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Management of Percutaneous Cholecystostomy Drains: A Consensus Statement
Mohammed Al Azzawi1,2,3, Carolyn Cullinane1,2, Michael Devine1,2
1Irish Surgical Research Collaborative, Royal College of Surgeons in Ireland, Dublin, Ireland.
JAMA Network Open
|June 5, 2026
Summary
Percutaneous cholecystostomy drains (PCDs) offer an alternative for acute cholecystitis patients unsuitable for surgery. Expert consensus now provides guidelines for PCD management, including drain duration and follow-up care.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Clinical Practice Guidelines
Background:
- Percutaneous cholecystostomy drains (PCDs) are crucial for managing acute cholecystitis (AC) in non-surgical candidates.
- Standardized guidelines for PCD indications, follow-up, and management are currently lacking in medical literature.
Purpose of the Study:
- To establish expert consensus recommendations for managing PCDs in patients with AC.
- To develop evidence-based guidelines for the indications, follow-up, and management of PCDs.
Main Methods:
- A 3-round Delphi consensus study involving 45 UK and Irish surgeons and interventional radiologists.
- Statements were developed from a literature review and refined through expert evaluation to achieve 80% agreement.
Main Results:
- Consensus was reached on 20 statements regarding PCD management, favoring laparoscopic cholecystectomy as first-line treatment for AC.
- PCDs are recommended for severe AC in poor surgical candidates, with transhepatic drains preferred and a 4-6 week in-situ duration.
- Cholangiography before drain removal and interval laparoscopic cholecystectomy at 6-8 weeks post-insertion were agreed upon.
Conclusions:
- Expert consensus provides crucial recommendations for standardizing PCD management in acute cholecystitis.
- These guidelines aim to improve clinical decision-making and patient outcomes for those with AC.
