Drainage of the Gallbladder in High-Risk Patients with Acute Cholecystitis: An Update on Management

Abstract

Acute calculus cholecystitis is a very common condition, affecting 20% of all cases of symptomatic gallstone disease. Drainage of the gallbladder has been incorporated into the management of acute cholecystitis in high-risk surgical patients. This review examines various gallbladder drainage procedures, their indications, and complications in the management of acute cholecystitis in high-risk patients.

The Tokyo Guidelines have included drainage of the gallbladder for the management of patients in grade 3 to stabilise them and perform an interval cholecystectomy later. Percutaneous cholecystostomy is the most common drainage procedure. The procedure is easy to perform, and it is associated with minimal procedural side effects. The common problem is the care and maintenance of the tube. Endoscopic drainage procedures are often indicated for high-risk patients who would never undergo a cholecystectomy. Still, endoscopic drainage procedures have slowly emerged for drainage of the gallbladder. Endoscopic drainage includes endoscopic trans papillary gallbladder drainage (ETGBD) and endoscopic ultrasound gallbladder drainage (EUSGBD). While effective, these techniques require advanced endoscopic training and facilities, and this limits its use in resource-limited settings.