Ann Hepatobiliary Pancreat Surg.  2023 Feb;27(1):56-62. 10.14701/ahbps.22-065.

Outcomes of endoscopic retrograde cholangiopancreatography-guided gallbladder drainage compared to percutaneous cholecystostomy in acute cholecystitis

• Ali H
• Shamoon S
• Bolick NL
• Manickam S
• Sattar U
• Poola S
• Mudireddy P

• KMID: 2539514
• DOI: http://doi.org/10.14701/ahbps.22-065

Abstract

Backgrounds/Aims
Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) is an alternative to percutaneous cholecystostomy (PTC) for hospitalized acute cholecystitis (AC) patients.
Methods
We retrospectively analyzed propensity score matched (PSM) AC hospitalizations using the National Inpatient Sample database between 2016 and 2019 to compare the outcomes of ERGD and PTC.
Results
After PSM, there were 3,360 AC hospitalizations, with 48.8% undergoing PTC and 51.2% undergoing ERGD. There was no difference in median length of stay between the PTC and ERGD cohorts (p = 0.110). There was a higher median hospitalization cost in the ERGD cohort, $62,562 (interquartile range [IQR] $40,707–97,978) compared to PTC, $40,413 (IQR $25,244–65,608; p < 0.001). The 30-day inpatient mortality was significantly lower in hospitalizations with ERGD compared to PTC (adjusted hazard ratio 0.16, 95% confidence interval [CI]: 0.1–0.41; p < 0.001). There was no difference in association with blood transfusions, acute renal failure, ileus, small bowel obstruction, and open cholecystectomy conversion (p > 0.05) between hospitalizations with ERGD and PTC. There was lower association of acute hypoxic respiratory failure (adjusted ratio [AOR] 0.46, 95% CI: 0.29–0.72; p = 0.001), hypovolemia (AOR 0.66, 95% CI: 0.49–0.82; p = 0.009) and higher association of lower gastrointestinal bleed (AOR 1.94, 95% CI: 1.48–2.54; p < 0.001) with ERGD compared to PTC.
Conclusions
ERGD is a safer alternative to PTC in patients with AC. The risk complications are lower in ERGD compared to PTC but no difference exists based on mortality or conversion to open cholecystectomy.

Keyword

Cholecystostomy; Cholangiopancreatography; endoscopic retrograde; Inpatients; Cholecystitis; acute; Health care costs

Figure

• 

  Fig. 1 Covariance graph before propensity matching the cohorts. ERGD, endoscopic retrograde cholangiopancreatography-guided gallbladder drainage; PTC, percutaneous cholecystostomy.

• 

  Fig. 2 Covariance graph after propensity matching the cohorts. ERGD, endoscopic retrograde cholangiopancreatography-guided gallbladder drainage; PTC, percutaneous cholecystostomy.

Reference

1. Wadhwa V, Jobanputra Y, Garg SK, Patwardhan S, Mehta D, Sanaka MR. 2017; Nationwide trends of hospital admissions for acute cholecystitis in the United States. Gastroenterol Rep (Oxf). 5:36–42. DOI: 10.1093/gastro/gow015. PMID: 27174434. PMCID: PMC5444253.

2. Shaffer EA. 2006; Gallstone disease: epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 20:981–996. DOI: 10.1016/j.bpg.2006.05.004. PMID: 17127183.

3. Knab LM, Boller AM, Mahvi DM. 2014; Cholecystitis. Surg Clin North Am. 94:455–470. DOI: 10.1016/j.suc.2014.01.005. PMID: 24679431.

4. Kaura K, Bazerbachi F, Sawas T, Levy MJ, Martin JA, Storm AC, et al. 2020; Surgical outcomes of ERCP-guided transpapillary gallbladder drainage versus percutaneous cholecystostomy as bridging therapies for acute cholecystitis followed by interval cholecystectomy. HPB (Oxford). 22:996–1003. DOI: 10.1016/j.hpb.2019.10.1530. PMID: 31685380.

5. Lee SO, Yim SK. 2018; Management of acute cholecystitis. Korean J Gastroenterol. 71:264–268. DOI: 10.4166/kjg.2018.71.5.264. PMID: 29791985.

6. Radder RW. 1980; Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging. 49:330–333.

7. Feretis CB, Manouras AJ, Apostolidis NS, Golematis BC. 1990; Endoscopic transpapillary drainage of gallbladder empyema. Gastrointest Endosc. 36:523–525. DOI: 10.1016/S0016-5107(90)71134-0. PMID: 2227333.

8. Ho CS, Warkentin AE. 2012; Evidence-based decompression in malignant biliary obstruction. Korean J Radiol. 13 Suppl 1:S56–S61. DOI: 10.3348/kjr.2012.13.S1.S56. PMID: 22563288. PMCID: PMC3341461.

9. Kiviniemi H, Mäkelä JT, Autio R, Tikkakoski T, Leinonen S, Siniluoto T, et al. 1998; Percutaneous cholecystostomy in acute cholecystitis in high-risk patients: an analysis of 69 patients. Int Surg. 83:299–302.

10. Davis CA, Landercasper J, Gundersen LH, Lambert PJ. 1999; Effective use of percutaneous cholecystostomy in high-risk surgical patients: techniques, tube management, and results. Arch Surg. 134:727–731. discussion 731–732. DOI: 10.1001/archsurg.134.7.727. PMID: 10401823.

