Efficacy and safety of ultrasound-guided bedside percutaneous cholecystostomy using the transhepatic approach and trocar technique in patients with acute cholecystitis.

purposeDespite the large number of patients requiring percutaneous cholecystostomy (PC) for acute cholecystitis (AC), no definitive results exist on the optimal imaging guidance modality, technique (Seldinger vs. trocar), or approach [transhepatic (TH) vs. transperitoneal]. This study evaluates the outcomes of ultrasound (US)-guided bedside PC using solely the TH approach and trocar technique in patients with AC.

methodsA single-center retrospective study was conducted at a tertiary university hospital between 2018 and September 2023. The study included 81 patients with AC treated with US-guided bedside PC using the TH approach and trocar technique alone. Patients were diagnosed through clinical, laboratory, and radiological examinations, and an experienced interventional radiologist performed the procedures. Outcomes and complication rates were then evaluated.

resultsTechnical and clinical success rates were 100% and 93%, respectively. No procedure-related complications occurred. Catheter dislodgement occurred in 4.9% (4/81). The catheter sizes used were 6 F (12.3%), 7 F (40.7%), 8 F (37%), and 10 F (9.9%). The median catheter dwell time was 42 days. Catheters were successfully removed in the majority of surviving patients following resolution of cholecystitis. At the end of the follow-up, 10 patients (12.3%) underwent elective cholecystectomy, and 12 patients (14.8%) died due to comorbidities with the catheter in place.

conclusionUS-guided bedside PC using the TH approach and trocar technique is safe and effective for managing AC in high-risk patients. The study found no significant complications, highlighting the importance of thorough preprocedural evaluation and technique optimization. Further studies with larger, homogeneous patient groups are needed to compare outcomes across different PC techniques and approaches. CLINICAL SIGNIFICANCE: Despite the growing adoption of PC in the management of AC, the definitive optimal access route and procedural technique remain unresolved. The current body of literature is limited by considerable heterogeneity across studies, including variability in technical approach, operator experience, patient coagulation profiles, and outcome definitions. This study exclusively employed bedside US-guided PC using the TH approach and trocar technique, and observed no procedure-related complications, including hemorrhage, bile leakage, infection, or abscess formation.