From the Guidelines
A cholecystostomy tube can be an effective treatment option for managing symptoms of chronic cholecystitis, particularly in patients who are poor surgical candidates or need temporary relief before definitive treatment, as it can convert a septic patient into a non-septic patient 1. This procedure involves placing a small tube through the skin into the gallbladder to drain infected bile and reduce inflammation. The tube is typically placed under ultrasound or CT guidance using local anesthesia, sometimes with conscious sedation. Some key points to consider when using a cholecystostomy tube include:
- The tube usually remains in place for several weeks, requiring regular flushing with 5-10ml of sterile saline 2-3 times daily to maintain patency 1.
- Patients should watch for signs of tube dislodgement, increased pain, fever, or drainage around the tube site.
- While cholecystostomy provides symptom relief, it's generally considered a bridge therapy rather than a permanent solution, as the underlying gallbladder disease remains.
- Most patients will eventually need cholecystectomy (gallbladder removal) once their condition stabilizes, though some high-risk patients may maintain the tube long-term with periodic exchanges every 2-3 months. The decision to use a cholecystostomy tube should be based on individual patient factors, including their overall health, surgical risk, and the severity of their symptoms. As noted in the 2020 World Society of Emergency Surgery updated guidelines, gallbladder drainage is recommended for patients with acute calculus cholecystitis who are not suitable for surgery, as it can effectively treat septic patients and improve clinical conditions 1. It's also important to consider the potential risks and complications associated with cholecystostomy, including procedure-related mortality and morbidity, as well as the potential for tube dislodgement or infection. Overall, a cholecystostomy tube can be a valuable treatment option for managing symptoms of chronic cholecystitis, particularly in high-risk patients or those who require temporary relief before definitive treatment.
From the Research
Cholecystostomy Tube for Chronic Cholecystitis
- The use of a cholecystostomy tube for chronic cholecystitis is not directly addressed in the provided studies, as they primarily focus on acute cholecystitis 2, 3, 4, 5, 6.
- However, it is mentioned that cholecystostomy and cholecystectomy remain appropriate and effective therapy for acute and chronic cholecystitis 2.
- Cholecystectomy is considered the gold standard treatment for chronic cholecystitis, but a cholecystostomy tube may be used as a temporary measure to alleviate symptoms in high-risk patients 2, 3, 4, 5, 6.
- The studies suggest that percutaneous cholecystostomy tube placement can be an effective treatment for acute cholecystitis, with some patients not requiring subsequent cholecystectomy 3, 5.
- The decision to use a cholecystostomy tube for chronic cholecystitis would depend on the individual patient's condition and medical history, as well as the presence of any comorbidities that may increase the risk of surgery 4, 5, 6.
Key Findings
- Cholecystostomy tubes can be used to treat acute cholecystitis in high-risk patients, with some studies suggesting that up to 90% of patients can recover without recurrent sepsis following tube removal 5.
- The use of cholecystostomy tubes may be associated with a higher rate of conversion to open surgery and higher hepatobiliary morbidity rate if subsequent cholecystectomy is performed 6.
- Patient demographics, such as age and comorbidities, can influence the decision to use a cholecystostomy tube and the likelihood of subsequent cholecystectomy 3, 4, 5.