Abstract Introduction Laparoscopic Cholecystectomy (LC) is the gold standard for treating acute cholecystitis (AC). However, for patients unfit for surgery, gallbladder drainage may be required, achieved via Percutaneous gallbladder drainage (PTGBD) or endoscopic ultrasound-guided drainage (EUGBD). EUGBD enables stone clearance or permanent drainage, whereas PTGBD carries risks of drain-related complications. This study examined PTGBD outcomes in a large District General Hospital to evaluate implementing EUGBD. Methods A retrospective analysis of all patients undergoing PTGBD between November 2013 and December 2023 in a single UK DGH was undertaken. Data included demographics and comorbidities, as well clinical outcomes. Results 47 patients underwent PTGBD (44.7% female; 55.3% male). 71.7% were ASA 3. The most common indications were acute cholecystitis (78.7%) and gallbladder perforation (19.1%). Technical and clinical success rates were 97.8% and 92.3%, and 30 and 90 day mortality were 2.2% (1) and 6.8 (3) respectively. Further procedures were required in 23.9% of patients (11) including: Cholangiogram (50%); Tube replacement (10%); Further drainage (10%). 7 patients underwent interval cholecystectomy while 18 patient underwent subsequent definitive cholecystectomy. Reintervention rate at 30 days was 43.5%. 54% of patients had a further unplanned admission mainly due to further episode of cholecystitis (6 cases), tube dislodgement (1), or to the tube falling out (1). Discussion PTGBD is effective for managing acute cholecystitis in high-risk surgical patients. Our series indicates a favourable 30 and 90 mortality compared to published series of both PTGBD and EUGBD. Intervention choice should be centre-specific and dependent on auditable clinical outcomes.
Abdelwahed et al. (Fri,) studied this question.