From the Guidelines
Cholecystostomy Tube Removal and Bile Leak
The tract typically closes after cholecystostomy tube removal, and bile leak is unlikely if the tract has matured.
- The duration of drainage ranges from 3 to 6 weeks, with an average of 1 month, allowing for tract maturation 1.
- A cholangiogram performed 2-3 weeks after percutaneous cholecystostomy can demonstrate biliary tree patency and ensure the absence of leak or obstructed cystic duct 1.
- Catheter removal is expected to become safer with respect to potential bile leak after tract maturation 1.
- However, in cases with associated diabetes, ascites, long-term steroid therapy, and malnutrition, the drain should be left in place for a longer period to allow for tract maturation 1.
- The transhepatic approach for percutaneous cholecystostomy reduces the risk of biliary leak and allows for quicker maturation of a drainage tract 1.
- No bile leakage was detected in any patient after catheter removal in a series of 27 consecutive transhepatic percutaneous cholecystostomies 1.
From the Research
Cholecystostomy Tube Removal and Bile Leak
- The incidence of bile leaks after cholecystostomy tube removal has been studied, with one study finding that major bile leaks occurred in 3% of patients and minor leaks occurred with equal frequency 2.
- Another study found that when distal biliary flow was confirmed, tube removal was favored, and no significant bile leaks were reported in this group 3.
- The fate of the tract after cholecystostomy tube removal is not explicitly stated in the studies, but it can be inferred that the tract may close on its own after tube removal, as there are no reports of persistent bile leaks in the majority of patients.
Factors Influencing Bile Leak Risk
- The risk of bile leak after cholecystostomy tube removal may be influenced by factors such as the duration of tube placement, patient recovery from acute illness, and the presence of patent cystic and common ducts 2, 3.
- Tract imaging may not be necessary in patients with small-bore gallbladder catheters who have recovered from critical illness, show patent cystic and common ducts, and have had catheters for 3-6 weeks 2.
Management of Bile Leaks
- In cases where bile leaks do occur, management strategies may include percutaneous drainage, endoscopic retrograde cholangiopancreatography (ERCP) stenting, or surgical intervention 4, 5, 6.
- The choice of management strategy may depend on the severity of the bile leak, the presence of sepsis or organ failure, and the patient's overall clinical condition 6.