Efficacy and Clinical Course of Percutaneous Cholecystostomy in the Treatment of Patients with Acute Cholecystitis

Year 2023, Volume: 20 Issue: 2, 326 - 332, 31.08.2023

Veysel Kaya , Mehmet Tahtabaşı

https://doi.org/10.35440/hutfd.1292102

Abstract

Background: In this study, it was aimed to evaluate the efficacy, safety, and clinical results of percutaneous cholecystostomy (PK) in the treatment of patients with acute cholecystitis (AC).
Materials and methods: All patients older than 18 years of age who underwent PC in Mehmet Akif Inan Hospital and Harran University Hospital between January 2020 and May 2022 were analyzed retrospectively. Demographic data (age and gender), comorbidities, duration of catheter removal, length of hospital stay, American Society of Anesthesia (ASA) score, interval cholecystectomy, and mortality development status of the patients were recorded. According to the severity of AC, it was divided into three grade 1 (mild), grade 2 (moderate), and grade 3 (severe).
Results: Of the 130 patients included in the study, 76 (58.5%) were female, and the mean age of the patients was 71.9 (range: 36-92) years. The most common comorbidities were hypertension (n=28, 21.5%) and coronary artery disease (n=26, 20.0%). Of the patients, 70 (53.8%) had calculous cholecystitis and 115 (88.5%) had hydropic gallbladder. The ASA score of 68 (52.3%) patients was 3-4 and 14 (10.8%) were grade 3 cholecystitis. The technical success of PK was 100%. The in-hospital mortality rate was 15.4% (n=20), and the mean age of patients who died was significantly higher than those who were discharged (81.2 ± 8.5 and 70.1 ± 13.8 years, p<0.001). The rate of severe (grade 3) AC and high ASA score (ASA 3 and 4) were significantly higher in patients who developed mortality compared to those who were discharged (40% vs. 5.5%, p<0.001 vs. 80% vs. 47.3%, p=0.006; respectively). Patients who died had a longer hospital stay (median value, 28 vs 13 days; p=0.002) and a significantly higher CRP (86.2 ±23.8 vs 11.4 ± 6.4 g/dl; p=0.032). Cholecystectomy was performed in 46.2% (n=60) of the patients after PC.
Conclusions: PC can be used effectively and safely in both preoperative bridging and definitive treatment of patients with acute cholecystitis. In addition, it was found that the advanced age of the patients who underwent PC, had a high ASA score due to comorbidity diseases, and the presence of severe cholecystitis increased mortality.

Keywords

percutaneous cholecystostomy, acute cholecystitis, Tokyo guideline, cholecystectomy, gallbladder

Akut Kolesistitli Hastaların Tedavisinde Perkütan Kolesistostominin Etkinliği ve Klinik Seyri

