Percutaneous cholecystostomy and acute cholecystitis: how, when and why

Area of Science:

• Gastroenterology
• Surgical Innovation
• Interventional Radiology

Background:

• Acute cholecystitis (AC) is a frequent emergency requiring urgent intervention.
• Surgical management of AC in high-risk patients with severe comorbidities is often challenging.
• Percutaneous cholecystostomy (PC) offers an alternative approach for these patients.

Purpose of the Study:

• To evaluate the safety and efficacy of percutaneous cholecystostomy (PC) in managing acute cholecystitis (AC) in patients with prohibitive surgical risk.
• To assess PC as both a definitive treatment and a bridge to surgery.

Main Methods:

• A retrospective analysis of 1105 patients with AC from January 2015 to May 2021.
• Focus on 23 high-risk patients treated with PC after failure of conservative management.
• PC was utilized as definitive therapy or as a bridge to subsequent cholecystectomy.

Main Results:

• All 23 patients treated with PC experienced clinical symptom resolution.
• No mortality or complications were recorded in the PC group.
• PC was used definitively in 14 patients and as a bridge to surgery in 9 patients.

Conclusions:

• Percutaneous cholecystostomy (PC) is a safe, less invasive, and effective treatment for acute cholecystitis in high-risk surgical patients.
• PC provides prompt symptom relief and can successfully transition high-risk patients to a moderate-risk category for definitive surgical treatment.
• Current guidelines support PC as a recommended management option for AC in patients with multiple comorbidities, with no absolute contraindications.