Beyond Cholecystostomy: Cryoablation for High-Risk Gallbladder Disease

BackgroundCryoablation is a well-established intervention for various pathologies. Cryoablation has been investigated as an alternative for cholecystitis in poor surgical candidates and as an adjunct to resection for invasive gallbladder cancer (GBC).MethodsA systematic search was performed in PubMed and Embase to identify studies investigating cryoablation in cholecystitis and GBC. Pooled overall (OS) and disease-free survival (DFS) analysis was conducted for the GBC population.ResultsFour studies in patients with cholecystitis (n = 29, mean age: 63.5 ± 16.8 years; 69% males) used 1-2 freeze cycles, and between 1 and 7 probes. The mean duration of cholecystostomy in place prior to cryoablation was 73.7 ± 37.1 days. Average hospital stay was 3.9 ± 7.5 days. At a follow-up of 15.6 ± 7.7 months, the efficacy of cryoablation varied between 86% and 100%. Complications included infection (6.9%), scrotal edema (3.4%), transient biliary obstruction (3.4%), anaphylaxis/death (3.4%), and hemorrhage/acute tubular necrosis (3.4%). In patients with GBC (n = 12, mean age: 57.9 ± 5.6 years), all four studies used one probe and most studies used 2 freeze cycles. At a follow-up of 13.1 ± 11.1 months, four patients (33.3%) with GBC had complications including pulmonary embolism, pleural effusion, exacerbation of congestive heart failure, and one biliary stricture, while one patient died at 3 months after the procedure. Gallbladder cancer recurred in 36.3% with median DFS of 10 (4-17) months. The OS was 88.8% at 6 months and 83.3% at 1-year post-procedure.ConclusionCryoablation is a technically feasible, definitive treatment option for poor surgical candidates with cholecystitis, targeting the same patient population typically selected for percutaneous cholecystostomy placement. Cryoablation is an experimental adjunct in GBC. Current evidence is limited, based on retrospective data and a very limited number of patients. Further prospective studies are needed to validate its efficacy and improve its safety in high-risk patients.