Clinical Study
Outcomes of Percutaneous Cholecystostomy in the Presence of Ascites

https://doi.org/10.1016/j.jvir.2015.12.004Get rights and content

Abstract

Purpose

To evaluate whether the presence of ascites increases complications following placement of percutaneous cholecystostomy tubes (PCTs).

Materials and Methods

Retrospective review of all transhepatic PCTs placed between January 2005 and June 2014 was performed: 255 patients were included (median age of 65 y; range, 20–95 y). Of these patients, 97 had ascites and 158 had no ascites or only pelvic fluid. In all, 115 patients had calculous cholecystitis (45%), 127 had acalculous cholecystitis (50%), and 13 had common bile duct obstruction (5%). The primary outcome of interest was all complications, including bile peritonitis, pericatheter leakage requiring PCT change, pericholecystic abscess formation, drain dislodgment, or death from biliary sepsis within 14 days of initial PCT insertion.

Results

The overall complication rate was 11% among patients with ascites (n = 11), compared with 10% in those without (n = 16; P = .834). No difference was found between the two groups in any one complication. The overall outcome of PCT drainage differed between groups, with significantly shorter survival times in patients with ascites. Patients with ascites underwent cholecystectomy less often than patients without ascites (21% vs 39%; P = .002). Likewise, patients with ascites were more likely than those without ascites to die with the PCT in place (49% vs 25%; P = .001).

Conclusions

Frequencies of complications following PCT insertion were similar in patients with and without ascites. Additionally, the overall complication rate was low and not significantly different between the two groups. These observations support the use of PCT placement in patients with ascites.

Section snippets

Patient Selection and Data Collection

In accordance with the institutional review board, a retrospective review of all patients who underwent a transhepatic percutaneous cholecystostomy procedure from January 2005 until June 2014 at an academic medical center was performed by examining the records from a dedicated interventional radiology database (HI-IQ; ConexSys, Lincoln, Rhode Island). In total, 255 patients were identified. All catheters were placed by interventional radiologists (mean experience, 12 y; range, 1–22 y) with

Results

The overall incidences of PCT complications were similar between the two groups. Complications occurred in 11% of patients with ascites (n = 11) compared with 10% of those without ascites (n = 16; P = .834). No difference was found between the two groups for any one type of complication. The incidences and types of complication for patients with and without ascites are further detailed in Table 3. Analysis of complications was also performed when only diffuse ascites was categorized as ascites

Discussion

Percutaneous cholecystostomy procedures have become an accepted technique for the management of clinically diagnosed acute cholecystitis in patients with extensive comorbidities or temporary high-risk factors that may make surgical intervention suboptimal (2, 3, 7, 8, 9, 10). Ascites has been cited as a potential factor that may lead to increased risk of complications in PCT, although there few studies addressing this hypothesis (3, 4). Increased mobility of the PCT and/or failure of a

References (15)

There are more references available in the full text version of this article.

Cited by (15)

  • Call for action: Increased healthcare utilization with growing use of percutaneous cholecystectomy tube over initial cholecystectomy in cirrhotics

    2022, Hepatobiliary and Pancreatic Diseases International
    Citation Excerpt :

    PCT has additionally been shown to be effective in cirrhotics with ascites, which was considered a relative contraindication in the past [8]. This procedure can provide patients with decompression of their biliary system, typically within a few days, reduce overall complications of ACC, and allow time to optimize cirrhotic patients for definitive surgery [7–9]. However, in the general population, PCT typically leads to multiple readmissions, prolonged hospital stays, and higher hospital costs when it is not followed by definitive management [8–10].

  • Society of Interventional Radiology Quality Improvement Standards for Percutaneous Cholecystostomy and Percutaneous Transhepatic Biliary Interventions

    2020, Journal of Vascular and Interventional Radiology
    Citation Excerpt :

    Ascites has historically represented a relative contraindication to percutaneous access to the biliary system or cholecystostomy owing to increased risk of bleeding and pericatheter leakage (54). Paracentesis may be performed simultaneously with the biliary intervention to mitigate some of this risk at some practices; however, a recent retrospective study suggests that ascites does not represent an increased risk to the patient with cholecystostomy (54). Decreasing the amount of ascites for percutaneous transhepatic cholangiography can be helpful in reducing radiation dose.

View all citing articles on Scopus

None of the authors have identified a conflict of interest.

Table E1 is available online at www.jvir.org.

View full text