US-guided Percutaneous Cholecystostomy: Features Predicting Culture-Positive Bile and Clinical Outcome

Jacob Sosna, Jonathan B. Kruskal, Laurian Copel, S. Nahum Goldberg, Robert A. Kane*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

18 Scopus citations


PURPOSE: To assess sonographic and clinical features that might be used to predict infected bile and/or patient outcome from ultrasonography (US)-guided percutaneous cholecystostomy. MATERIALS AND METHODS: Between February 1997 and August 2002 at one institution, 112 patients underwent US-guided percutaneous cholecystostomy (59 men, 53 women; average age, 69.3 years). All US images were scored on a defined semiquantitative scale according to preset parameters: (a) gallbladder distention, (b) sludge and/or stones, (c) wall appearance, (d) pericholecystic fluid, and (e) common bile duct size and/or choledocholithiasis. Separate and total scores were generated. Retrospective evaluation of (a) the bacteriologic growth of aspirated bile and its color and (b) clinical indices (fever, white blood cell count, bilirubin level, liver function test results) was conducted by reviewing medical records. For each patient, the clinical manifestation was classified into four groups: (a) localized right upper quadrant symptoms, (b) generalized abdominal symptoms, (c) unexplained sepsis, or (d) sepsis with other known infection. Logistic regression models, exact Wilcoxon-Mann-Whitney test, and the Kruskal-Wallis test were used. RESULTS: Forty-seven (44%) of 107 patients had infected bile. A logistic regression model showed that wall appearance, distention, bile color, and pericholecystic fluid were not individually significant predictors for culture-positive bile, leaving sludge and/or stones (P = .003, odds ratio = 1.647), common bile duct status (P = .02, odds ratio = 2.214), and total score (P = .007, odds ratio = 1.267). No US covariates or clinical indices predicted clinical outcome. Clinical manifestation was predictive of clinical outcome (P = .001) and aspirating culture-positive bile (P = .008); specifically, 30 (86%) of 35 patients with right upper quadrant symptoms had their condition improve, compared with one (7%) of 15 asymptomatic patients with other known causes of infection. CONCLUSION: US variables can be used to predict culture-positive bile but not patient outcome. Clinical manifestation is important because patients with right upper quadrant symptoms have the best clinical outcome.

Original languageAmerican English
Pages (from-to)785-791
Number of pages7
Issue number3
StatePublished - Mar 2004
Externally publishedYes


  • Cholecystitis
  • Gallbladder, US
  • Gallbladder, calculi
  • Gallbladder, interventional procedures


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