TPT 8.18 PErcutaneous CHolecystostomy in Acute Cholecystitis (PECHA) Study – Time to Face the Truth

Abstract

Percutaneous cholecystostomy (PC) is commonly used in high-risk patients with acute cholecystitis, yet guidance on patient selection and post-procedural management remains limited. The PECHA study evaluated contemporary UK practice to identify factors associated with complications and downstream outcomes. PECHA is a multicentre retrospective cohort study across eight UK district general hospitals (2019–2024). Adult patients undergoing PC were identified from radiology and electronic health records. Data included demographics, ASA grade, frailty, comorbidity burden, indication for PC, antibiotic and drain management, operator grade, and system factors such as theatre availability. Primary outcomes were tube-related complications and 90-day readmission; secondary outcomes included recurrence of cholecystitis, progression to interval cholecystectomy, and mortality. Associations were explored using chi- square/Fisher’s exact tests and Mann–Whitney U tests, followed by multivariable logistic regression to identify independent predictors of complications. A total of 374 patients were included (median age 56.8 years). PC was most commonly performed for biliary sepsis, with a technical success rate of 97.8%. Tube- related complications occurred in 6%, most frequently drain dislodgement. On multivariable analysis, higher ASA grade was independently associated with complications (p=0.0034). Antibiotic duration, drain duration, and age were not independently associated with complications (all p>0.05). Theatre unavailability significantly influenced the decision to proceed with PC (p=0.004). Percutaneous cholecystostomy is safe but variably applied. Outcomes appear driven by baseline patient risk and system-level factors rather than post-procedural management strategies, supporting the need for clearer, standardised pathways to improve consistency of care.