Surgeon-performed point-of-care ultrasound for acute cholecystitis: indications and limitations: a European Society for Trauma and Emergency Surgery (ESTES) consensus statement

  • Jorge PereiraEmail author
  • Gary A. Bass
  • Diego Mariani
  • Bogdan D. Dumbrava
  • Andrea Casamassima
  • António Rodrigues da Silva
  • Luis Pinheiro
  • Isidro Martinez-Casas
  • Mauro Zago



Acute cholecystitis (AC), frequently responsible for presentation to the emergency department, requires expedient diagnosis and definitive treatment by a general surgeon. Ultrasonography, usually performed by radiology technicians and reported by radiologists, is the first-line imaging study for the assessment of AC. Targeted point-of-care ultrasound (POCUS), particularly in the hands of the treating surgeon, may represent an evolution in surgical decision-making and may expedite care, reducing morbidity and cost.


This consensus guideline was written under the auspices of the European Society of Trauma and Emergency Surgery (ESTES) by the POCUS working group. A systematic literature search identified relevant papers on the diagnosis and treatment of AC. Literature was critically-appraised according to the GRADE evidence-based guideline development method. Following a consensus conference at the European Congress of Trauma & Emergency Surgery (Valencia, Spain, May 2018), final recommendations were approved by the working group, using a modified e-Delphi process, and taking into account the level of evidence of the conclusion.


We strongly recommend the use of ultrasound as the first-line imaging investigation for the diagnosis of AC; specifically, we recommend that POCUS may be adopted as the primary imaging adjunct to surgeon-performed assessment of the patient with suspected AC. In line with the Tokyo guidelines, we strongly recommend Murphy’s sign, in conjunction with the presence of gallstones and/or wall thickening as diagnostic of AC in the correct clinical context. We conditionally recommend US as a preoperative predictor of difficulty of cholecystectomy. There is insufficient evidence to recommend contrast-enhanced ultrasound or Doppler ultrasonography in the diagnosis of AC. We conditionally recommend the use of ultrasound to guide percutaneous cholecystostomy placement by appropriately-trained practitioners.


Surgeons have recently embraced POCUS to expedite diagnosis of AC and provide rapid decision-making and early treatment, streamlining the patient pathway and thereby reducing costs and morbidity.


POCUS Cholecystitis Diagnostic ultrasound 


Compliance with ethical standards

Conflict of interest

The authors state to have no conflict of interest regarding this manuscript.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jorge Pereira
    • 1
    Email author
  • Gary A. Bass
    • 2
    • 3
  • Diego Mariani
    • 4
  • Bogdan D. Dumbrava
    • 3
  • Andrea Casamassima
    • 5
  • António Rodrigues da Silva
    • 6
  • Luis Pinheiro
    • 7
  • Isidro Martinez-Casas
    • 8
  • Mauro Zago
    • 9
  1. 1.Division of Hepatobiliary Surgery, Department of General SurgeryHospital São TeotónioViseuPortugal
  2. 2.Department of SurgeryTallaght University HospitalDublin 24Ireland
  3. 3.Royal College of Surgeons in IrelandDublin 2Ireland
  4. 4.Department of Emergency General SurgeryLegnano HospitalLegnanoItaly
  5. 5.Department of Emergency MedicineOspedale “S. Maria delle Stelle”, ASST Melegnano e MartesanaMelzoItaly
  6. 6.Division of Colorectal Surgery, Department of General SurgeryPedro Hispano HospitalMatosinhosPortugal
  7. 7.Division of Esophagogastric Surgery, Department of General SurgeryHospital São TeotónioViseuPortugal
  8. 8.Department of General SurgeryHospital Médico-QuirúrgicoJaénSpain
  9. 9.Division of Minimally Invasive Surgery and Surgical Oncology, Department of SurgeryPoliclinico San PietroBergamoItaly

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