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
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 in symptoms and the systemic inflammatory response,
allowing for subsequent lower-risk elective cholecystectomy [4,
5].
PCs are currently indicated in the management of acute cholecystitis in elderly patients or those who have a high ASA grade,
following a multidisciplinary decision depending on the individual patient’s response to therapy [3,
4].
Furthermore,
there is evidence to support the beneficial use of PC in patients who fail to respond appropriately to medical treatment of acute cholecystitis [6].
The procedure can be performed using either ultrasound alone or with the added help of fluoroscopic guidance.
Computed tomography (CT) can also be used to guide the procedure in some cases [3]. With imaging confirming placement of the drain within the gallbladder; this would be interpreted as a technically successful procedure and should be achieved in >90% of cases [4].
Clinical success following percutaneous cholecystostomy is related to a reduction in pain,
fever,
white cell count (WCC) and C-Reactive protein (CRP) [4].
The purpose of this study was to retrospectively review cholecystostomies performed in our unit; and compare the collected clinical and biochemical data with currently available guidelines.