Management Of Acute Cholecystitis Research Articles

Predictive factors associated with Bile culture positivity And phenotypiCal antIbiogram resistance patterns in patients taken to LaparOscopic cholecystectomy (BACILO): protocol for a prospective observational cohort study and development of a prognostic prediction model.

Bile fluid is aseptic under normal conditions; however, in the presence of cholecystitis, its susceptibility to bacterial colonisation varies, with reported rates of 20%-70% of cases. This process is referred to as bactibilia and/or bacteriobilia and can be considered a secondary complication of biliary stasis and cholecystitis in general. In the management of acute cholecystitis, the antibiotic regimen should be prescribed based on the presumed pathogens involved, taking into consideration the risk factors for resistance patterns according to demographics and local exposure. The aim of this study is to determine the predictive factors for bile culture positivity and antibiotic resistance in patients who underwent laparoscopic cholecystectomy in the Méderi Hospital Network. We hope to develop a predictive model that allows us to better guide antibiotic therapy. This is a prospective observational cohort study with prognostic prediction model. Patients who will undergo laparoscopic cholecystectomy and have bile cultures taken in the Méderi Hospital Network during the study period will be included. The dependent variables will be positive bile culture and antibiotic resistance, and the predictive variables will be age, presence of diabetes, diagnosis of choledocholithiasis, diagnosis of cholecystitis and severity of cholecystitis according to the Tokyo criteria. The minimum sample size has been calculated at 703 patients. Follow-up will continue until a control appointment 15 days after the procedure. The primary outcomes are bile culture positivity and phenotypical antibiogram resistance. For each outcome, a multivariate logistic regression will be performed using frequentist and Bayesian prediction techniques. This study was approved by the Méderi network research department committee (CIMED) and by Universidad del Rosario's Research Ethics Committee (CEI-UR; DVO005 2555-CV1837). Written informed consent is required for participation. The results will be disseminated through the submission of an academic article to a high-impact scientific journal, presentations at academic conferences, and sharing with our institution's faculty to inform antimicrobial therapy management based on local epidemiological data. NCT06314399.

Ultrasound-guided erector spinae plane nerve block for relief of acute cholecystitis pain

Background: Acute cholecystitis is a common surgical emergency and a painful condition that often requires frequent intravenous opioid analgesia. Sometimes, pain control of patients with acute cholecystitis is challenging. In this case, we present a potential alternative to managing acute cholecystitis pain.Case Report: A 40-year-old female presented to the ED with right upper quadrant pain. While awaiting testing and ultrasound, she received multiple doses of opioid analgesia. A point-of-care ultrasound of the right upper quadrant was performed and demonstrated findings of acute cholecystitis. Given that her pain was challenging to manage, even with intravenous opioids, an ultrasound-guided erector spinae plane (ESP) nerve block was discussed and subsequently performed at the T7 level. Thirty minutes after the procedure, the patient reported significant relief of her pain and did not require any opioid analgesia until ten hours later on the inpatient floor.Why should an emergency medicine physician be aware of this?ESP nerve blocks can potentially offer an alternative analgesic in the management of acute cholecystitis, subsequently reducing the use of opioids in the ED.ESP nerve blocks can potentially offer patients longer-lasting analgesia.ESP nerve blocks can potentially manage visceral pain in the ED.

Laparoscopic Cholecystectomy in Acute Cholecystitis: An Updated Review

Laparoscopic cholecystectomy is the gold standard for the management of gallstone disease, but it has recently been incorporated into the treatment of acute cholecystitis. It is divided into early and delayed laparoscopic cholecystectomy. Early laparoscopic cholecystectomy is done within 72 hours of the onset of symptoms, and delayed laparoscopic cholecystectomy is done after eight weeks. As there is no consensus on the timing of early laparoscopic cholecystectomy in adults and elderly patients, we have conducted this review article to examine the timing of early laparoscopic cholecystectomy, the risk factors for conversion to open cholecystectomy, and the role of laparoscopic subtotal cholecystectomy in the management of acute cholecystitis.

Conservative Treatment of Acute Cholecystitis: An Updated Narrative Review

Conservative treatment of acute cholecystitis has been the initial treatment for acute cholecystitis, which involves the use of antibiotics to control the infection and prepare the patient for cholecystectomy. The Tokyo Guidelines have categorized patients who present with acute cholecystitis into three categories: Categories one, two and three. Although laparoscopic cholecystectomy is the gold standard of treatment, antibiotics and percutaneous cholecystostomy play a role in the management of patients with category two and three. This review aimes to examine the role of antibiotics and percutaneous cholecystostomy in the management of acute cholecystitis.

Laparoscopic Cholecystectomy in Management of Acute Cholecystitis

Laparoscopic Cholecystectomy in Management of Acute Cholecystitis

Influence of Percutaneous Transhepatic Gallbladder Aspiration and Drainage for Severe Acute Cholecystitis on the Surgical Outcomes of Subsequent Laparoscopic Cholecystectomy: Post Hoc Analysis of the CSGO-HBP-017 (CSGO-HBP-017C).

Percutaneous transhepatic gallbladder aspiration (PTGBA) and/or drainage (PTGBD) are useful approaches in the management of acute cholecystitis in patients who cannot tolerate surgery because of poor general condition or severe inflammation. However, reports regarding its effect on the surgical outcomes of subsequent laparoscopic cholecystectomy (LC) are sparse. The aim of this retrospective study was to investigate the influence of PTGBA on surgical outcomes of subsequent LC by comparing the only-PTGBA group, including patients who did not need the additional-PTGBD, versus the additional-PTGBD group, including those who needed the additional-PTGBD after PTGBA. We conducted a post hoc analysis of our multi-institutional data. This study included 63 patients who underwent LC after PTGBA, and we compared the surgical outcomes between the only-PTGBA group (n = 56) and the additional-PTGBD group (n = 7). No postoperative complications occurred among the 63 patients, and the postoperative hospital stay was 11 ± 12 days. Fourteen patients (22.2%) had a recurrence of cholecystitis, of whom 7 patients (11.1%) needed the additional-PTGBD after PTGBA. Significantly longer operative time (245 ± 74 vs 159 ± 65 min, P = 0.0017) and postoperative hospital stay (22 ± 27 vs 10 ± 9 d, P = 0.0118) and greater intraoperative blood loss (279 ± 385 vs 70 ± 208 mL, P = 0.0283) were observed among patients in the additional-PTGBD group compared with the only-PTGBA group, whereas the rates of postoperative complications (Clavien-Dindo grade ≥3: 0% each) and conversion to open surgery (28.6% vs 8.9%, P = 0.1705) were comparable. PTGBA for acute cholecystitis could result in good surgical outcomes of subsequent LC, especially regarding postoperative complications. However, we should keep in mind that the additional-PTGBD after PTGBA failure, which sometimes happened, would be associated with increased operative difficulty and longer recovery.

Management of acute cholecystitis with concomitant liver abscess

Management of acute cholecystitis with concomitant liver abscess

Percutaneous cholecystostomy as a bridge therapy in the geriatric age group with acute cholecystitis.

The aim of this study was to investigate the efficacy of percutaneous cholecystostomy (PC) in the geriatric patients with acute cholecystitis. The records of geriatric patients with high surgical risk who underwent percutaneous cholecystostomy for acute cholecystitis were reviewed retrospectively. The median age of 134 patients who underwent percutaneous cholecystostomy was 77 (65-98) years and 63.4% were women. The mean length of hospital stay was 5 (4-18) days, and the follow-up period until the procedure was 2 (1-6) days. Murphy's sign was positive in 79.1% of patients on physical examination, and the remaining patients (20.9%) had only tenderness on examination. As USG findings, 59.0% of the patients had a gall bladder wall thickness (> 4mm) with pericholecystic fluid. Additional imaging method, abdominal CT, was performed in 29 patients (21.6%), MRCP was performed in three patients (2.2%), and ERCP was performed in one patient (0.7%). Bacterial growth was detected in 27.6% of the bile cultures performed. During the follow-up period, laparoscopic cholecystectomy was performed in 60.4% of the patients and open cholecystectomy was performed in 5.2% of the patients electively. 34.3% of the patients did not undergo any surgery. Bile leakage was detected in two patients (1.5%) as a procedure-related complication, and no mortality was observed. Abdominal ultrasonography-guided PC is a safe and effective method in the management of acute cholecystitis in high-risk patients in the geriatric age group.

