Safety and usefulness of percutaneous transhepatic cholecystoscopy examination in high-risk surgical patients with acute cholecystitis

Background: The aim of the present study was to evaluate the diagnostic and therapeutic usefulness of percutaneous transhepatic cholecystoscopy in hig h-risk surgical patients with acute cholecystitis. Methods: Between January 1992 and June 1998, there were 33 consecutive pati ents who underwent percutaneous transhepatic cholecystostomy and subsequent percutaneous transhepatic cholecystoscopy for the management of acute chol ecystitis. Results: Percutaneous transhepatic cholecystostomy and subsequent percutane ous transhepatic cholecystoscopy were successfully accomplished in all 33 p atients. During percutaneous transhepatic cholecystoscopy, minor complicati ons (2 episodes of minor bleeding during electrohydraulic lithotripsy, 2 of tube dislodgement, and 1 of bile leakage to peritoneum) occurred in 5 pati ents. Percutaneous transhepatic cholecystoscopy revealed gallstones in 26 c ases, sludge ball in 3, gallbladder carcinoma in 3, and 1 case of clonorchi asis related with acute cholecystitis. The 3 gallbladder cancers which were not identified radiologically were found incidentally during percutaneous transhepatic cholecystoscopy. For the 26 patients with gallstones, percutan eous transhepatic cholecystoscopy and concomitant stone removal were succes sful in 1 to 4 consecutive sessions (mean 2.2 sessions). Gallstones recurre d in 3 of 22 patients (14%) during the mean follow-up period of 27 months. All of them remain asymptomatic. Conclusion: Percutaneous transhepatic cholecystostomy may be justified in t he management of acute cholecystitis in selected patients with high surgica l risk.