Abstract

Amaç: Akut kolesistitli (AK) hastaların tedavisinde perkütan kolesistostomi’nin (PK) etkinliğinin, güvenilirliğinin ve klinik sonuçlarının değerlendirilmesidir.
Materyal ve metod: Ocak 2020 ve Mayıs 2022 tarihleri arasında Mehmet Akif İnan Hastanesi ve Harran Üniversitesi Hastanesi’nde PK uygulanan 18 yaşından büyük tüm hastalar retrospektif olarak analiz edildi. Hastaların demografik verileri (yaş ve cinsiyet), komorbiditeleri, katater çekilme süresi, hastanede yatış süresi, Amerikan Anestezi Derneği (ASA) skoru, interval kolesistektomi ve mortalite gelişme durumu kaydedildi. AK şiddetine göre grade 1 (hafif), grade 2 (orta) ve grade 3 (şiddetli) olmak üzere üçe ayrıldı.
Bulgular: Çalışmaya dahil edilen 130 hastanın 76’sı (%58.5) kadın olup hastaların ortalama yaşı 71.9 (aralık: 36-92) yıl idi. En sık eşlik eden hastalıklar hipertansiyon (n=28, % 21.5) ve koroner arter hastalığı (n=26, %20.0) idi. Hastaların 70’inde (%53.8) taşlı kolesistit ve 115’inde (%88.5) hidropik safra kesesi vardı. Hastaların 68’inin (% 52.3) ASA skoru 3-4 ve 14’ü (%10.8) grade 3 kolesistit idi. PK’nın teknik başarısı %100 idi. Hastane içi mortalite oranı %15.4 (n=20) olup ölen hastaların yaş ortalaması taburcu olanlara göre anlamlı olarak daha fazlaydı (81.2 ± 8.5 ve 70.1 ± 13.8 yıl, p<0.001). Mortalite gelişen hastalarda şiddetli (grade 3) AK oranı ve yüksek ASA skoruna (ASA 3 ve 4) sahip olma oranı taburcu olanlara kıyasla anlamlı olarak daha yüksekti (sırasıyla; %40’a %5.5; p<0.001 ve %80’e %47.3; p=0.006). Ölen hastaların hastanede kalış süresi daha uzun (median değer, 28’e 13 gün; p=0.002) ve CRP değeri anlamlı olarak daha yüksekti (86.2 ±23.8 ve 11.4 ± 6.4 g/dl; p=0.032). PK sonrası hastaların %46.2’sine (n=60) kolesistektomi uygulandı.
Sonuç: Akut kolesistitli hastaların hem cerrahi öncesi köprüleme tedavisinde hem de kesin tedavisinde PK etkin ve güvenle uygulanabilir. Ayrıca PK uygulanan hastaların ileri yaşta olmasının, eşlik eden hastalıklara bağlı yüksek ASA skoruna sahip olmasının ve şiddetli kolesistit varlığının mortaliteyi arttırdığı görünmektedir.

Keywords

perkütan kolesistostomi, akut kolesistit, Tokyo kılavuzu, kolesistektomi, safra kesesi

