Percutaneous Cholecystostomy for Severe Acute Cholecystitis Associated with Organ Dysfunction: Is It as Effective and Safe as That Without Organ Dysfunction?

Purpose: The management of acute cholecystitis (AC) associated with organ dysfunction (Grade 3 AC according to Tokyo Guidelines 2018) remains controversial. Percutaneous cholecystostomy (PC) is usually the first-line treatment, however, recent studies reported higher mortality and complications in patients with Grade 3 AC undergoing PC compared to cholecystectomy {1,2}. This study's purpose was to evaluate the efficacy and safety of PC for Grade 3 AC in comparison with that for Grade 1 or 2 AC (without organ dysfunction).

Materials and Methods: This single-institution retrospective study included 248 PCs performed from 2014 to 2023 (152/96: male/female, median age: 69), including 150 patients with Grade 3 AC, and 98 with Grade 1 or 2 AC. Efficacy was evaluated by: 1) 30-day mortality, 2) rate of a bail-out cholecystectomy (due to lack of clinical improvement post-PC), 3) resolution of sepsis or abdominal pain within 48 hours, and 4) length of hospitalization post-PC. Major complications were recorded per SIR Quality Standards {3}. Chi-Square analysis was used for comparison.

Results: The 30-day mortality rate was significantly higher in patients with Grade 3 AC (Table). There were no significant differences between groups in other clinical outcomes, or major complication rates (Table). Hypotension requiring pressor support was significantly more frequent in Grade 3 AC (Table).

Conclusion: Despite similar safety profiles, patients with Grade 3 AC demonstrated a significantly higher 30-day mortality rate following PC. Further research is needed to determine the role of PC for Grade 3 AC, especially when laparoscopic cholecystectomy for high-risk patients is available.