Comparing outcomes of percutaneous cholecystostomy drain placement between patients within and outside of Tokyo guidelin
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INTERVENTIONAL RADIOLOGY
Comparing outcomes of percutaneous cholecystostomy drain placement between patients within and outside of Tokyo guidelines diagnostic criteria for acute cholecystitis Alex Lionberg1 · Thomas Tullius1 · Teresa Jiang2 · Chukwuemeka Okafor2 · Travis Wassermann2 · Thuong Van Ha1 Received: 11 July 2020 / Revised: 7 September 2020 / Accepted: 10 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective To compare outcomes following percutaneous cholecystostomy drain placement based on presence or absence of Tokyo Guidelines diagnostic criteria for acute cholecystitis. Methods Chart review was performed to identify the presence or absence of Tokyo Guidelines diagnostic criteria for acute cholecystitis in 146 patients who underwent percutaneous cholecystostomy between 2012 and 2015. Those who met criteria were compared to those who did not in terms of demographics, laboratory values, drain indwelling time, treatment response, eventual surgical management, and 30-day mortality. Results 94 patients (64%) met Tokyo Guidelines diagnostic criteria, while 52 did not (36%). Patients within criteria had a shorter mean length of stay (13.5 days vs 18.9 days), were more likely to have a positive gallbladder fluid culture (64.5% vs 28.6%), demonstrated greater response to treatment (87.2% vs 32.7%), and had lower 30-day mortality (6.4% vs 37.8%). There was no significant difference in terms of ICU requirement (38.3% vs 38.9%), mean drain indwelling time (58.8 days vs 65.3 days), eventual laparoscopic cholecystectomy (40.4% vs 25.0%), or open cholecystectomy performed (9.5% vs 9.6%). Conclusion Patients outside of Tokyo Guidelines diagnostic criteria for acute cholecystitis were less likely to respond to treatment with percutaneous cholecystostomy and had worse outcomes. Further research may be indicated to better define the indications for percutaneous cholecystostomy placement in this group. Keywords Cholecystostomy · Cholecystitis · Gallbladder diseases · Tokyo guidelines
Introduction Since its initial use in the 1980s, percutaneous cholecystostomy (PC) has been shown to be a safe and efficacious technique for the management of diseases affecting the gallbladder and biliary system [1, 2]. The procedure is most often used as a temporizing measure for patients with acute cholecystitis (AC) deemed too sick to undergo cholecystectomy in the acute setting or who are otherwise high risk, including pregnant women and the hemodialysis population * Alex Lionberg [email protected] 1
Section of Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC2026, Chicago, IL 60367, USA
Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
2
[3–5]. In some cases, such as for treatment of acute acalculous cholecystitis, PC may be used as definitive management without the need for subsequent elective surgery. Less common indications for PC include access to the biliary tr
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