title: Percutaneous cholecystostomy for acute cholecystitis in patients with high comorbidity and re-evaluation of treatment efficacy.
abstract: BACKGROUND
  In high-risk and unfit-for-surgery patients with acute cholecystitis (AC), treatment options are controversial. Few studies have reported the results of long-term follow-up. This study aimed to evaluate the clinical course of patients after removal of the percutaneous cholecystostomy (PC) catheter in high-risk patients with AC, time interval to relapse, and factors influencing relapse.
  
  
  METHODS
  From 2000 to 2011, 183 patients with AC underwent PC and catheter removal in Seoul National University Hospital and Boramae Hospital, Korea. Sixty cases were reviewed retrospectively after excluding cases with intended interval cholecystectomy, malignant biliary obstruction, loss to follow-up, and insufficient follow-up information.
  
  
  RESULTS
  The mean age was 68.6 ± 13.8 years, and the mean Karnofsky performance score was 24.8 ± 9.7. After insertion of a PC catheter, symptom resolution and improvement on imaging were achieved in 95% and 97.9% of patients, respectively. Laboratory values were also improved (P < .01). There was no mortality during admission; 2 patients (3.3%) experienced complications during removal of the PC catheter. Relapse was observed in 7 patients (11.7%) during a median follow-up of 38.1 ± 24.8 months. There were no differences in clinical, laboratory, or imaging findings between relapsing and nonrelapsing patients. Therefore, prediction of relapse was not possible.
  
  
  CONCLUSIONS
  Among high-risk patients with AC, 88.3% were managed with PC without relapse within a median follow-up period of 38.1 months, despite radiologically severe AC in some patients. We conclude that a temporary PC can be a first-line treatment for AC without interval cholecystectomy.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ye Rim
authors.initials: YR
authors.lastname: Chang
authors.affiliation: Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Young-Joon
authors.initials: YJ
authors.lastname: Ahn
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. Electronic address: jangjy4@snu.ac.kr.
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Mee Joo
authors.initials: MJ
authors.lastname: Kang
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Wooil
authors.initials: W
authors.lastname: Kwon
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Woo Hyun
authors.initials: WH
authors.lastname: Jung
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D041881:Cholecystitis, Acute / Q000453:epidemiology / Q000601:surgery*; D002767:Cholecystostomy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors