COMMENTARY

Percutaneous Cholecystostomy: An Alternative to Urgent Surgery for Cholecystitis?

Albert B. Lowenfels, MD

Disclosures

October 05, 2017

How effective is percutaneous cholecystostomy for managing acute cholecystitis? The authors of a study published in the American Journal of Surgery presented their experience with this procedure in 119 of a total group of 678 patients admitted with acute cholecystitis.[1] These patients, with an average age of 76 years, had significant comorbidity including diabetes (38%), hypertension (67%), and heart disease or congestive heart failure (35%).

Seven patients died during the first hospitalization; most had severe comorbidities. A total of 103 patients were discharged; 41 had elective cholecystectomy, and three required urgent surgery. Over a follow-up period of 21 months, no further operation was required for 56 patients (or nearly half of the original group).

Viewpoint

The Tokyo Guidelines suggested that initial cholecystostomy is appropriate for managing patients with severe cholecystitis.[2] The favorable results from this case series tend to support that viewpoint, although the follow-up time was short.

Another recent report pointed out that there are likely to be complications including tube displacement, infection, and a high rate of common bile duct stones.[3]

A Cochrane review performed in 2013 found insufficient evidence to evaluate the role of cholecystostomy in the management of high-risk patients with acute cholecystitis.[4]

In the absence of a large clinical trial, this case series provides modest evidence that cholecystostomy provides an alternative to urgent surgery for selected high-risk patients.

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