Management of acute cholecystitis in patients on anti-thrombotic therapy: A single center experience

BackgroundAcute cholecystitis in patients on anti-thrombotic therapy (ATT) presents a clinical dilemma at the intersection between conflicting guidelines, specifically between timing of early operative management (OM) versus time-to-reversal of certain ATT agents. With growing recognition that nonoperative management (NOM) is associated with considerable morbidity, and evidence in the literature that early OM in patients on ATT is safe, we reviewed our own practice to examine how we addressed these conflicting guidelines. Materials and methodsWe performed a retrospective review of patients with acute cholecystitis between December 2017 and March 2022. Patients were classified as ATT or non-ATT; ATT patients were subdivided into anticoagulation (AC) and antiplatelet (AP) groups. Rates of OM were compared. Results502 patients with acute cholecystitis were identified, 464 non-ATT and 38 ATT. 30 ATT patients were on AC, 7 on AP, and 1 on both. Non-ATT patients were significantly more likely to receive OM at index presentation compared to those on ATT: 89.9 % vs 63.2 % (p < 0.05). Subgroup analysis of the ATT group showed AP patients were significantly less likely to receive OM compared to those on AC, 12.5 % vs 77 % (p < 0.05). ConclusionsAt our institution, patients on ATT were significantly less likely to undergo OM for acute cholecystitis compared with non-ATT patients. Those on AC received OM significantly more than patients on AP. Further study is needed to better define the management of this growing population so that acute cholecystitis guidelines might address this issue in the future.

FTP7.11 The role of percutaneous cholecystostomy in the management of acute cholecystitis in critically ill surgical patients, a single-centre experience, UK

Abstract Percutaneous cholecystostomy (PC) is a minimally invasive procedure that aims to stabilise critically unwell patients with acute cholecystitis. Particularly important for poor surgical candidates, PC facilitates therapeutic benefit with fewer complications and allows patient stabilisation before definitive cholecystectomy. A large 2018 study demonstrated the role of PC to be as effective as emergency laparoscopic cholecystectomy, with no significant difference in mortality. There are no UK national guidelines for the safe practice of PC. This study reports the outcomes in patients admitted as emergency cases undergoing PC for acute cholecystitis. This was a retrospective descriptive study evaluating 24 consecutive patients admitted with acute cholecystitis to a tertiary centre, and underwent PC from 1st May 2019 to 27th January 2021. The data was collected and analysed on Microsoft Excel. The mean age of patients was 76.1 (range 56-107 years) and predominantly female (67%). Mean duration of antibiotics therapy was 13.1 (7-24) days. The most common indication for PC was failed antibiotic therapy (16 patients) followed by gallbladder empyema (4 patients) and severe frailty (4 patients), with 21 patients ASA grade III or above. Mean duration for PC drain in-situ was 31.9 (3-164) days. In five patients, the PC drain fell out spontaneously and 9 patients underwent tubogram before removal. Interval cholecystectomy was performed in 7 patients. No patients died during their acute admission. PC is a safe, established technique to manage acute cholecystitis in critically ill and high-risk surgical patients with favourable outcomes. More research to develop guidelines that identifies suitable patients through emergency admission would be beneficial.

MOY 3 Management of acute cholecystitis in Scotland: A population wide cohort study

Abstract Aims Acute cholecystitis (AC) is a common Emergency General Surgery presentation, and is managed either by a cholecystectomy or conservatively. Surgery during the acute inflammatory phase has been shown to be safe and superior, however, operative rates vary widely. Also, medium-long term survival rates with each approach are still not definitively established. This real-world population analysis aims to describe the current management and outcomes of patients with AC across Scotland. Methods This was a national cohort study using data obtained from Information Services Division, Scotland. All adult patients with the admission diagnostic code for AC were included. Patient level data were used to identify all patients admitted to Scottish hospitals between 1997-2019 and outcomes tracked for inpatients or after discharge through the unique patient identifier. This was mapped to mortality data to establish date and cause of death. Results 47558 patients diagnosed with AC, admitted in one of 46 hospitals were included. These patients accounted for 58824 episodes (27.2% of patients encountered &amp;gt;1 episode). The study population had a median age of 58 years (IQR=43-71), 64.4% were female, and most had no comorbidities. 28741(60.4%) patients had an operative intervention during the index admission. Patients who had an operation during their index admission had a lower risk of 90-day mortality compared to non-operative management (OR 0.62, 95% CI 0.55-0.70). Conclusions In this comprehensive analysis of AC in Scotland, 60% of patients had an index cholecystectomy. Patients undergoing surgery had a superior survival to those managed conservatively, further advocating for an operative approach in this cohort.

