Keywords:
Abdomen, Gastrointestinal tract, Interventional non-vascular, Ultrasound, CT, MR, Drainage
Authors:
T. Peachey, J. Smith, H. Nathani, F. Lee; Sheffield/UK
DOI:
10.1594/ecr2018/C-2008
Methods and materials
All patients who underwent cholecystostomy at our centre from 1st January 2014 to 31st December 2016 were included in the study. Cases were retrospectively identified through interrogation of the radiology information system using all codes for cholecystostomy at our centre which are ICHOSD,
UABDOD and UDRAID.
The clinical details on imaging requests and cholecystostomy referrals were reviewed. Clinical features of sepsis,
right upper quadrant pain,
other abdominal pain,
temperature and patient's age were recorded for each case.
The findings of radiological studies performed prior to cholecystostomy were recorded. The imaging studies performed prior to cholecystostomy was variable but included ultrasound,
CT and MR.
The following imaging findings were recorded for each patient: one or more gallstone(s),
distended gallbladder,
oedematous gallbladder,
pericholecystic fluid,
gallbladder perforation, pericholecystic abscess, hepatic abscess,
and biliary dilatation. Tenderness over the gallbladder on ultrasound examination was also recorded.
Periprocedural biochemistry and haematology were identified through our centre’s clinical results digital database. Where available we recorded the results of these investigations performed both before and after cholecystostomy.
The clinical findings,
imaging findings and blood results were used to retrospectively grade cholecystitis severity into mild,
moderate and severe according to the Tokyo guidelines [1]. A combination of the Tokyo acute cholecystitis guideline and UK National Institute of Health and Care Excellence clinical guideline on gallstone disease diagnosis and management [2] were used to retrospectively evaluate the suitability of each case for cholecystostomy.
Practical aspects relating to cholecystostomy insertion were recorded. These aspects were day of week,
time of day,
whether the procedure was performed by a radiology registrar or consultant,
and whether the gallbladder drain was inserted via a transhepatic or direct approach. We reviewed the proportion performed within and outside normal working hours. Normal working hours were taken to be Monday to Friday between 7am and 7pm. For a subgroup of patients we investigated the microbiology analysis of the aspirate taken at cholecystostomy insertion.
All data was recorded and analysed using a standard commercially available spreadsheet software.