Acute cholecystitis: Which flow-chart for the most appropriate management?

Area of Science:

• Gastroenterology
• Surgical Innovation
• Minimally Invasive Procedures

Background:

• Acute cholecystitis (AC) is a common clinical condition.
• Laparoscopic cholecystectomy is the standard treatment but poses risks for elderly patients with comorbidities or on anticoagulants.
• Mini-invasive management is emerging as a viable option for high-risk AC patients.

Purpose of the Study:

• To review and compare non-operative treatments for acute cholecystitis.
• To highlight the benefits and drawbacks of various minimally invasive gallbladder drainage techniques.
• To propose a stepwise approach and flowchart for optimizing AC patient management.

Main Methods:

• Review of current literature on non-operative treatments for AC.
• Description and comparison of percutaneous gallbladder drainage (PT-GBD), endoscopic transpapillary gallbladder drainage (ETGBD), and EUS-guided drainage (EUS-GBD).
• Discussion of technique feasibility, cost-effectiveness, and reintervention rates.

Main Results:

• PT-GBD is common, easy to perform, and cost-effective.
• ETGBD is challenging, requires expert endoscopists, and is indicated for select cases.
• EUS-guided drainage (EUS-GBD) is less available but effective, potentially reducing reinterventions.

Conclusions:

• Non-operative treatments provide effective alternatives for high-risk AC patients.
• A tailored, stepwise approach considering patient-specific factors and multidisciplinary discussion is crucial.
• These minimally invasive techniques, including PT-GBD, ETGBD, and EUS-GBD, offer valuable options for managing AC.