Percutaneous Cholecystostomy in Acutely Unwell Patients with Acute Calculous Cholecystitis - A 5-Year Experience of a Busy District General Hospital in the UK

Congress:

ECR 2019

Poster Number:

C-1010

Type:

Scientific Exhibit

Keywords:

Interventional non-vascular, Biliary Tract / Gallbladder, Gastrointestinal tract, Ultrasound, Technical aspects, Laboratory tests

Authors:

K. Sabarwal¹, T. Pedelty², T. Osborne¹, V. Joshi¹, A. Chapman¹, S. Prabhudesai¹; ¹Chertsey/UK, ²Leeds/UK

DOI:

10.26044/ecr2019/C-1010

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-1010

Fig. 1: Figure 1 demonstrates the results of the positive microbiological analysis...

Fig. 2: Figure 2 demonstrates the trend in the WCC. On admission, the mean WCC was...

Fig. 3: Figure 3 demonstrates the trend in the CRP. On admission, the mean CRP level...

Fig. 4: Figure 4 demonstrates the trend in the serum bilirubin levels. On admission,...

Aims and objectives

Cholelithiasis is very common, affecting approximately 1 in 10 adults in the United Kingdom [1]; with the most common complication being acute calculous cholecystitis [1, 2]. The gold-standard management for acute calculous cholecystitis is surgical removal via a laparoscopic cholecystectomy, however, if the patient is very unwell or has numerous medical co-morbidities, immediate surgical management may be disadvantageous due to increased surgical risk [3, 4]. In this instance, percutaneous cholecystostomy (PC) has a role to play through decompression of the gallbladder leading to a reduction...

Methods and materials

Our PACs system was used to search ultrasound, fluoroscopic and CT-guided procedures with the key phrase “into the gallbladder” between the 1st of January 2013 to the 31st of December 2017. A list of patients who had a cholecystostomy was subsequently obtained. Basic demographic data as well as procedural details were recorded. Blood tests of the patients were then retrospectively collected at the following time periods: on admission, pre-procedure and post-procedure at 1-2 days, 3-4 days and 5-7 days. GraphPad Prism (version 8, 2018) was...

Results

A total number of 49 patients were identified over the 5-year period. The mean age was 74.5 years (range 33 to 94). 59.2% were female (n=29). Based on the individual consultant radiologist’s preference, the procedure was performed with ultrasound guidance alone in 57.1% of cases (n=28), ultrasound with fluoroscopic guidance in 32.6%, (n=16) and CT guidance in 6.1% (n=5). A transhepatic approach was adopted in 51% of cases (n=25). The technical success rate was 100%. An aspirate was obtained in all 49 cases, however in...

Conclusion

In our institution, over the 5-year time period, our PCs had a technical success > 90%, in keeping with published standards [4] with no immediate complications following PC. Based on the most recent Tokyo Guidelines [7], initial management with antibiotics and supportive care is recommended across all 3 grades of severity [5]. If there is a failure of this conservative management, thenPC can be considered [5], with the suggested time being after 3 days of conservative management [2, 6]. In our centre, the mean time...

Personal information

References

NHS Choices. Acute cholecystitis [Internet]. National Health Service; 2016. Available from: http://www.nhs.uk/Conditions/acute-cholecystitis Gomes, CA; Junior, CS; Di Saverio, S; Sartelli, M; Kelly, MD; Gomes, CC; Gomes, FC; Corrêa, LD; Alves, CB; Guimarães, SF. Acute calculous cholecystitis: Review of current best practices. World J Gastrointest Surg. 2017; 9: 118-126 Little, MW; Briggs, JH; Tapping, CR; Bratby, MJ; Anthony, S; Phillips-Hughes, J; Uberoi, R. Percutaneous cholecystostomy: the radiologist's role intreating acute cholecystitis. Clin Radiol. 2013; 68: 654-60 Saad, WEA; Wallace, MJ; Wojak, JC; Kundu, S; Cardella, JF....