REGULAR CONTENT
Final ID
513
Type
Original Scientific Research-Oral or Pos
Authors
R Cobb1, I Sullivan1, B Berg2, A Patel2, E Cuthbertson1, D Pryluck1, D Niman1, M Burshteyn1, J Panaro1, G Cohen1
Institutions
1Temple University Hospital, Philadelphia, PA, 2Lewis Katz School of Medicine at Temple University, Philadelphia, PA
Purpose
Percutaneous cholecystostomy tube (PCT) placement has traditionally served as a temporizing measure to bridge a comorbid patient presenting with acute cholecystitis and/or acute cholangitis to the current mainstay definitive treatment of cholecystectomy. While criteria outlined by the 2013 Tokyo Guidelines have subsequently resulted in a rise of PCT placements, there is lack of a definitive treatment plan if these patients forego surgery due to excessive perioperative risk.
Materials & Methods
147 patients (67 females and 80 males; average age 64.4yo, range 22-91yo, SD 16.0 years) received a PCT at our institution from February 2011 to February 2016 and were retrospectively analyzed. Patient endpoints were cholecystectomy (laparoscopic, conversion to open, or open), tube removal, mortality, and loss to follow-up.
Results
Of the 147 patients, 62 (42.2%) received a cholecystectomy (46 [74.2%] laparoscopic, 10 [16.1%] conversion to open, 6 [9.7 %] open); 22 (15.0%) expired with the tube in place; 21 (14.3%) had the tube removed as definitive treatment; 7 (4.8%) continued indefinite tube management; 35 (23.8%) were lost to follow-up.
Conclusions
Currently, general surgery clinically manages patients after PCT placement with minimal interventional team involvement. While a portion of these patients will be bridged to surgery, some remain too high risk to undergo cholecystectomy. In our hospital, the conversion to open rate for our patients exceeds reported averages of 6.1-10% in patients with chronic and acute cholecystitis [1]. Due to the severity of these patients' chronic comorbidities, there is a need for closer clinical management of their PCTs and possible alternative definitive treatment options. Interventionalists are uniquely positioned to take on primary management role with this population. Definitive management including criteria for catheter removal, utilizing fluoroscopic and endoscopic stone removal, as well as, gallbladder ablation has been concept proven [2-4]; however, integrating interventionalists as part of an interdisciplinary treatment algorithm for patients suffering from acute cholecystitis needs to be addressed.
Final ID
513
Type
Original Scientific Research-Oral or Pos
Authors
R Cobb1, I Sullivan1, B Berg2, A Patel2, E Cuthbertson1, D Pryluck1, D Niman1, M Burshteyn1, J Panaro1, G Cohen1
Institutions
1Temple University Hospital, Philadelphia, PA, 2Lewis Katz School of Medicine at Temple University, Philadelphia, PA
Purpose
Percutaneous cholecystostomy tube (PCT) placement has traditionally served as a temporizing measure to bridge a comorbid patient presenting with acute cholecystitis and/or acute cholangitis to the current mainstay definitive treatment of cholecystectomy. While criteria outlined by the 2013 Tokyo Guidelines have subsequently resulted in a rise of PCT placements, there is lack of a definitive treatment plan if these patients forego surgery due to excessive perioperative risk.
Materials & Methods
147 patients (67 females and 80 males; average age 64.4yo, range 22-91yo, SD 16.0 years) received a PCT at our institution from February 2011 to February 2016 and were retrospectively analyzed. Patient endpoints were cholecystectomy (laparoscopic, conversion to open, or open), tube removal, mortality, and loss to follow-up.
Results
Of the 147 patients, 62 (42.2%) received a cholecystectomy (46 [74.2%] laparoscopic, 10 [16.1%] conversion to open, 6 [9.7 %] open); 22 (15.0%) expired with the tube in place; 21 (14.3%) had the tube removed as definitive treatment; 7 (4.8%) continued indefinite tube management; 35 (23.8%) were lost to follow-up.
Conclusions
Currently, general surgery clinically manages patients after PCT placement with minimal interventional team involvement. While a portion of these patients will be bridged to surgery, some remain too high risk to undergo cholecystectomy. In our hospital, the conversion to open rate for our patients exceeds reported averages of 6.1-10% in patients with chronic and acute cholecystitis [1]. Due to the severity of these patients' chronic comorbidities, there is a need for closer clinical management of their PCTs and possible alternative definitive treatment options. Interventionalists are uniquely positioned to take on primary management role with this population. Definitive management including criteria for catheter removal, utilizing fluoroscopic and endoscopic stone removal, as well as, gallbladder ablation has been concept proven [2-4]; however, integrating interventionalists as part of an interdisciplinary treatment algorithm for patients suffering from acute cholecystitis needs to be addressed.