Skip to main content
SpringerLink
Log in

Percutaneous cholecystostomy: techniques and applications

  • Review
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Acute cholecystitis (AC) is a critical condition requiring immediate medical attention and treatment and is one of the most frequently encountered acute abdomen emergencies in surgical practice, requiring hospitalization. Laparoscopic cholecystectomy is considered the favored treatment for patients with AC who are fit for surgery. However, in high-risk patients considered poor surgical candidates, percutaneous cholecystostomy (PC) has been suggested and employed as a safe and reliable alternative option. PC is a minimally invasive, nonsurgical, image-guided intervention that drains and decompresses the gallbladder, thereby preventing its perforation and sepsis. It can act as a bridge to surgery, but it may also serve as a definitive treatment for some patients. The goal of this review is to familiarize physicians with PC and, more importantly, its applications and techniques, pre- and post-procedural considerations, and adverse events.

Graphical Abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. R. M. Gore, V. Yaghmai, G. M. Newmark, J. W. Berlin, and F. H. Miller, “Imaging benign and malignant disease of the gallbladder,” Radiol. Clin. North Am., vol. 40, no. 6, pp. 1307–1323, Dec. 2002, doi: https://doi.org/10.1016/S0033-8389(02)00042-8

  2. K. Gurusamy, K. Samraj, C. Gluud, E. Wilson, and B. R. Davidson, “Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis,” Br. J. Surg., vol. 97, no. 2, pp. 141–150, Feb. 2010, doi: https://doi.org/10.1002/bjs.6870

  3. I. F. Yusoff, J. S. Barkun, and A. N. Barkun, “Diagnosis and management of cholecystitis and cholangitis,” Gastroenterol. Clin. North Am., vol. 32, no. 4, pp. 1145–1168, 2003, doi: https://doi.org/10.1016/S0889-8553(03)00090-6

  4. S. M. Strasberg, “Clinical practice. Acute calculous cholecystitis.,” N. Engl. J. Med., vol. 358, no. 26, pp. 2804–2811, Jun. 2008, doi: https://doi.org/10.1056/NEJMcp0800929

  5. J. L. Huffman and S. Schenker, “Acute acalculous cholecystitis: a review.,” Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc., vol. 8, no. 1, pp. 15–22, Jan. 2010, doi: https://doi.org/10.1016/j.cgh.2009.08.034

  6. K. Maddu, S. Phadke, and C. Hoff, “Complications of cholecystitis: a comprehensive contemporary imaging review.,” Emerg. Radiol., vol. 28, no. 5, pp. 1011–1027, Oct. 2021, doi: https://doi.org/10.1007/s10140-021-01944-z

  7. N. J. Soper, L. M. Brunt, and K. Kerbl, “Laparoscopic general surgery.,” N. Engl. J. Med., vol. 330, no. 6, pp. 409–419, