Endoscopy 2019; 51(04): S229
DOI: 10.1055/s-0039-1681856
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: ERCP ePosters
Georg Thieme Verlag KG Stuttgart · New York

ACUTE CHOLECYSTITIS IN HIGH RISK SURGERY PATIENTS. VALUE OF PERCUTANEOUS CHOLECYSTOSTOMY AND ERCP

C García-Ramos García
1   Hospital Severo Ochoa, Leganés, Spain
,
EM Quintanilla Lázaro
1   Hospital Severo Ochoa, Leganés, Spain
,
I Maestro Prada
1   Hospital Severo Ochoa, Leganés, Spain
,
P Chaudarcas Castiñeira
1   Hospital Severo Ochoa, Leganés, Spain
,
M Alvarez Sánchez
1   Hospital Severo Ochoa, Leganés, Spain
,
JL Castro Urda
1   Hospital Severo Ochoa, Leganés, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

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.

Tab. 1:

Rate of patients free of recurrence or need additional invasive procedures.

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.