11. Clements WD, Diamond T, McCrory DC, Rowlands BJ. 1993; Biliary drainage in obstructive jaundice: experimental and clinical aspects. Br J Surg. 80:834–842. DOI: 10.1002/bjs.1800800707. PMID: 7690298.

12. Parikh MP, Wadhwa V, Thota PN, Lopez R, Sanaka MR. 2018; Outcomes associated with timing of ERCP in acute cholangitis secondary to choledocholithiasis. J Clin Gastroenterol. 52:e97–e102. DOI: 10.1097/MCG.0000000000000982. PMID: 29356786.

13. Novikov AA, Fieber JH, Saumoy M, Rosenblatt R, Mekelburg SAC, Shah SL, et al. 2021; ERCP improves mortality in acute biliary pancreatitis without cholangitis. Endosc Int Open. 9:E927–E933. DOI: 10.1055/a-1320-0041. PMID: 34079880. PMCID: PMC8159624.

14. Khera R, Angraal S, Couch T, Welsh JW, Nallamothu BK, Girotra S, et al. 2017; Adherence to methodological standards in research using the national inpatient sample. JAMA. 318:2011–2018. DOI: 10.1001/jama.2017.17653. PMID: 29183077. PMCID: PMC5742631.

15. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. 2008; The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 61:344–349. DOI: 10.1016/j.jclinepi.2007.11.008. PMID: 18313558.

16. Menendez ME, Neuhaus V, van Dijk CN, Ring D. 2014; The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery. Clin Orthop Relat Res. 472:2878–2886. DOI: 10.1007/s11999-014-3686-7. PMID: 24867450. PMCID: PMC4117875.

17. Hanna N, Sun M, Trinh QD, Hansen J, Bianchi M, Montorsi F, et al. 2012; Propensity-score-matched comparison of perioperative outcomes between open and laparoscopic nephroureterectomy: a national series. Eur Urol. 61:715–721. DOI: 10.1016/j.eururo.2011.12.026. PMID: 22209172.

18. Ali H, Pamarthy R, Manickam S, Sarfraz S, Sahebazamani M, Movahed H. 2022; Effect of constipation on outcomes in mechanically ventilated patients. Proc (Bayl Univ Med Cent). 35:284–290. DOI: 10.1080/08998280.2022.2035153. PMID: 35518807. PMCID: PMC9037557.

19. Adjei Boakye E, Osazuwa-Peters N, Chen B, Cai M, Tobo BB, Challapalli SD, et al. 2020; Multilevel associations between patient- and hospital-level factors and in-hospital mortality among hospitalized patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg. 146:444–454. DOI: 10.1001/jamaoto.2020.0132. PMID: 32191271. PMCID: PMC7082768.

20. Lin WC, Chang CW, Chu CH. 2016; Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients. Kaohsiung J Med Sci. 32:518–525. DOI: 10.1016/j.kjms.2016.08.006. PMID: 27742036.

21. Preston SD, Southall AR, Nel M, Das SK. 2008; Geriatric surgery is about disease, not age. J R Soc Med. 101:409–415. DOI: 10.1258/jrsm.2008.080035. PMID: 18687864. PMCID: PMC2500244.

22. Mazen Jamal M, Yoon EJ, Saadi A, Sy TY, Hashemzadeh M. 2007; Trends in the utilization of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. Am J Gastroenterol. 102:966–975. DOI: 10.1111/j.1572-0241.2007.01127.x. PMID: 17319932.

23. McNabb-Baltar J, Trinh QD, Barkun AN. 2013; Biliary drainage method and temporal trends in patients admitted with cholangitis: a national audit. Can J Gastroenterol. 27:513–518. DOI: 10.1155/2013/175143. PMID: 24078935. PMCID: PMC3956005.

24. Kothaj P, Okapec S, Kúdelová A. 2014; [Complications after percutaneous transhepatic drainage of the biliary tract]. Rozhl Chir. 93:247–254. Czech.

25. Kröner PT, Bilal M, Samuel R, Umar S, Abougergi MS, Lukens FJ, et al. 2020; Use of ERCP in the United States over the past decade. Endosc Int Open. 8:E761–E769. DOI: 10.1055/a-1134-4873. PMID: 32490161. PMCID: PMC7247893.

26. García-Cano J, González Martín JA, Morillas Ariño MJ, Pérez García JI, Redondo Cerezo E, Jimeno Ayllón C, et al. 2007; Outcomes of bile duct drainage by means of ERCP in geriatric patients. Rev Esp Enferm Dig. 99:451–456. DOI: 10.4321/S1130-01082007000800005.

27. Bakkaloglu H, Yanar H, Guloglu R, Taviloglu K, Tunca F, Aksoy M, et al. 2006; Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention. World J Gastroenterol. 12:7179–7182. DOI: 10.3748/wjg.v12.i44.7179. PMID: 17131483. PMCID: PMC4087782.

28. Audisio RA, Bozzetti F, Severini A, Bellegotti L, Bellomi M, Cozzi G, et al. 1988; The occurrence of cholangitis after percutaneous biliary drainage: evaluation of some risk factors. Surgery. 103:507–512.

29. Johnson KD, Perisetti A, Tharian B, Thandassery R, Jamidar P, Goyal H, et al. 2020; Endoscopic retrograde cholangiopancreatography-related complications and their management strategies: a "scoping" literature review. Dig Dis Sci. 65:361–375. DOI: 10.1007/s10620-019-05970-3. PMID: 31792671.