A Comparison of Direct Gallbladder Puncture with the Transhepatic Puncture Technique in Ultrasound-guided Cholecystostomy for High Surgical Risk Patients with Acute Calculous Cholecystitis

KW Yang, WH Luk, DHY Cho, TKL Loke, JCS Chan

Hong Kong J Radiol 2005;8:222-5

Objective: To compare the clinical response and outcome for direct gallbladder puncture and transhepatic puncture techniques in ultrasound-guided percutaneous cholecystostomy for critically ill and non-surgically fit patients with acute calculous cholecystitis.

Patients and Methods: Twenty seven consecutive critically ill and high surgical risk patients admitted with acute calculous cholecystitis between July 2002 and May 2005 who underwent ultrasound-guided percutaneous cholecystostomy were included in the study. The technique of the procedure and clinical outcomes of these patients were retrospectively evaluated.

Results: Ultrasound-guided percutaneous cholecystostomy was performed using direct gallbladder puncture in 17 patients and transhepatic puncture in 10 patients. There was one procedural failure in transhepatic puncture due to lack of patient cooperation. No procedural failure was reported for direct gallbladder puncture. There were no procedure-related complications. Both groups had a similar clinical response rate, with fever or leucocytosis normalising within 3 days. There was no statistically significant difference in numbers of needle passage, length of hospital stay, or mortality between the two groups. Four patients died due to profound ongoing sepsis and multi-organ failure, while the remaining patients showed clinical improvement and were discharged. Three patients had catheter slippage within one week of the procedure (two following direct gallbladder puncture and one following transhepatic puncture).

Conclusion: Ultrasound-guided percutaneous cholecystostomy for high surgical risk patients with acute calculous cholecystitis is safe and effective. No significant difference in clinical response or outcome was seen between the direct gallbladder puncture or transhepatic puncture techniques in this retrospective study.