Sandy Chan, MD1, Wahid Wassef, MD2; 1UMass Memorial Medical Center, Worcester, MA; 2University of Massachusetts Medical Center, Shrewsbury, MA
Introduction: Percutaneous cholecystectomy tubes (PCT) are commonly placed as an alternative intervention for patients with acute cholecystitis (AC) who have contraindications for cholecystectomy (CCY) due to medical comorbidities or advanced age. However, high quality data on short- and long-term complications after PCT placement for AC is limited and its use as an established treatment remains to be elucidated. In our study, we aim to assess rates of complications with emphasis on complications encountered during follow-up after initial hospitalization for PCT placement. Methods: We retrospectively studied a cohort of 41 patients who received PCT placement for AC. Demographic and biliary complication profile, including PCT dysfunction rates and need for re-intervention or subsequent cholecystectomy was collected. Results: We evaluated 41 patients with median age of 66.5 years (32-95). 13 patients presented acute acalculus cholecystitis and 28 patients presented with acute calculus cholecystitis. Overall complication rate was 73% with recurrent biliary symptoms (31.7%) and stent dislodgment or migration (19.5%) presenting as the most common complications. Average length of hospital stay after PTC placement was 8.43 days. Average length of time stent was in place was 54.6 days. Most common comorbidities were cardiac disease (28.8%), use of blood thinners (20.5%) and diabetes (17.8%). Discussion: Average length of hospital stay (8.4%) after PCT placement in our institution is shorter than described in the literature despite similar rates of gender and age distribution and may be attributed to differences in tube placement technique. Stent dislodgment or migration (19.5%) was one of the most common complications found at our institution. Similarly, dislodgment incidence in the literature was as high as 38%. PCT failure necessitated CCY in 19.5% of patients, sepsis occurred in 9.8% of patients, and abscess development occurred in 4.9% of patients. These complication rates suggest that although PCT is an alternative to cholecystectomy for unstable, critically ill patients or elderly patients, it may not be the best alternative. The development of lumen apposing metal axial stents for gallbladder drainage suggests a role for this approach and warrants further investigation.
Disclosures: Sandy Chan indicated no relevant financial relationships. Wahid Wassef: Boston Scientific – Consultant.