Cholecystostomy Tube

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Overview

Overview content for Cholecystostomy Tube is not yet available.

Pre-Procedure

Indications:
• Gallbladder decompression
• Access to biliary tract for intervention
• Cholecystitis is most common indication

Contraindications:
• Few if any absolute contraindications
• Interposed colon or small bowel may preclude access
• Severe bleeding diathesis
• Gallbladder tumor and risk of seeding along tract
• Porcelain gallbladder or gallbladder completely filled with stones can make drain placement difficult
• Perforated gallbladder can make tube placement extremely difficult

SIR periprocedural coagulation parameters:
• INR, aPTT, platelets labs recommended
• INR: correct to < 1.9
• Platelets: < 50,000/µl recommend transfusion
• aPTT: correct so that value is < 1.5 control
Suggested laboratory parameters for patients with chronic liver disease
• INR < 2.5
• Platelets: > 30,000
• Consider fibrinogen level

Preprocedural evaluation:
• H&P
• Known indication for referral
• Evaluate patient comorbidities for procedure and anesthesia plan
• Medication review: antibiotics and anticoagulation
Imaging
• Signs of cholecystitis or cystic duct patency
• Cross-sectional helpful to evaluate access route and plan for adjacent critical structures


Procedure

Antibiotic:
• 1 g ceftriaxone (Rocephin) IV
• Vancomycin or clindamycin-gentamicin for PCN allergy
Other regimens
• 1.5–3 g ampicillin/sulbactam (Unasyn) IV
• 1 g cefotetan IV plus 4 g mezlocillin IV
• 2 g ampicillin IV plus 1.5 mg/kg gentamicin IV

Approach:
[1] Transhepatic
• Drain anchored within liver parenchyma improves drain stability
• Reduces risk of bile leak
• Faster tract maturation
• Higher risk of bleeding or liver injury when traversing liver parenchyma
• Often access site is higher which increased risk of lung/pleural transgression
[2] Transperitoneal
• May be preferred route if planning for subsequent intervention such as lithotripsy
• Reduces risk of liver injury or hemorrhage
• Avoids diffuse liver disease or potential liver metastasis

Procedure:
• Approach: transhepatic vs transperitoneal approach
• Access gallbladder with US guidance using 18-22 gauge needle
• Inject contrast to confirm position with option for cholecystogram to evaluate cystic duct
• If 20 gauge needle or smaller, will need to place 0.018" wire
• Accustick or Neff set to transition to 0.035" wire
• Serial dilate
• Place 8 or 10 Fr pigtail drain
• Obtain bile for cultures
• Attach drain to gravity bag

Post-Procedure

Postprocedural care
• Bed rest for 2-4 hours
• Continue antibiotics for at least 48 hours
• Flush catheter at least once per day with 10 mL normal saline
• Record drain output

Complications:
• Tube displacement or dislodgement: 4.5-13.2% (most common)
• Bile leak or peritonitis: 1.9-2.4%
• Bleeding requiring transfusion: < 2%
• Sepsis: < 1%
• Procedure-related mortality: 0-1.4%

Related Procedures

No related procedures.

 

References

[1] Patel IJ, Rahim S, Davidson JC, et al. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions-Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol. 2019;30(8):1168-1184.e1. doi:10.1016/j.jvir.2019.04.017
[2] Chehab MA, Thakor AS, Tulin-Silver S, et al. Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol. 2018;29(11):1483-1501.e2. doi:10.1016/j.jvir.2018.06.007
[3] Ansaloni L, Pisano M, Coccolini F, et al. 2016 WSES guidelines on acute calculous cholecystitis [published correction appears in World J Emerg Surg. 2016 Nov 4;11:52]. World J Emerg Surg. 2016;11:25. Published 2016 Jun 14. doi:10.1186/s13017-016-0082-5
[4] Popowicz A, Lundell L, Gerber P, et al. Cholecystostomy as Bridge to Surgery and as Definitive Treatment or Acute Cholecystectomy in Patients with Acute Cholecystitis. Gastroenterol Res Pract. 2016;2016:3672416. doi:10.1155/2016/3672416
[5] Yeo CS, Tay VW, Low JK, Woon WW, Punamiya SJ, Shelat VG. Outcomes of percutaneous cholecystostomy and predictors of eventual cholecystectomy. J Hepatobiliary Pancreat Sci. 2016;23(1):65-73. doi:10.1002/jhbp.304
[6] Pang KW, Tan CH, Loh S, et al. Outcomes of Percutaneous Cholecystostomy for Acute Cholecystitis. World J Surg. 2016;40(11):2735-2744. doi:10.1007/s00268-016-3585-z
[7] Katabathina VS, Zafar AM, Suri R. Clinical Presentation, Imaging, and Management of Acute Cholecystitis. Tech Vasc Interv Radiol. 2015;18(4):256-265. doi:10.1053/j.tvir.2015.07.009
[8] Joseph T, Unver K, Hwang GL, et al. Percutaneous cholecystostomy for acute cholecystitis: ten-year experience. J Vasc Interv Radiol. 2012;23(1):83-8.e1. doi:10.1016/j.jvir.2011.09.030


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