Percutaneous Cholecystostomy Versus Conservative Treatment for Acute Cholecystitis: a Cohort Study

• Published in: Journal of gastrointestinal surgery Vol. 23; no. 2; pp. 297 - 303
• Main Authors: Turiño, Stine Ydegaard, Shabanzadeh, Daniel Mønsted, Eichen, Nethe Malik, Jørgensen, Stine Lundgaard, Sørensen, Lars Tue, Jørgensen, Lars Nannestad
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2019; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Cholecystitis, Acute - mortality; Cholecystitis, Acute - therapy; Cholecystostomy - methods; Cohort analysis; Cohort Studies; Conservative Treatment - methods; Denmark - epidemiology; Female; Gallbladder diseases; Gallstones; Gastroenterology; Gastrointestinal surgery; Hospitalization - trends; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Original Article; Recurrence; Surgery; Surgical anastomosis; Survival Rate - trends; Treatment Outcome; Denmark; Cholecystostomy; Cholecystitis; Elderly; Acute
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-018-4021-5

Background Percutaneous cholecystostomy is frequently used as a treatment option for acute calculous cholecystitis in patients unfit for surgery. There is sparse evidence on the long-term impact of cholecystostomy on gallstone-related morbidity and mortality in patients with acute calculous cholecystitis. This study describes the long-term outcome of acute calculous cholecystitis following percutaneous cholecystostomy compared to conservative treatment. Methods This was a cohort study of patients admitted at our institution from 2006 to 2015 with acute calculous cholecystitis without early or delayed cholecystectomy. Endpoints were gallstone-related readmissions, recurrent cholecystitis, and overall mortality. Results The investigation included 201 patients of whom 97 (48.2%) underwent percutaneous cholecystostomy. Patients in the cholecystostomy group had significantly higher age, comorbidity level, and inflammatory response at admission. The median duration of catheter placement in the cholecystostomy group was 6 days. The complication rate of cholecystostomy was 3.1% and the mortality during the index admission was 3.5%. The median follow-up was 1.6 years. The rate of gallstone-related readmissions was 38.6%, and 25.3% had recurrence of cholecystitis. Cox regression analyses revealed no significant differences in gallstone-related readmissions, recurrence of acute calculous cholecystitis, and overall mortality in the two groups. Conclusions Percutaneous cholecystostomy in the treatment of acute calculous cholecystitis was neither associated with long-term benefits nor complications. Based on the high gallstone-related readmission rates of this study population and todays perioperative improvements, we suggest rethinking the indications for non-operative management including percutaneous cholecystostomy in acute calculous cholecystitis.