Safety and usefulness of percutaneous transhepatic cholecystoscopy examination in high-risk surgical patients with acute cholecystitis

Gastrointest Endosc. 2000 Nov;52(5):645-9. doi: 10.1067/mge.2000.107286.

Abstract

Background: The aim of the present study was to evaluate the diagnostic and therapeutic usefulness of percutaneous transhepatic cholecystoscopy in high-risk surgical patients with acute cholecystitis.

Methods: Between January 1992 and June 1998, there were 33 consecutive patients who underwent percutaneous transhepatic cholecystostomy and subsequent percutaneous transhepatic cholecystoscopy for the management of acute cholecystitis.

Results: Percutaneous transhepatic cholecystostomy and subsequent percutaneous transhepatic cholecystoscopy were successfully accomplished in all 33 patients. During percutaneous transhepatic cholecystoscopy, minor complications (2 episodes of minor bleeding during electrohydraulic lithotripsy, 2 of tube dislodgement, and 1 of bile leakage to peritoneum) occurred in 5 patients. Percutaneous transhepatic cholecystoscopy revealed gallstones in 26 cases, sludge ball in 3, gallbladder carcinoma in 3, and 1 case of clonorchiasis related with acute cholecystitis. The 3 gallbladder cancers which were not identified radiologically were found incidentally during percutaneous transhepatic cholecystoscopy. For the 26 patients with gallstones, percutaneous transhepatic cholecystoscopy and concomitant stone removal were successful in 1 to 4 consecutive sessions (mean 2.2 sessions). Gallstones recurred in 3 of 22 patients (14%) during the mean follow-up period of 27 months. All of them remain asymptomatic.

Conclusion: Percutaneous transhepatic cholecystostomy may be justified in the management of acute cholecystitis in selected patients with high surgical risk.

Publication types

  • Clinical Trial

MeSH terms

  • Acute Disease
  • Aged
  • Cholecystitis / diagnosis*
  • Cholecystitis / surgery*
  • Cholecystostomy* / adverse effects
  • Endoscopy, Digestive System* / adverse effects
  • Female
  • Humans
  • Male
  • Postoperative Complications / epidemiology
  • Risk Factors