ThTP5.1 Laparoscopic cholecystectomy on index admission – are we following AUGIS guidelines?

Abstract Background Laparoscopic cholecystectomy is the gold standard in management of acute cholecystitis, biliary colic and gallstone induced pancreatitis. AUGIS has produced guidelines recommending optimal timing during index presentation for surgery. Aim To identify if our local acute surgical unit was following AUGIS guideline recommendations and performing laparoscopic cholecystectomy on index admission for recurrent/ongoing biliary colic, mild gallstone pancreatitis and for acute cholecystitis within 72 hours of onset of symptoms. Methods Prospective review of surgical patients admitted to DGH in Northern Ireland with acute cholecystitis, biliary colic and gallstone pancreatitis over six-month period between April and September 2021. Results 103 patients were admitted during 6 months with gallstone disease. Of these, only 20 underwent inpatient lap cholecystectomy during their admission. 21 patients were deemed unfit for surgery and 3 declined surgery. 10 patients with acute cholecystitis had surgery; only 4 had symptom onset within 72 hours as recommended. Conclusion This unit was not following AUGIS recommendations on the timing of laparoscopic cholecystectomy for patients presenting with gallstone disease. During this data collection a pathway was started for day case laparoscopic cholecystectomy at a satellite site to help expedite patients who were unable to have their operation as inpatient.

Management of Acute Cholecystitis in High-Risk Patients: Percutaneous Gallbladder Drainage as a Definitive Treatment vs. Emergency Cholecystectomy-Systematic Review and Meta-Analysis.

This systematic review aims to investigate whether percutaneous transhepatic gallbladder biliary drainage (PTGBD) is superior to emergency cholecystectomy (EC) as a definitive treatment in high-risk patients with acute cholecystitis (AC). A systematic literature search was performed until December 2022 using the Scopus, Medline/PubMed and Web of Science databases. Seventeen studies have been included with a total of 783,672 patients (32,634 treated with PTGBD vs. 4663 who underwent laparoscopic cholecystectomy, 343 who had open cholecystectomy and 746,032 who had some form of cholecystectomy, but without laparoscopic or open approach being specified). An analysis of the results shows that PTGBD, despite being less invasive, is not associated with lower morbidity with respect to EC (RR 0.77 95% CI [0.44 to 1.34]; I2 = 99%; p = 0.36). A lower postoperative mortality was reported in patients who underwent EC (2.37%) with respect to the PTGBD group (13.78%) (RR 4.21; 95% CI [2.69 to 6.58]; p < 0.00001); furthermore, the risk of hospital readmission for biliary complications (RR 2.19 95% CI [1.72 to 2.79]; I2 = 48%; p < 0.00001) and hospital stay (MD 4.29 95% CI [2.40 to 6.19]; p < 0.00001) were lower in the EC group. In our systematic review, the majority of studies have very low-quality evidence and more RCTs are needed; furthermore, PTGBD is inferior in the treatment of AC in high-risk patients. The definition of high-risk patients is important in interpreting the results, but the methods of assessment and definitions differ between studies. The results of our systematic review and meta-analysis failed to demonstrate any advantage of using PTGBD over ER as a definitive treatment of AC in critically ill patients, which suggests that EC should be considered as the treatment of choice even in very high-risk patients. Most likely, the inferiority of PTGBD versus early LC for high-risk patients is related to an association of various patient-side factor conditions and the severity of acute cholecystitis.

Endoscopic ultrasound in the management of acute cholecystitis. a practical review.

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged over the last years as an alternative procedure to percutaneous drainage (PT)-GBD in patients with acute cholecystitis (AC) at high surgical risk. This process has been driven by the advent of lumen-apposing metal stents (LAMSs) with electrocautery-enhanced capability, which has rendered the drainage procedure easier to accomplish and safer. Studies and meta-analyses have proven the superiority of EUS-GBD over PT-GBD in high-surgical-risk patients with AC. Little evidence also exists in the same setting that EUS-GBD compares equally with laparoscopic cholecystectomy (LC). Moreover, EUS-GBD might theoretically have a possible role in patients at high surgical risk with an indication to undergo cholecystectomy or with a high probability of conversion from LC to open cholecystectomy. Properly designed studies are needed to better clarify the role of EUS-GBD in these patient populations.

