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DOI: 10.1055/s-0039-1681856
ACUTE CHOLECYSTITIS IN HIGH RISK SURGERY PATIENTS. VALUE OF PERCUTANEOUS CHOLECYSTOSTOMY AND ERCP
Publication History
Publication Date:
18 March 2019 (online)
Aims:
Either percutaneous cholecystostomy (PC) and ERCP is recommended in patients with diagnosis of acute calculous cholecystitis (ACC) and high surgical risk. We aimed to compare the outcome of PC and/or ERCP in patient with ACC who are high-risk surgery candidates (HRSC).
Methods:
During January 2005-December 2017, we retrospectively reviewed patients with ACC who are HRSC and managed with ERCP and/or PC as a first line treatment.
Results:
We identified 71 cases, 22 treated with ERCP (31%), 47 (66,2%) with PC and 2 with PC+ERCP (2.81%) and a follow-up time of 5 years or until surgery.
The average age was 74 years-old in ERCP group and 77 years-old in CP group. Anesthetic risk ASAIII or greater was observed in 13 patients (59.1%) in ERCP group and 43 patients (91.48%) in PC group.
The rate of patients free of recurrence or need additional invasive procedures were discussed in table 1.
ERCP |
PERCUTANEUS CHOLECYSTOSTOMY |
ERCP + PC |
|
Not recurrence not surgery |
41% (9 patients of 22) |
51% (24 patients of 47) |
100% (2 patients) |
Biliary recurrences (A new episode in spite of correct treatment) |
27,3% (6 patients of 22) – 4 cholecystitis (3 surgical treatment) – 2 cholangitis (2 treated with ERCP). |
25,53% (12 patients of 47) – 6 cholecystitis (4 surgical treatment) – 4 cholangitis (1 treated with ERCP) – 2 pancreatitis |
|
Time to recurrence |
14,5 months |
8 months |
|
Surgery after a first episode or biliary recurrence. |
50% (11 patients of 22) |
32% (15 patients of 47) |
Morbidity in ERCP group was 4.5% (1/22), due to delayed postpapillotomy bleeding, which was solved by endoscopy procedure later, and 2.1% (1/47) due to biliary peritonitis in PC group. In PC+ERCP group, there were not technical procedures complications, but a patient died because of biliary sepsis. PC and ERCP mortality was 1/71 (1.4%).
Finally, the morbidity and mortality of cholecystectomies were 3.8% (1/26) due to surgical site infection and death.
Conclusions:
Patients free of recurrence of biliary event were similar in both techniques (40 – 50%). 50% of not surgical patients who an ERCP were performed and 32% who a PC were performed, need a cholecystectomy afterwards.