Surgical endoscopy · 2026
Long-term outcomes of percutaneous transhepatic gallbladder drainage without cholecystectomy: impact of comorbidity and potential role of stone removal.
СтатьяНазвание и аннотация: Перевод в очереди
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Cho Young-Kwan, Choi Dong-Joo, Ha Won-Hee, Lee Jun-Chae, Kim Yong Hoon, Kim Tae-Seok, Kim Min Jae, Cho In Soo, Kim Young Hwan, Hwang Euntaek, Lee Mu Sook, Ahn Keun Soo
Аннотация
BACKGROUND: Percutaneous transhepatic gallbladder drainage (PTGBD) is commonly employed in high-risk patients with acute cholecystitis. However, the long-term outcomes of PTGBD without subsequent cholecystectomy and the clinical significance of gallbladder stone removal are still unclear.
METHODS: We conducted a retrospective analysis of patients with acute cholecystitis who underwent PTGBD followed by catheter removal without an interval cholecystectomy. We evaluated recurrence-free survival (RFS) using Kaplan-Meier analysis and identified risk factors for recurrence through Cox proportional hazards models. Additionally, we examined the impact of gallbladder stone removal via the PTGBD tract.
RESULTS: Our study included 161 patients, with a median follow-up of 40.3 months. The 5-year RFS rate exceeded 80%, with the majority of recurrences occurring within the first two years post-catheter removal. Cerebrovascular disease emerged as the strongest independent predictor of recurrence (adjusted HR ~ 2.7, p < 0.05). Although multiple gallstones showed an association with recurrence in univariate analysis, they did not emerge as independent predictors in multivariate analysis. Percutaneous stone removal was found to be technically feasible and safe, but it did not significantly reduce recurrence; however, a trend toward improved outcomes was noted in selected patients with a low stone burden.
CONCLUSION: PTGBD without cholecystectomy serves as a durable non-surgical treatment option for selected patients who do not undergo cholecystectomy. Recurrence appears to be primarily influenced by patient-related factors, specifically cerebrovascular disease, rather than solely by gallstone burden. While percutaneous stone removal may be advantageous in certain cases, its long-term clinical impact remains uncertain and requires further research.
METHODS: We conducted a retrospective analysis of patients with acute cholecystitis who underwent PTGBD followed by catheter removal without an interval cholecystectomy. We evaluated recurrence-free survival (RFS) using Kaplan-Meier analysis and identified risk factors for recurrence through Cox proportional hazards models. Additionally, we examined the impact of gallbladder stone removal via the PTGBD tract.
RESULTS: Our study included 161 patients, with a median follow-up of 40.3 months. The 5-year RFS rate exceeded 80%, with the majority of recurrences occurring within the first two years post-catheter removal. Cerebrovascular disease emerged as the strongest independent predictor of recurrence (adjusted HR ~ 2.7, p < 0.05). Although multiple gallstones showed an association with recurrence in univariate analysis, they did not emerge as independent predictors in multivariate analysis. Percutaneous stone removal was found to be technically feasible and safe, but it did not significantly reduce recurrence; however, a trend toward improved outcomes was noted in selected patients with a low stone burden.
CONCLUSION: PTGBD without cholecystectomy serves as a durable non-surgical treatment option for selected patients who do not undergo cholecystectomy. Recurrence appears to be primarily influenced by patient-related factors, specifically cerebrovascular disease, rather than solely by gallstone burden. While percutaneous stone removal may be advantageous in certain cases, its long-term clinical impact remains uncertain and requires further research.