Percutaneous cholecystostomy: institutional experience and outcomes

No. 486 Percutaneous cholecystostomy: institutional experience and outcomes J. Diamond, A. Malamis; Loyola University Chicago, Stritch School of Medicine, Maywood, IL; Loyola University Medical Center, Maywood, IL Purpose: Cholecystitis is a prominent disease most commonly treated with antibiotics and cholecystectomy (CCY). For highrisk patients, placement of a percutaneous cholecystostomy (PC) can be easily performed. These tubes are classically considered a “bridge to surgery” until CCY can be safely accomplished. The purpose of this study was to define the role and clinical course of PC, i.e., to determine the rate of surgical vs. non-surgical tube removal after PC. Materials: A retrospective study of 137 men and women (mean age, 65.9; range, 22-98) who underwent PC for cholecystitis between 1/2007 and 9/2015 was undertaken. All patients underwent PC because they were deemed poor surgical candidates. One hundred eleven patients (81.0%) had cardiovascular comorbidities, 49 (35.8%) had pulmonary comorbidities, 20 (14.6%) had cancer, and 16 (11.7%) had cirrhosis. Data on the method of tube removal and subsequent surgical interventions were recorded. Patients who underwent non-surgical tube removal were divided into calculous and acalculous groups based on radiological studies. Fisher’s exact test was used to determine if there was a statistically significant difference in the rate of CCY following PC between the two groups. Results: In total, 119/137 had endpoint data available. Fiftyfive tubes (46.2%) were removed non-surgically either in a doctor’s office (20, 36.4%), a hospital bed (12, 21.8%), an IR suite following cholangiogram (11, 20%), or accidentally (12, 21.8%). Nine patients (16.4%) eventually underwent CCY. There was no statistically significant difference between the non-surgical removal calculous group (5/26, 19.2%) vs. acalculous group (4/29, 13.8%) undergoing CCY (p 1⁄4 0.72). Thirty-one PC tubes (26.1%) were removed during CCY. Thirty-three patients (27.7%) expired with a PC tube in place, but none were due to complications of the procedure. The mean day of death was 23.5 days after PC (range: 1-86). In total, 40 of 119 patients (33.6%) underwent CCY. Conclusions: The majority of patients who undergo PC do not bridge to CCY. Non-surgical tube removal is performed regardless of the presence of calculi, creating a paradigm shift in clinical care, patient expectation and management. Educational Exhibit Abstract No. 487 Animal models for liver cancer research: benefits and challenges O. Akinwande, H. Kim; Johns Hopkins University, Randallstown, MD; Yale School of Medicine, New Haven, CT Learning Objectives: 1. Review the various animal models used for hepatic interventional oncology. 2. Review the various tumor mimics used in each animal model. 3. Highlight the advantages of each animal model as well as the limitations with regard to technique (ablation, transarterial therapy), cancer generation, and applicability to clinical practice. Background: Animal models of liver cancer provide the ability to evaluate tumor biology and treatment response. There is a relative paucity of animal research in interventional oncology (IO), but animal models may help solve important clinical ambiguity that is commonplace in IO. Animal models have evolved over the years, but each model has advantages and disadvantages. Clinical Findings/Procedure Details: In this exhibit, we will review the literature and present the various animal models Posters and Exhibits ’ JVIR S216 P os te rs an d Ex hi bi ts that have been used for the study of liver cancer (mice, rat, rabbit, pig, dog, woodchuck). Examples will be presented from our animal database and literature review. We will discuss the various ways tumors can be generated in each particular animal model: spontaneous models, xenograft models (stem cells, cancer cells) and synergic models (hepatocarcinogen induced, virus induced, genetically engineered model (GEM)). Ablation treatment is less influenced by the size of the animal; however, transarterial therapy is more challenging in small animals. Techniques, pearls and anatomical considerations from the existing literature and from our institutional experience will be presented. Lastly, the authors will suggest and tabulate preferred animal models depending on the disease (HCC vs metastatic) or technique (ablation, transarterial embolization) being studied. Conclusions: Animal models are valuable in hepatic interventional oncology research. They allow simplicity and a more controlled environment; however, current models are not ideal and may not provide satisfactory answers given the complexity and heterogeneity of liver cancer. Future studies should be directed at improving upon animal models to allow evaluation of both technique feasibility and treatment efficacy. Educational Exhibit Abstract No. 488 The interventional radiologist’s role in precision medicine W. Randazzo, T. Gade, G. Nadolski, S. Hunt; North Augusta, SC; Hospital of the University of Pennsylvania, Philadelphia, PA; Wynnewood, PA; Penn Image-Guided Interventions Lab, Philadelphia, PA Learning Objectives: To discuss the impact of precision medicine initiatives on the future practice of medicine and the role for interventional radiologists in the coming era of precision medicine. Background: In January of 2015, President Obama announced $215 million in funding for a Precision Medicine Initiative which seeks to accelerate progress in prevention and treatment strategies that take individual patient variability into account. Technological advances in bioinformatics, proteomics, genomics, molecular imaging, targeted therapeutics and a variety of other fields have improved the prospects of matching patient-specific variables to patient-specific targeted prevention and treatment strategies. Clinical Findings/Procedure Details: This educational exhibit provides a broad background in defining the various facets of precision medicine and the ways in which clinical treatment and research algorithms can be affected by these technological advances. Interventional radiologists have long used imaging guidance as a tool for targeted diagnostics and therapeutics. From molecular imaging-guided biopsies and interventions, to intra-procedural metabolic imaging of tumor heterogeneity, to sampling the microbiome of abscess cavities, interventional radiology will play a primary role in the transition into this era of precision medicine. Conclusions: The evolution toward precision medicine will have a profound impact on the practice of medicine at large and on interventional radiology. Interventional radiologists have a unique position to aid in this transformation, with the opportunity to guide its successful implementation. References 1. Hunt S, Jha S. Can precision medicine reduce overdiagnosis? Acad Radiol