References

• 1. Indar AA. Acute cholecystitis. BMJ. 2002 Sep 21;325(7365):639–43.
• 2. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Waka-bayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):41–54.
• 3. Mueller P, van Sonnenberg E, Ferrucci J. Percutaneous biliary drainage: technical and catheter-related problems in 200 procedures. Am J Roentgenol. 1982 Jan 1;138(1):17–23.
• 4. Aroori S, Mangan C, Reza L, Gafoor N. Percutaneous Cho-lecystostomy for Severe Acute Cholecystitis: A Useful Pro-cedure in High-Risk Patients for Surgery. Scand J Surg. 2019 Jun 18;108(2):124–9.
• 5. Morales-Maza J, Rodríguez-Quintero JH, Santes O, Hernández-Villegas AC, Clemente-Gutiérrez U, Sánchez-Morales GE, et al. Colecistostomía percutánea como trata-miento de colecistitis aguda: ¿qué ha pasado en los últimos 5 años? Revisión de la literatura. Rev Gastroenterol México. 2019 Oct;84(4):482–91.
• 6. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, et al. Tokyo Guidelines 2018: flowchart for the mana-gement of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):55–72.
• 7. Karakas H. Percutaneous Cholecystostomy: An Update for the 2020s. North Clin Istanbul. 2021 Oct;8(5): 537–542.
• 8. Elsharif M, Forouzanfar A, Oaikhinan K, Khetan N. Percuta-neous cholecystostomy… why, when, what next? A syste-matic review of past decade. Ann R Coll Surg Engl. 2018 Nov;100(8):618–31.
• 9. Mayumi T, Takada T, Kawarada Y, Nimura Y, Yoshida M, Sekimoto M, et al. Results of the Tokyo Consensus Meeting Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007 Jan 30;14(1):114–21.
• 10. Devane AM, Annam A, Brody L, Gunn AJ, Himes EA, Patel S, et al. Society of Interventional Radiology Quality Improve-ment Standards for Percutaneous Cholecystostomy and Percutaneous Transhepatic Biliary Interventions. J Vasc In-terv Radiol. 2020 Nov;31(11):1849–56.
• 11. Chang YR, Ahn Y-J, Jang J-Y, Kang MJ, Kwon W, Jung WH, et al. Percutaneous cholecystostomy for acute cholecystitis in patients with high comorbidity and re-evaluation of treat-ment efficacy. Surgery. 2014 Apr;155(4):615–22.
• 12. Winbladh A, Gullstrand P, Svanvik J, Sandström P. Systema-tic review of cholecystostomy as a treatment option in acute cholecystitis. HPB. 2009 May;11(3):183–93.
• 13. Pang KW, Tan CHN, Loh S, Chang KYS, Iyer SG, Madhavan K, et al. Outcomes of Percutaneous Cholecystostomy for Acute Cholecystitis. World J Surg. 2016 Nov 2;40(11):2735–44.
• 14. Akhan O, Akıncı D, Özmen MN. Percutaneous cholecystos-tomy. Eur J Radiol. 2002 Sep;43(3):229–36.
• 15. Akyürek N, Salman B, Yüksel O, Tezcaner T, İrkörücü O, Yücel C, et al. Management of Acute Calculous Cholecystitis in High-Risk Patients. Surg Laparosc Endosc Percutan Tech. 2005 Dec;15(6):315–20.
• 16. de Mestral C, Gomez D, Haas B, Zagorski B, Rotstein OD, Nathens AB. Cholecystostomy: a bridge to hospital discharge but not delayed cholecystectomy. J Trauma Acute Care Surg. 2013 Jan;74(1):175–80.
• 17. Leveau P, Andersson E, Carlgren I, Willner J, Andersson R. Percutaneous cholecystostomy: A bridge to surgery or defi-nite management of acute cholecystitis in high-risk patients? Scand J Gastroenterol. 2008 Jan 8;43(5):593–6.
• 18. Popowicz A, Lundell L, Gerber P, Gustafsson U, Pieniowski E, Sinabulya H, et al. Cholecystostomy as Bridge to Surgery and as Definitive Treatment or Acute Cholecystectomy in Pati-ents with Acute Cholecystitis. Gastroenterol Res Pract. 2016;2016:1–6.
• 19. Atar E, Bachar GN, Berlin S, Neiman C, Bleich-Belenky E, Litvin S, et al. Percutaneous cholecystostomy in critically ill patients with acute cholecystitis: Complications and late out-come. Clin Radiol. 2014 Jun;69(6):e247–52.
• 20. Bakkaloglu H. Ultrasound guided percutaneous cholecystos-tomy in high-risk patients for surgical intervention. World J Gastroenterol. 2006;12(44):7179.
• 21. Hsieh Y-C, Chen C-K, Su C-W, Chan C-C, Huo T-I, Liu C-J, et al. Outcome After Percutaneous Cholecystostomy for Acute Cholecystitis: a Single-Center Experience. J Gastrointest Surg. 2012 Oct 25;16(10):1860–8.
• 22. Peters R, Kolderman S, Peters B, Simoens M, Braak S. Percu-taneous cholecystostomy: single centre experience in 111 patients with an acute cholecystitis. J Belgian Soc Radiol. 2014 Jul 1;97(4):197.
• 23. Anderson JE, Chang DC, Talamini MA. A nationwide exami-nation of outcomes of percutaneous cholecystostomy com-pared with cholecystectomy for acute cholecystitis, 1998–2010. Surg Endosc. 2013 Sep 3;27(9):3406–11.
• 24. Nitzan O, Brodsky Y, Edelstein H, Hershko D, Saliba W, Ke-ness Y, et al. Microbiologic Data in Acute Cholecystitis: Ten Years’ Experience from Bile Cultures Obtained during Percu-taneous Cholecystostomy. Surg Infect (Larchmt). 2017 Apr;18(3):345–9.
• 25. Daniele M, Luca D, Massimo O, Davide L, Pietro P, Fabrizio R, et al. Timing of percutaneous cholecystostomy tube remo-val: systematic review. Minerva Chir. 2016;71(6):415–26.