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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.
Insights
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.
Importance:
Percutaneous cholecystostomy drains (PCDs) are frequently used in patients with acute cholecystitis (AC) who are poor surgical candidates. However, standardized guidance on the indications, follow-up, and management of PCDs is lacking in the literature.
Objective:
To gather expert consensus recommendations and develop guidelines on the management of PCDs in patients with AC.
Evidence Review:
This Delphi consensus study was conducted between August 2024 and April 2025. Statements were generated following a structured literature review and evaluated through a 3-round Delphi process. Consultant surgeons and interventional radiologists practicing in Ireland and the UK were invited to participate through national surgical societies and professional networks. The primary outcome was the level of agreement among experts on statements addressing indications, follow-up imaging, duration of drainage, and timing of definitive surgery following percutaneous cholecystostomy. Consensus was predefined as agreement of 80% or greater among panelists.
Findings:
The panel included 45 experts (39 surgeons [86.7%] and 6 interventional radiologists [13.3%]). After 3 Delphi rounds, consensus was reached on 20 statements regarding PCD management. The panel agreed that laparoscopic cholecystectomy should be the first-line management for AC. Use of PCDs was considered an appropriate alternative strategy to cholecystectomy for patients with severe AC who were poor candidates for surgery. Transhepatic drains were preferred to transperitoneal drains, and panelists agreed drains should remain in situ for at least 4 to 6 weeks postinsertion. The panel agreed that cholangiography should be performed prior to PCD removal. A completion cholecystectomy was considered feasible with low perioperative complications in most cases. The optimal time for interval laparoscopic cholecystectomy was agreed to be 6 to 8 weeks after drain insertion. Endoscopic drainage was considered a novel technique that could be used where available. There was no consensus on the management of AC during pregnancy or the feasibility of clamping tests.
Conclusions And Relevance:
In this Delphi consensus study, expert agreement was achieved on key aspects of the management and follow-up of PCDs. These recommendations may help standardize clinical practice and inform decision-making in the management of AC.
