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Role of Percutaneous Cholecystostomy in Acute Cholecystitis2019

Type: New Practice Management Guideline (PMG)
Category: Emergency General Surgery
Committee Liaison: Nikolay Bugaev, MD


Team leader(s)

Acute cholecystitis can be a life-threatening illness in the elderly and the chronically ill, and its treatment is fraught with complications as well. Percutaneous cholecystostomy was initially described more than 30 years ago, and is been considered a rescue therapy in frail and severely ill patients. The 2013 Tokyo Guidelines codified PC as a bridging therapy to cholecystectomy in severe acute cholecystitis and recommended its consideration as terminal therapy for cholecystitis of any severity in surgically unfit patients. Thus far, though, the only attempts to analyze existing papers in order to provide evidence-based strategies have either been plagued by lack of appropriate studies (the Cochrane Library, 2013) or have not utilized GRADE methodology (Stanek et al 2018, Elsharif et al 2018, and Morales-Maza et al 2019). Additionally, the role of percutaneous cholecystostomy in acute cholecystitis was recently named as a gap in current practice management guidelines by an Emergency Surgery working group of the American Association for the Surgery of Trauma (Schuster, et al 2019). As there are now many more studies on percutaneous cholecystostomy in severe acute cholecystitis as well as cholecystitis in poor surgical candidates, the Emergency Surgery Working Group of the EAST Guidelines Committee proposes a systematic review and meta-analysis using GRADE methodology. Recommendations are needed for: 1) Role of percutaneous cholecystostomy as bridging therapy to cholecystectomy in severe acute calculous cholecystitis as defined by the Tokyo Guidelines; 2) Use of percutaneous cholecystostomy as terminal/destination therapy in patients with limited life expectancy or chronic illnesses which render the patient a poor surgical candidate; and 3) Use of percutaneous cholecystostomy as terminal/destination therapy in patients with acute acalculous cholecystitis References: Yokoe, M., et al. (2013). TG13 diagnostic criteria and severity grading of acute cholecystitis. Journal of Hepatobiliary and Pancreatic Science 20:35-46. Takada, T., et al. (2013). TG13: Updated Tokyo guidelines for the management of acute cholangitis and cholecystitis. Ibid, pp. 1-7. Gurusamy, K., et al. (2013). Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database of Systematic Reviews 2013(8):1-24. Gulaya, K., et al. (2016). Percutaneous cholecystostomy: evidence-based current clinical practice. Seminars in Interventional Radiology 33:291-296. Mori, Y., et al. (2018). Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis. Journal of Hepatobiliary and Pancreatic Science 25:87-95. Stanek, A., et al. (2018). Percutaneous cholecystostomy: a simple bridge to surgery or an alternative option for the management of acute cholecystitis? The American Journal of Surgery 216:595-603. Elsharif, M., et al. (2018). Percutaneous cholecystostomy…why, when, what next? A systematic review of the past decade. Annals of the Royal College of Surgeons (England) 100:618-631. Loozen, C., et al. (2018). Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicenter randomized clinical trial. British Medical Journal 363:k3965. Schuster, K., et al. (2019). American Association for the Surgery of Trauma emergency general surgery guidelines gap analysis. Journal of Trauma and Acute Care Surgery 86(5):909-915.

Work Group
Sheryl Sahr, MD - Leader
Bishwajit Bhattacharya, MD
Tejal Brahmbhatt, MD
Nilokay Bugaev, MD
Christopher Butts, PhD, DO
John Como, MD, MPH
Michael Cripps, MD
Paul Engels, MD
Haytham Kaafarani, MD, MPH
Caleb Mentzer, DO
Kaushal Shah, MD 
Devesh Tiwary, MD


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Eastern Association for the Surgery of Trauma

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