Systematic Review of Percutaneous Cholecystostomy (PC) as Definitive vs Bridge Therapy for Acute Cholecystitis in High-Risk Patients

This systematic review aims to assess the efficacy, safety, and outcomes of percutaneous cholecystostomy as a definitive vs bridge therapy for acute cholecystitis in high-risk patients. Acute cholecystitis, characterized by inflammation of the gall bladder, presents a significant challenge in high-risk patients due to their compromised health status. Percutaneous cholecystostomy (PC) has emerged as an alternative approach to traditional cholecystectomy in managing such patients. This review critically evaluates available evidence to guide clinical decision-making and provide insights into the optimal management strategy for high-risk patients. The authors searched PubMed and Google Scholar databases until July 2023 about studies comparing PC as definitive therapy vs bridge therapy for acute cholecystitis in high-risk patients. Other available modalities for the nonoperative management of acute cholecystitis were also studied. The outcomes were assessed in terms of technical success, clinical success, rates of conversion to surgery, morbidity, length of stay at the hospital, long-term results, and mortality. Articles were reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Quality assessment was performed using the Newcastle-Ottawa Scale for non-randomized studies. The outcomes of the studies selected were compared, and their conclusions were tabulated for prompt review. Percutaneous cholecystostomy demonstrates satisfactory technical and clinical success rates, comparable morbidity and mortality rates to bridge therapy, and favorable long-term outcomes in the studies reviewed. PC can be used as a definitive therapy in many patients while as a bridging treatment for others before subsequent cholecystectomy.