Usefulness of single and repetitive percutaneous transhepatic gallbladder aspiration for the treatment of acute cholecystitis.
BACKGROUND
The aim of this study was to evaluate the safety and usefulness of single and repetitive percutaneous transhepatic gallbladder aspiration (PTGBA) for the treatment of acute cholecystitis.


METHODS
PTGBA was performed in patients with acute cholecystitis who showed no improvement after treatment with broad-spectrum antibiotics. PTGBA was carried out at bedside. When the bile was too thick to be aspirated through a 21-gauge needle, an 18-gauge needle was used. Aspiration of the gallbladder contents and injection of antibiotics into the gallbladder were performed without the placement of a drainage catheter. When improvement was not observed after the first attempt, PTGBA was repeated.


RESULTS
Single PTGBA achieved improvement in 32 of 45 patients. In 11 of the remaining 13 patients, the second PTGBA was effective. In the remaining two patients, repetitive PTGBA was not carried out because of advanced cancer. In two of 45 patients, 18-gauge needles were necessary for PTGBA because of the high viscosity of the bile. PTGBA was carried out in three patients with blockage of the cystic duct by a stent, and it was effective in all three. Two patients whose conditions improved with a single PTGBA experienced a recurrence at 4 and 31 months, respectively, after PTGBA. No other severe complications related to PTGBA were observed in any patients.


CONCLUSIONS
For the treatment of acute cholecystitis that does not react to conservative therapies, PTGBA is a safe, simple, and effective treatment modality that can be performed at bedside without any severe complications.
Tsutsui
Kunihiko
K
Department of Gastroenterology and Neurology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
Uchida
Naohito
N
Hirabayashi
Shuko
S
Kamada
Hideki
H
Ono
Masahiro
M
Ogawa
Mutsumi
M
Ezaki
Toru
T
Fukuma
Hiroki
H
Kobara
Hideki
H
Aritomo
Yuichi
Y
Masaki
Tsutomu
T
Nakatsu
Toshiaki
T
Kuriyama
Shigeki
S
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D041881:Cholecystitis, Acute / Q000628:therapy*; D003131:Combined Modality Therapy; D003549:Cystic Duct / Q000473:pathology; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005704:Gallbladder; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D012008:Recurrence; D015607:Stents / Q000009:adverse effects
D000900:Anti-Bacterial Agents