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Cholecystostomy Tube

Percutaneous cholecystostomy tube placement is a common interventional radiology procedure that involves placing a drain into the gallbladder lumen. The most common cholecystostomy tube indication is for drainage of the gallbladder in the setting of cholecystitis. Often patients are poor surgical candidates. The procedure can be performed using multiple modalities including fluoroscopy, ultrasound and/or CT. Many operators prefer the combination of US and fluoroscopy. Techniques for gallbladder drain tube placement can vary between operators and between patients, but with a solid understanding of the basics of drain placement, this procedure can be accomplished safely. Understanding the indications and drain management following cholecystostomy tube placement often involve more expert training.

Percutaneous Cholecystostomy Tube Placement Procedure

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Pre-Procedure Prep

Cholecystostomy Tube Indications

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


• 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

Pre-Procedural Evaluation

• H&P
• Known indication for referral
• Evaluate patient comorbidities for procedure and anesthesia plan
• Medication review: antibiotics and anticoagulation

• Signs of cholecystitis or cystic duct patency
• Cross-sectional helpful to evaluate access route and plan for adjacent critical structures

Cholecystostomy Tube Podcasts

Listen to leading physicians discuss cholecystostomy tube on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.

Episode #185


Co-hosts Dr. Christopher Beck and Dr. Aaron Fritts discuss cholecystostomy tube placement for acute cholecystitis, including the pros and cons of different techniques, and pitfalls to avoid.

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Cholecystostomy Tube Procedure Steps


• 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


[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

Cholecystostomy Tube Placement 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 Cholecystostomy Tube Placement 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


• 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%

Cholecystostomy Tube Demos

Watch video walkthroughs of cholecystostomy tube on the BackTable VI expanded content network.


[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

Disclaimer: The Materials available on are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.



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