ACUTE CHOLECYSTITIS IN HIGH-RISK PATIENTS. SURGICAL, RADIOLOGICAL, OR ENDOSCOPIC TREATMENT? BRAZILIAN COLLEGE OF...

Area of Science:

• Digestive Surgery
• Interventional Gastroenterology
• Minimally Invasive Surgery

Background:

• Acute cholecystitis (AC) presents significant risks, including sepsis and gallbladder perforation.
• Laparoscopic cholecystectomy is standard but high-risk for elderly patients with comorbidities.
• Percutaneous cholecystostomy and endoscopic gallbladder drainage are alternative options for critically ill patients.

Purpose of the Study:

• To present advances in AC treatment for high-risk surgical patients.
• To guide surgeons, endoscopists, and physicians in selecting optimal therapies.
• To discuss effectiveness, safety, and outcomes of various AC interventions.

Main Methods:

• Review of current treatment modalities for acute cholecystitis in high-risk populations.
• Discussion of laparoscopic cholecystectomy, percutaneous cholecystostomy, and endoscopic gallbladder drainage.
• Analysis of advantages, disadvantages, and outcomes of each procedure.

Main Results:

• High-risk AC patients require tertiary hospital care with specialized expertise.
• Individualized treatment based on clinical status and available resources is crucial.
• Laparoscopic cholecystectomy remains viable; drainage procedures require experienced personnel and specialized centers.

Conclusions:

• Percutaneous cholecystostomy and endoscopic drainage are temporary measures, requiring catheter removal post-AC resolution.
• Prolonged catheter use risks complications like bleeding and recurrent AC.
• Optimal timing for cholecystectomy post-drainage is not established but delayed procedures increase readmissions and costs.