecystic drainage witli ENGBD and PTCCD were safe, effective and useful procedures for the management of acute cholecystitis, especially in high surgical risk group,

Keyword

Nonsurgical cholecystic drainage; Acute cholecystitis; Pl'CCD (Percutaneous transhe-patic cholecystic drainage); ENGBD (Endoscopic nasobiliary gallblackler Irainage)

MeSH Terms

Acalculous Cholecystitis
Cholangiocarcinoma
Cholecystitis
Cholecystitis, Acute*
Cholecystostomy
Disulfiram
Drainage*
Emergencies
Gallstones
Humans
Mortality
Pancreatitis
Stomach Neoplasms
Disulfiram
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