100 - What Happens to Patients Who Get Percutaneous Cholecystostomies? 233-Patient Single-Center 5-year Analysis

Purpose: Percutaneous cholecystostomy (PC) is commonly performed for patients with acute acalculous cholecystitis (AAC) and acute calculous cholecystitis (ACC) who are not surgical candidates at initial presentation. Various surgical and non-surgical treatment options [with interventional radiology (IR) and gastroenterology (GI)] are now available to remove PCs in patients with ACC who remain non-surgical candidates at their follow-up (Reference 1). This analysis reviews the flow of patients after PC.

Materials and Methods: 233 consecutive patients who underwent PC for acute cholecystitis at our institution in the last 5 years were included. 122 (52%) of these were for AAC while 111 (48%) had ACC. The median age was 69 (range 18-98). 115 were male (49%). Cancer (23%), sepsis (18%), and heart disease (17%) were the most common reasons to place a PC rather than undergo surgery. All PC patients were re-evaluated by Surgery to determine surgical candidacy at initial presentation and at their 4-week follow-up PC drain check, prior to definitive IR/GI intervention.

Results: 133 patients (57%) did not have their drains removed; 92/133 (69%) of these patients died with their PC in place. PC drains were successfully removed in 74/111 (66%) of patients with ACC and 26/122 (21%) patients with AAC. 27/122 (22%) patients with AAC and 22/111 (20%) patients with ACC underwent cholecystectomy after PC. 51 patients with ACC (46%) had successful percutaneous lithotripsy and cholecystoduodenal stenting. 4/51 (4%) patients developed acute pancreatitis which resolved with conservative management. 1/51 (2%) patients had a gallbladder perforation. One patient with ACC (1%) had successful endoscopic ultrasound guided gallbladder drainage (EUS-GBD) by GI.

Conclusion: The PC removal rates in patients with ACC were high (66%), with room for improvement. The establishment of a streamlined protocol (including re-evaluation of surgical candidacy prior to IR or GI options) is needed to increase the number of patients who undergo surgery, percutaneous lithotripsy/cholecystoduodenal stenting, and EUS-GBD.