Background
In high-risk and unfit-for-surgery patients with acute cholecystitis (AC), treatment
options are controversial. Few studies have reported the results of long-term follow-up.
This study aimed to evaluate the clinical course of patients after removal of the
percutaneous cholecystostomy (PC) catheter in high-risk patients with AC, time interval
to relapse, and factors influencing relapse.
Methods
From 2000 to 2011, 183 patients with AC underwent PC and catheter removal in Seoul
National University Hospital and Boramae Hospital, Korea. Sixty cases were reviewed
retrospectively after excluding cases with intended interval cholecystectomy, malignant
biliary obstruction, loss to follow-up, and insufficient follow-up information.
Results
The mean age was 68.6 ± 13.8 years, and the mean Karnofsky performance score was 24.8 ± 9.7.
After insertion of a PC catheter, symptom resolution and improvement on imaging were
achieved in 95% and 97.9% of patients, respectively. Laboratory values were also improved
(P < .01). There was no mortality during admission; 2 patients (3.3%) experienced complications
during removal of the PC catheter. Relapse was observed in 7 patients (11.7%) during
a median follow-up of 38.1 ± 24.8 months. There were no differences in clinical, laboratory,
or imaging findings between relapsing and nonrelapsing patients. Therefore, prediction
of relapse was not possible.
Conclusion
Among high-risk patients with AC, 88.3% were managed with PC without relapse within
a median follow-up period of 38.1 months, despite radiologically severe AC in some
patients. We conclude that a temporary PC can be a first-line treatment for AC without
interval cholecystectomy.
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Article info
Publication history
Published online: January 13, 2014
Accepted:
December 26,
2013
Footnotes
Y.R.C. and Y.-J.A. equally contributed to this study.
Identification
Copyright
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
