Use of Percutaneous Cholecystostomy - Mission Creep or a Genuine Bridge to Surgery?

Abstract Aim Appropriately used, percutaneous cholecystostomy (PC) can be lifesaving. We have noted an increase their use. This may be due to an increasing population frailty combined with delayed presentations or treatment from the COVID pandemic. We sought to audit the use of PC in our Trust. Method Retrospective analysis of prospectively collected data from 2020-2022 at a large DGH with comparison to PC insertion standards (failed antibiotic response & not fit for surgery, septic/too unstable or PC as definitive treatment). Results PC performed 67 times in 64 patients (F = 36.5%. mean age 72 (45-92yrs)). 31 (48.4%) were definitive treatment. 36 (53.7%) were not definitive, 19 subsequently underwent surgery (5 as readmissions, 12 elective & 2 same admission). 25 patients did not meet criteria for PC and potentially could have been considered for emergency laparoscopic cholecystectomy. 35.8% (n = 24) had a DNACPR in place at the time of drain insertion. 25.4% (n = 17) had died at the time of analysis. In the same timeframe n = 168 emergency laparoscopic cholecystectomies were completed. Conclusions PC is an effective treatment strategy but our data suggest that some patients may have been suitable for operative intervention, indicative of “mission creep”. However, the reasons for this are unclear, but may include availability of hot list slots, presentations before a weekend where subspecialty UGI surgeons may not be at hand or a genuine belief that PC is a beneficial bridge to surgery. The wider role of PC requires further evaluation, especially if subspecialty cover is not available.