TY - JOUR
TI - Two-center prospective comparison of the trocar and seldinger techniques for percutaneous cholecystostomy
AU - Reppas, L.
AU - Arkoudis, N.-A.
AU - Spiliopoulos, S.
AU - Theofanis, M.
AU - Kitrou, P.M.
AU - Katsanos, K.
AU - Palialexis, K.
AU - Filippiadis, D.
AU - Kelekis, A.
AU - Karnabatidis, D.
AU - Kelekis, N.
AU - Brountzos, E.
JO - AJR.  AMERICAN JOURNAL OF ROENTGENOLOGY
PY - 2020
VL - 214
TODO - 1
SP - 206-212
PB - American Roentgen Ray Society
SN - 0361-803X
TODO - 10.2214/AJR.19.21685
TODO - abscess;  acute cholecystitis;  aged;  Article;  bedside ultrasound guided trocar technique;  bile leakage;  bleeding;  cholecystostomy;  controlled study;  echography;  female;  fluoroscopy;  fluoroscopy guided Seldinger technique;  follow up;  gallbladder disease;  human;  intermethod comparison;  major clinical study;  male;  operation duration;  pain assessment;  patient safety;  percutaneous cholecystostomy;  postoperative complication;  postoperative pain;  priority journal;  prospective study;  surgical technique;  tertiary care center;  treatment outcome;  ultrasound guided Seldinger technique;  university hospital;  cholecystostomy;  clinical trial;  comparative study;  controlled clinical trial;  devices;  middle aged;  multicenter study;  procedures;  surgical equipment;  very elderly, Aged;  Aged, 80 and over;  Cholecystostomy;  Female;  Humans;  Male;  Middle Aged;  Prospective Studies;  Surgical Instruments
TODO - OBJECTIVE: The purpose of this study is to compare the safety and efficacy of the bedside ultrasound (US)-guided trocar technique versus the US- and fluoroscopy-guided Seldinger technique for percutaneous cholecystostomy (PC). SUBJECTS AND METHODS: This prospective noninferiority study compared the bedside US-guided trocar technique for PC (the trocar group; 53 patients [28 men and 25 women]; mean [± SD] age, 74.31 ± 16.19 years) with the US- and fluoroscopy-guided Seldinger technique for PC (the Seldinger group; 52 patients [26 men and 26 women], mean age, 79.92 ± 13.38 years) in consecutive patients undergoing PC at two large tertiary university hospitals. The primary endpoints were technical success and procedure-related complication rates. Secondary endpoints included procedural duration, pain assessment, and clinical success after up to 3 months of follow-up. RESULTS: PC was successfully performed for all 105 patients. The clinical success rate was similar between the two study groups (86.8% in the trocar group vs 76.9% in the Seldinger group; p = 0.09). Mean procedural time was significantly lower in the trocar group than in the Seldinger group (1.77 ± 1.62 vs 4.88 ± 2.68 min; p < 0.0001). Significantly more procedure-related complications were noted in the Seldinger group than in the trocar group (11.5% vs 1.9%; p = 0.02). Among patients in the Seldinger group, bile leak occurred in 7.7%, abscess formation in 1.9%, and gallbladder rupture in 1.9%. No procedure-related death was noted. Minor bleeding occurred in one patient (1.9%) in the trocar group, but the bleeding resolved on its own. The mean pain score during the procedure was significantly lower in the Seldinger group than in the trocar group (3.2 ± 1.77 vs 4.76 ± 2.17; p = 0.01). At 12 hours after the procedure, the mean pain score was significantly lower for patients in the trocar group (0.78 ± 1.0 vs 3.12 ± 1.36; p = 0.0001). CONCLUSION: Use of the bedside US-guided trocar technique for PC was equally effective as the Seldinger technique but was associated with fewer procedure-related complications, required less procedural time, and resulted in decreased postprocedural pain, compared with fluoroscopically guided PC using the Seldinger technique. © American Roentgen Ray Society.
ER -