Bile Aspiration vs Drain in Acute Cholecystitis

Randomized Controlled Trial of Bile Aspiration vs Drain in Acute Cholecystitis

In order to compare percutaneous cholecystostomy and leaving a drain in situ with percutaneous gallbladder aspiration we plan to undertake a double-blind randomized controlled trial.

Study Overview

• Status: Not yet recruiting
• Conditions: Cholecystitis, Acute
• Intervention / Treatment: Procedure: Cholecystostomy; Procedure: Gallbladder aspiration

Detailed Description

Percutaneous cholecystostomy is a minimally invasive technique for treatment of cholecystitis. The cholecystostomy can be inserted transhepatically or transabdominally. The transhepatic route is preferred due to lower risk for bile leakage. The drainage decompresses the gallbladder and drains the bile. This decompression reduces the inflammatory process in the gallbladder. Percutaneous cholecystostomy is often applied in patients not fit for emergency surgery who are in need of intervention due to deterioration of their clinical status. However, even though cholecystostomy is widely practised, it is not fully evaluated.

Percutaneous cholecystostomy has a high success rate, a low procedure-related mortality but a 30 day mortality of 15%. Furthermore, recurrence rates within one year after a cholecystostomy are reported to range between 4 to 22%.

The time duration of the drainage differ between different studies and range from three to six weeks. Optimal timing for drainage has not been studied. Two weeks seem to be sufficient for a maturation of the tract for the transhepatic route and 3 weeks for the transabdominal route. It has been suggested that a prolonged drainage duration is associated with increased risk for recurrence of inflammation due to local irritation of the gallbladder mucosa by the drain.

Percutaneous cholecystostomy is often considered as a bridge to surgery. However, less than half of patients treated with PC are treated with cholecystectomy. This suggests that this treatment is often chosen in a group not fit for surgery and often turns out to be a definitive treatment.

Percutaneous gallbladder aspiration is a technique used for purposes similar to percutaneous cholecystostomy. This technique is an alternative that may be more convenient than percutaneous cholecystostomy. The aspiration is performed with a small gauge needle under ultrasound guidance without leaving a drain. The aspiration leads to a decompression of the gallbladder, which facilitates recovery. However, it has only been described in a few studies and need more evaluation.

One single aspiration may be sufficient to relief symptoms for the majority of patients, but if two aspirations are performed the success rate increases substantially. One randomized controlled trial has been presented where PC is compared to gallbladder aspiration. In this trial PC was superior to gallbladder aspiration in terms of effectiveness. In this trail, however, only one aspiration was performed. No major complications occurred in either group and minor complications were equal between the groups. In a retrospective study comparing aspiration with PC it was found that gallbladder aspiration is safer than PC and has a comparable clinical outcome.

It is believed that single decompressions are sufficient for reduction of the intraluminal pressure. Only a minority of patients have positive bile cultures which, indicates that infection is not a key mechanism in development of cholecystitis, which indicates that a continuous drainage may not be necessary. As lower rates of complications are reported for aspiration due to usage of smaller needle and no drain left that can dislocate and cause bile leakage which is feared complication of PC. It is suggested that PC can have a role as a salvage method when aspiration is not successful.

In order to compare percutaneous cholecystostomy and leaving a drain in situ with percutaneous gallbladder aspiration we plan to undertake a double-blind randomized controlled trial.

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Gabriel Sandblom, Assoc Prof; Phone Number: +46 70 415 82 18; Email: gabriel.sandblom@ki.se
• Study Contact Backup: Name: Agnieszka Popowicz, MD; Phone Number: +46 73 582 62 13; Email: a.e.popowicz@gmail.com

Study Locations

• Sweden
  • Stockholm, Sweden, 14186
    • Karolinska University Hospital, Center for Digestive Diseases

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Acute cholecystitis, not warranting acute cholecystectomy

Exclusion Criteria:

• Indication for acute cholecystectomy, i.e. history < 5 days and no contraindication to surgery
• Liver cirrhosis
• Ascites
• Emphysematous cholecystitis
• Gallbladder perforation
• Suspected malignant condition
• Portal Hypertension
• Biliary pancreatitis
• Common bile duct stones

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Cholecystostomy; Percutaneous cholecystostomy, leaving drain in situ	Procedure: Cholecystostomy; Ultrasound-guided insertion of drain in the gallbladder. The drain is left in the gallbladder until clinical assessment and laboratory analyses show that the acute cholecystitis has been successfully treated.; Other Names: Percutaneous intervention
Experimental: Gallbladder aspiration; Gallblader aspiration without drain	Procedure: Gallbladder aspiration; Percutaneous ultrasound-guided aspiration of bile from the gallbladder. This is performed without leaving a drain in the gallbladder. The aspiration is performed with the intention to relief the pressure in the gallbladder, without drain.; Other Names: Percutaneous intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Amount of morphine administrated	The total amount of morphine required to relieve the pain the first 24 hours	24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain	Pain intensity rated on a Visual Analogue Scale	5 days
Nausea	Nausea estimated with a Likert scale	5 days
Re-intervention	Repeated percutaneous aspiration of adjustment of drain	5 days
Body temperature	Temperature measured daily	5 days
CRP	Daily measures of C-reactive protein	5 days
LPK	Daily measures of Leukocyte particle Concentration	5 days
Time to discharge	Time from intervention to discharge from the hospital	30 days
Complications	Procedure-related complications	30 days

Collaborators and Investigators

• Sponsor: Karolinska Institutet
• Investigators: Principal Investigator: Gabriel Sandblom, Assoc Prof, Karolinska Institutet

Study record dates

Study Major Dates

• Study Start (Estimated): March 1, 2026
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): March 31, 2028

Study Registration Dates

• First Submitted: January 4, 2017
• First Submitted That Met QC Criteria: January 5, 2017
• First Posted (Estimated): January 6, 2017

Study Record Updates

• Last Update Posted (Actual): August 13, 2025
• Last Update Submitted That Met QC Criteria: August 12, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Biliary Tract Diseases; Gallbladder Diseases; Cholecystitis; Acalculous Cholecystitis; Cholecystitis, Acute
• Other Study ID Numbers: Bile aspiration vs drain trial

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No