EFFECTIVENESS OF TOKYOGUIDELINES 2018 IN THE MANAGEMENT OF ACUTE CHOLANGITIS AND ACUTE CHOLECYSTITIS

Acute biliary sepsis which includes Acute cholecystitis and Acute Cholangitis are life threatening surgical emergencies which needs early recognition and prompt institution of appropriate management strategies. Except for some well-known clinical signs like Murphys sign and Charcots triad there are no well-defined criteria for the diagnosis of above said biliary infections. Tokyo Guidelines 2018 is expert panel formulated Diagnostic and severity assessment criteria guidelines is the only guidelines available till date which aids in the diagnosis and management of the same. More number of patients can be diagnosed at an early stage of infection and appropriate treatment instituted at the earliest by using this guidelines, thus avoiding any foreseen complications. In this study, we have assessed the feasibility of using TG 18 guidelines in diagnosing and managing acute biliary infections in ESI Medical College and Hospital Rajajinagar, Bengaluru. Objective: To study the effectiveness of Tokyo Guidelines 2018 in diagnosing, assessing severity and management of acute cholecystitis and acute cholangitis. Material and Methods: All cases of acute cholangitis and acute cholecystitis admitted in ESI Medical College and Hospital Rajajinagar, Bengaluru. Patients who had been diagnosed as a case of acute Cholecystitis and acute cholangitis were followed up and assessed using the TG 18 guidelines criteria and the outcomes were analysed. The efficacy of Using the guidelines in our setup and reproducibility of guideline demanding parameters were analysed that were appropriate in our setup. Clinical details and lab and imaging findings were recorded using a well detailed clinical proforma that included detailed description of analysis of a case of acute cholecystitis and cholangitis. Also other contributing factors, clinical patterns ,presentation ,treatment outcomes were analysed in detail. Results: Acute Cholecystitis with most common etiology being gallstone disease is more common in females (66.6%),While Acute cholangitis is more common among elderly females(60%). 56.7 % patients diagnosed with Acute cholecystitis and 46.7% patients diagnosed with acute cholangitis presented to us in 24 - 72 hours of symptom onset. 33.3 % of cholecystitis and &gt; 50% cholangitis patients were Diabetics Under treatment for the same.

Endoscopic Ultrasound-Guided Gallbladder Drainage for Malignant Biliary Obstruction: A Systematic Review.

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a rescue technique for patients with malignant biliary obstruction who fail conventional treatment with ERCP or EUS-guided biliary drainage. The technique has been successfully employed in the management of acute cholecystitis in patients not fit for surgery. However, the evidence for its use in malignant obstruction is less robust. This review article aims to evaluate the data available at present to better understand the safety and efficacy of EUS-guided gallbladder drainage. A detailed literature review was conducted and several databases were searched for any studies relating to EUS-GBD in malignant biliary obstruction. Pooled rates with 95% confidence intervals were calculated for clinical success and adverse events. Our search identified 298 studies related to EUS-GBD. The final analysis included 7 studies with 136 patients. The pooled rate of clinical success (95% CI) was 85% (78-90%, I2: 0%). The pooled rate of adverse events (95% CI) was 13% (7-19%, I2: 0%). Adverse events included: peritonitis, bleeding, bile leakage, stent migration, and stent occlusion. No deaths directly related to the procedure were reported; however, in some of the studies, deaths occurred due to disease progression. This review supports the use of EUS-guided gallbladder drainage as a rescue option for patients who have failed conventional measures.

Impact of percutaneous cholecystostomy in the management of acute cholecystitis: a retrospective cohort study at a tertiary center.

