Endoscopic gallbladder drainage of patients with acute cholecystitis

Abstract

The standard treatment for acute cholecystitis is early laparoscopic cholecystectomy. In cases of increased operative risk surgery may be postponed or rejected, and instead alternative methods, such as percutaneous or endoscopic drainage, may be attempted. This paper is a retrospective assessment of our results with endoscopic gallbladder drainage (EGBD) by means of endoscopic retrograde cholangiopancreatography (ERCP). Over a 9-year period, data from all patients who underwent attempted EGBD, primarily referred for diagnosis and treatment of cholestasis by ERCP, were analyzed. EGBD was attempted in those patients who had concomitant acute cholecystitis. EGBD was successful in 24 of 34 patients with acute cholecystitis (70.6%). The success rate rose from 50% during the first 4-year period to 89% during the subsequent 5-year period. Of the 24 patients in whom EBGD had been successful, 21 showed clinical improvement and 10 were finally managed nonoperatively. Of the 21 clinically improved patients, 14 underwent elective surgery a median of 24 days later. Of the 10 patients in whom EGBD failed nine underwent surgery four of whom required surgery within one week. Treatment of acute cholecystitis in patients could be done successfully by EGBD, and in 70% of cases cholecystectomy could then be carried out on an elective basis rather than as emergency surgery. Some patients could be treated with EGBD alone. Future prospective trials will clarify the role of EGBD in patients with acute cholecystitis.