{
  "abstract": "Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is the first line treatment for biliary decompression in patients presenting with acute cholangitis. Certain factors such as patient frailty or lack of its availability may preclude ERCP. In patients with an in-situ gallbladder and a patent cystic duct, percutaneous cholecystostomy (PC) could be a temporising option for biliary decompression. Our aim was to assess the effectiveness of PC in patients with acute cholangitis who did not receive ERCP at a tertiary care facility.Methods A retrospective study of patients who underwent PC for acute cholangitis between April 2015 to June 2025 was performed. The data was identified from a radiology database. Information regarding patient characteristics and outcomes was obtained from analysis of electronic patient records.Results During the specified study period, 39 patients (17 males and 22 females) underwent PC for acute cholangitis instead of ERCP. The median age was 80(IQR 14). The predominant aetiology of cholangitis was common bile duct stones in 92.3% (n=36), followed by a stent dysfunction in 5.1% (n=2) and malignant stricture in 2.5% (n=1). As per Tokyo classification, the severity of cholangitis was classified as severe in 30.7% (n=12) of patients, moderate in 64.1% (n=25), and mild in 5.1% (n=2). The median Charlson Comorbidity Index score was 6(IQR 3) and median Clinical Frailty Score was 5(IQR 2). The reason for not performing ERCP was due to 74.3% patients being unwell, 28.2% presented out of hours, 12.8% failed ERCP, the patients’ frailty in 10.2% of cases, 2.5% patients’ refusal and 2.5% associated GB perforation. The median time from diagnosis to PC was 2 days (IQR 2). Technical success of PC was achieved in all the patients, and the Clinical success was demonstrated by reduction in the median CRP value to 92(IQR 92), compared with a pre-procedure value of 266(IQR 158), measured 24 hours after the procedure. The mean National Early Warning Sign (NEWS) scores decreased significantly from 6.82 ± 2.65 pre-procedure to 2.46 ± 2.04 post-procedure ( t(38) = 11.39, p < .0001). Definitive ERCP was performed in 66.6% of patients (n=26) at a median time of 12days (IQR 14) following PC. The 30-day all-cause mortality rate was 12.8% (n=5). The median length of the hospital stay was 20 days (IQR 23). Additionally, 7.6%(n=3) had an indwelling catheter indefinitely.Conclusion There has been little evidence of cholecystotomy’s effectiveness in treating acute cholangitis. Our cohort of 39 patients is the largest single-centred study been reviewed in United Kingdom, demonstrating it to be a valuable temporizing measure prior to definitive ERCP in these patients or as a salvage therapy when other treatment modalities have failed achieving high level of clinical success with early intervention associated with lower mortality. This underscores the necessity for further research involving larger cohorts to inform future clinical practices.",
  "authors": [
    {
      "affiliations": [
        "Speciality Registrar, Leeds Teaching Hospital, St James University Hospital, Leeds, United Kingdom"
      ],
      "name": "Ankur Gupta"
    },
    {
      "affiliations": [
        "Speciality Registrar, Leeds Teaching Hospital, St James University Hospital, Leeds, United Kingdom"
      ],
      "name": "Muhammad Zain Akhtar"
    },
    {
      "affiliations": [
        "Consultant, Interventional Radiology, Leeds Teaching Hospital, St James University Hospital, Leeds, United Kingdom"
      ],
      "name": "Simon Burbidge"
    },
    {
      "affiliations": [
        "Consultant, General Surgery, Leeds Teaching Hospital, St James University Hospital, Leeds, United Kingdom"
      ],
      "name": "Adam Peckham-Cooper"
    },
    {
      "affiliations": [
        "Consultant, Hepato-pancreato-biliary Medicine, Leeds Teaching Hospital, St James University Hospital, Leeds, United Kingdom"
      ],
      "name": "Aaron Wei Heng On"
    }
  ],
  "title": "P152 Utility of percutaneous cholecystostomy in patients with acute cholangitis",
  "uid": "1fea3f40-5397-50cc-ae4f-76417d4360bd"
}