Laparoscopic cholecystectomy is the gold standard for the treatment of acute cholecystitis (AC). Percutaneous cholecystostomy (PC) for management of AC is increasing; safe and less invasive than laparoscopic cholecystectomy and is very useful in selected patients with severe comorbidities, not suitable for surgery/general anesthesia. We conducted a retrospective observational study between 2016 and 2021 of patients treated with PC for AC, based on the application of the Tokyo guidelines 13/18. The aim was to analyse the clinical results and management of PC in patients undergoing elective or emergency cholecystectomy. Subsequently, a retrospective analytical study was designed to compare various cohorts: elective or emergency surgery and management with PC alone; patients with/without a high surgical risk; and elective vs emergency surgery. Hundred and ninety five patients with AC were treated with PC. Mean age was 74years, 59.5% were ASA class III/IV, and the mean Charlson comorbidity index was 5.5. Adherence to Tokyo guidelines regarding indication of PC was 50.8%. The rate of complications associated to PC was 12.3% and the 90-day mortality rate was 14.4%. Mean length of time using PC was 10.7days. Emergency surgery was performed in 4.6%. The overall success rate using PC was 66.7%, and the 1-year readmission rate due to biliary complications after PC was 28.2%. The rate of scheduled cholecystectomy after PC was 22.6%. Conversion to laparotomy and open approach was more frequent in patients who underwent emergency surgery (p = 0.009). No differences were found in 90-day mortality or in the complication rate. PC achieves improvements in the inflammation and infection associated with AC. In our series, it proved to be an effective and safe treatment during the acute episode of AC. Mortality in patients treated with PC is high due to their older age, greater morbidity, and higher Charlson comorbidity index scores. After PC, emergency surgery is uncommon but readmission due to biliary events is high. Cholecystectomy after PC is the definitive treatment and the laparoscopic approach is feasible. Clinical trial registery: The study was registered in the public accessible database clinicaltrials.gov with the ClinicalTrials.gov ID: NCT05153031. Public release date: 12/09/2021.

Ruptured cystic artery pseudoaneurysm after long-term transpapillary placement of a gallbladder stent for acute cholecystitis.

Endoscopic transpapillary gallbladder drainage (ETGBD), including endoscopic gallbladder stenting (EGBS), has utility in the management of acute cholecystitis in patients considered to be high risk candidates for surgery [1]. A recent meta-analysis reported that the pooled rate of cholecystitis recurrence was 4.6 % following ETGBD in patients with acute cholecystitis [2]. Long-term biliary drainage via EGBS is often performed to prevent the recurrence of cholecystitis in patients with contraindications to cholecystectomy.

Management of Acute Cholecystitis at Ouakam Military Hospital of Dakar, Senegal

Introduction: Acute lithiasis cholecystitis complicates 10 to 15% of symptomatic gallbladder stones. Emergency management with laparoscopic cholecystectomy within the first 72 hours treats the infection and the stones involved in one step without increasing morbidity or mortality. The aim of the study was to report our experience with laparoscopic treatment of acute lithiasis cholecystitis. Material and method: This is a descriptive retrospective study from January 2015 to December 2019. It include all patients treated urgently for acute lithiasis cholecystitis by laparoscopic route. Results: There were twenty-three (23) patients composed of 6 men and 17 women, ie a sex ratio of 3/1 in favor of women. The average age was 50.91 years (range 26 years and 85 years). One patient has sickle cell type SS. The duration of symptoms was 4 days on average (extreme 2 days and 7 days). The symptoms consisted of pain in the right hypochondrium (100%), fever, vomiting (30.4%), pain and localized defense in the right hypochondrium (82.6%). Hyperleukocytosis and elevated CRP were found in all patients. Biological cholestasis was noted in 1 patient. Ultrasound showed stones and a thickened gallbladder wall in 23 cases (100%), a Murphy's sign in 19 cases (82,6). Cholecystectomy was retrograde in 82.6% and anterograde 17.3% of cases. Conversion to laparotomy was performed in 4.3% (1 case). The intervention time was on average 59.6 min (range of 30 min and 180 min). The mean hospital stay was on average 3.6 days (range 2 and 13 days). No death was noted. Morbidity was 8.6%. Conclusion: The delay in consultation and the antibiotic therapy protocols lengthen the time taken for treatment. Laparoscopic cholecystectomy in the early forms can treat the inflammation and the stones involved in one step.

Management of acute cholecystitis

Acute cholecystitis is an inflammation of the gallbladder most often related to gallstones. The diagnostic and severity criteria are well described by the Tokyo criteria. Early laparoscopic cholecystectomy remains the treatment of choice. It can also be performed in elderly patients and in pregnant women during any trimester. For patients not eligible for surgery, percutaneous or echo-endoscopic gallbladder drainage (EUS-GBD) are effective treatment alternatives. The management of acute cholecystitis must therefore be adapted to each patient by carefully evaluating the risks and benefits associated with surgery.