Safety and Effectiveness of Percutaneous Cholecystostomy (PC) as a Treatment O Acute Cholecystitis (AC) in Selected Patients. Prospective 10 Years Study of Adverse Events (AE)

Introduction: Definitive treatment for AC is cholecystectomy. However in patients with medical comorbidities or critical illness, PC could be and effective and safe alternative. Methods: We evaluated 1223 patients with AC recovered from 2008 to 2017. Medical treatment was used in 273 patients. In 66 out of 273 a PC was indicated. PC was performed under ultrasonography and local anaesthesia. A minimum follow-up of one year was done. AE were recorded prospectively according to Clavien-Dindo Classification. Results: PC was indicated due to severe comorbidities (55%), critical illness (31%), or long-time AC evolution in weak patients (8%). Median age was 79 years. Eighteen patients were admitted in ICU. Sixty-two patients were ASA III or superior. Twenty patients were treated with delayed cholecystectomy (30%). Two patients needed emergent cholecystectomy due to PC failure, one of them died due to sepsis. Six more patients died with PC (mortality 10%). Effectiveness 48/66 (88%) Twenty-two AE were observed in 14 patients during hospitalization. Seven grade V and 4 grade III in 4 patients. Thirty patients presented AE during follow-up related to the PC. Thirty-two out of 59 patients died during follow-up. Five died in the group of patients with delayed cholecystectomy. Twenty patients died in the group of PC without cholecystectomy. Conclusions: PC is safe alternative to cholecystectomy in critically ill or high-risk patients and could be the only treatment. AE are high. The high mortality during follow-up is due to other medical problems. Delayed Cholecystectomy should be done in very selected patients.