S250 Percutaneous Gallbladder Drainage in Patients Not Currently Candidates for Cholecystectomy: Is Percutaneous Cholecystostomy Really a Good Option?

Introduction: Surgical management is the standard of care for most patients with acute cholecystitis, but in patients with severe acute or chronic disease, percutaneous cholecystostomy (PC) has been the conventional strategy. However, PC, while boasting a high technical success rate, is fraught with adverse events, morbidity, and poor quality of life. Methods: Among 22,708 patients with cholecystitis and cholangitis identified in our multi-hospital system from 2015 to 2025, 9,942 patients underwent cholecystectomy, and 1,179 patients underwent PC. 128 PC patients initially deemed appropriate for eventual surgery were randomly selected and retrospectively evaluated to determine demographic data, rates of surgical completion, technical and clinical success of PC, as well as adverse events undergoing PC who never received cholecystectomy. Results: Of the 128 PC patients randomly selected, 62 patients did not go for surgery (48.4%). OF these 62 patients, mean patient age was 80.6 ± 13.0 years, and 67.7% were men. 82.3% were Caucasian. 27.4% had concurrent malignancy that precluded surgical intervention. The average number of drain exchanges was 5.6 ± 8.4 (range 0-45). 30 (48.4%) were able to have drain removed without replacement. Average duration of drain was 350 ± 546 days. While technical success was high (100%), there was a high rate of adverse events, including 56.5% with drain dislodgment 50%; 40.3% with leak; 30% with bleeding of at least 2 g/dL drop in hemoglobin (9.7% with liver hematoma rate overall); and 8.1% with biloma. 50% had unplanned admissions related to at least 1 drain-related adverse event. Salvage EUS-GB drainage was performed in 1 patient with ultimate removal of the PC. Seven patients (11.3%) underwent a total of 12 attempted salvage percutaneous endoscopic biliary lithotomy (PEBL) procedures with mean number of 1.7 PEBL procedures per patient with technical success rate (defined as ability to establish patency of cystic duct, extract all gallstones, and remove the percutaneous drain) of 50% (but 85.7% of patients were able to have drain removed if multiple PEBL procedures resulted in success). One bile leak occurred as a result of 1 PEBL-related perforation (8.3%). Conclusion: While PC has historically been a valuable tool for management of patients with PC, an alarmingly high percentage of patients do not receive cholecystectomy. PC has an alarmingly high adverse event profile that may be prohibitive in the EUS-GBD era.