MACAFI collaborator UK National Interventional Radiology Trainee Network
Jim Zhong, MBChB BSc(hons) PGDip FRCR FBIR: No financial relationships to disclose
Purpose: The study aims were to assess the technical success and clinical outcomes related to percutaneous cholecystostomy (PC) insertion in patients with acute calculous cholecystitis (ACC) based on procedural technique [transhepatic (TH) or transperitoneal (TP)] and determine the safest approach.
Materials and Methods: The data set used was from the United Kingdom nationwide MACAFI (Multicentre Audit of Cholecystostomy and Further Interventions) study which included patients who underwent PC for ACC between 1st January 2019 and 1st January 2021. Data included patient demographics, imaging diagnosis, insertion technique, tube size, and 6 month follow-up/ outcomes (complications, readmission and mortality rate). Statistical analysis was performed using IBM SPSS v27 (IBM Corp. Armonk, NY).
Results: 1186 patients from 36 sites were identified through the MACAFI study with 913 patients having access route recorded. A TH route was used in 572 [62.6%] compared to 308 TP [33.7%]. There was an increased rate of bleeding when using the TH route (TH 2.5% vs TP 0.3%, p = 0.04) although other post procedural complications (such as bile leak) were similar between the two groups. No significant difference was demonstrated in 30 or 90 day mortality (TH v TP, 8.7% vs 9.3%, p = 0.86 and 13.8% vs 15.4%, p = 0.58 respectively). The readmission rate with recurrent cholecystitis was significantly greater in those with TH compared to TP approach (22.0% vs 14.9%, p = 0.01, respectively).
Conclusion: The TP PC approach may be safer than TH, with lower bleeding complication rate and fewer readmissions.