Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2020; 8(6): 1033-1041
Published online Mar 26, 2020. doi: 10.12998/wjcc.v8.i6.1033
Clinical course of percutaneous cholecystostomies: A cross-sectional study
Sadettin Er, Hüseyin Berkem, Sabri Özden, Birkan Birben, Erdinç Çetinkaya, Mesut Tez, Bülent Cavit Yüksel
Sadettin Er, Hüseyin Berkem, Sabri Özden, Birkan Birben, Erdinç Çetinkaya, Mesut Tez, Bülent Cavit Yüksel, Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
Author contributions: All authors helped perform the research; Er S, Özden S manuscript writing, performing procedures and data analysis; Er S, Tez M manuscript writing, drafting conception and design, performing experiments, and data analysis; Berkem H manuscript writing, drafting conception and design; Özden S, Birben B, Çetinkaya E manuscript writing; Tez M, Yüksel BC manuscript writing, drafting conception and design and critical revision of manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Ankara Numune Training and Research Hospital (Approval number: E-1720).
Informed consent statement: Informed consent of the patients was not required because the analysis used anonymous clinical data obtained from each patient that agreed to the treatment by written consent.
Conflict-of-interest statement: The authors declare no conflict of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mesut Tez, MD, Associate Professor, Lecturer, Surgical Oncologist, Department of Surgery, Ankara Numune Training and Research Hospital, Sakarya Mh. Ulucanlar Cd. No. 89 Altındağ/ANKARA, Ankara 06100, Turkey. mesuttez@yahoo.com
Received: December 19, 2019
Peer-review started: December 19, 2019
First decision: January 12, 2020
Revised: March 11, 2020
Accepted: March 19, 2020
Article in press: March 19, 2020
Published online: March 26, 2020
Processing time: 97 Days and 18.1 Hours
Abstract
BACKGROUND

Although cholecystectomy is the standard treatment modality, it has been shown that perioperative mortality is approaching 19% in critical and elderly patients. Percutaneous cholecystostomy (PC) can be considered as a safer option with a significantly lower complication rate in these patients.

AIM

To assess the clinical course of acute cholecystitis (AC) in patients we treated with PC.

METHODS

The study included 82 patients with Grade I, II or III AC according to the Tokyo Guidelines 2018 (TG18) and treated with PC. The patients’ demographic and clinical features, laboratory parameters, and radiological findings were retrospectively obtained from their medical records.

RESULTS

Eighty-two patients, 45 (54.9%) were male, and the median age was 76 (35-98) years. According to TG18, 25 patients (30.5%) had Grade I, 34 (41.5%) Grade II, and 23 (28%) Grade III AC. The American Society of Anesthesiologists (ASA) physical status score was III or more in 78 patients (95.1%). The patients, who had been treated with PC, were divided into two groups: discharged patients and those who died in hospital. The groups statistically significantly differed only concerning the ASA score (P = 0.0001) and WBCC (P = 0.025). Two months after discharge, two patients (3%) were readmitted with AC, and the intervention was repeated. Nine of the discharged patients (13.6%) underwent interval open cholecystectomy or laparoscopic cholecystectomy (8/1) within six to eight weeks after PC. The median follow-up time of these patients was 128 (12-365) wk, and their median lifetime was 36 (1-332) wk.

CONCLUSION

For high clinical success in AC treatment, PC is recommended for high-risk patients with moderate-severe AC according to TG18, elderly patients, and especially those with ASA scores of ≥ III. According to our results, PC, a safe, effective and minimally invasive treatment, should be preferred in cases suffering from AC with high risk of mortality associated with cholecystectomy.

Keywords: Catheter ablation; Cholecystostomy; Cholecystitis; Acute; Cholecystectomy; Mortality; Morbidity

Core tip: Percutaneous cholecystostomy is a safer treatment option especially for patients who have high risk of mortality after surgery. This option can be chosen after determining the severity of cholecystitis, the patient’s general status, and underlying disease. Tokyo Guidelines 2018 can be used to determine the severity of acute cholecystitis. In this study, we aimed to assess the clinical course of acute cholecystitis in patients treated with percutaneous cholecystostomy.