Experience with PCT placement in High-Risk Patients with acute cholecystitis.

Author(s):
Melissa Meghpara; David Fan; Omar Wain

Background:
Percutaneous cholecystostomy tube (PCT) is a procedure performed in place of surgical cholecystectomy only on select cases of cholecystitis, in which patients may be poor surgical candidates due to their pre-existing or co-existing comorbidities and critical conditions.

Hypothesis:
The objective of this study is to do an in depth analysis of utilization of PCT in our institute with clinical outcomes for patients and eventual definitive surgery.

Methods:
In this retrospective clinical study with institutional review board (IRB) approval, we accessed EMR charts of 73 patients who were unfit to undergo surgery at the time of diagnosis of acute cholecystitis and had PCT placed in our institute by the interventional radiology department. The data collected spans over 3 years (December 2012-December 2015) for patients diagnosed with acute cholecystitis unable to undergo surgery at time of diagnosis. For the analysis, charts were examined for: Patient Factors, IR Procedure Details (including type of catheter used, approach to placement, bile cultures, any immediate complications), clinical condition following PCT, delayed complication associated with PCT within 30 days of placement, duration of PCT in place before removal and/or cholecystectomy, and finally number of patients who were operated on and their surgical outcome.

Results:
Significant clinical improvements were seen within 3 days following PCT placement in high risk patients with acute cholecystitis. There were no immediate complications identified and major complication within 30-day was identified to be tube dislodgement in 12% of the patients. Majority of bile cultures were found to have no growth however; E.coli, Enterobacter, Klebsiella, Streptococcus, and Yeast were organisms in positive cultures. Out of the 73 patients 43.84% (n=32) underwent cholecystectomy, of whom; 65.63% (n=21) were laparoscopic, 25% (n=8) were converted to open and 9.37% (n=3) underwent open cholecystectomy.

Conclusions:
PCT is an effective initial treatment in patients with acute cholecystitis not amenable to cholecystectomy and in some patients it may be the definitive treatment.