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Indications for and Optimal Management of Percutaneous Cholecystostomy Drainage: A Systematic Review

Aymen H Sadaka1,2, Jennifer F Tseng2, Kamal M F Itani1,2,3

  • 1Department of Surgery, Veterans Affairs Boston Health Care System, Boston, Massachusetts.

JAMA Surgery
|September 3, 2025
PubMed

Insights

Percutaneous cholecystostomy (PC) is best for poor surgical candidates, offering no benefit over antibiotics unless sepsis is present. Interval cholecystectomy within 8-13 weeks post-PC improves outcomes.

Area of Science:

  • Gastroenterology and Hepatology
  • Interventional Radiology
  • Surgical Innovation

Background:

  • Percutaneous cholecystostomy (PC) use has risen without clear guidelines.
  • Indications and optimal management strategies for PC remain debated.

Purpose of the Study:

  • To identify indicators for PC procedures.
  • To clarify percutaneous cholecystostomy tube (PCT) management.
  • To suggest optimal timing for subsequent interventions.

Main Methods:

  • Systematic review of five databases (PubMed, Embase, Cochrane, ICTRP, ClinicalTrials.gov).
  • Inclusion of systematic reviews, meta-analyses, RCTs, cohort studies, and case-control studies published within the last 5 years.
  • Analysis of 69 studies from 3774 identified publications.

Main Results:

  • PC is outperformed by cholecystectomy and offers no benefit over antibiotic-only management (AOM) except in sepsis.
  • Interval cholecystectomy (IC) after PC yields better outcomes than definitive PC.
  • Factors like CHF and CLD impede IC; IC within 8-13 weeks post-PC is optimal.
  • PCT clamping trial superior to cholangiogram for tube removal.

Conclusions:

  • PC is a bridging therapy for poor surgical candidates, indicated for cholecystitis, sepsis, or AOM failure.
  • Careful consideration is needed for patients with CHF and CLD.
  • Successful PCT clamping trial guides removal before IC (8-13 weeks) to reduce complications and recurrence.
Abstract

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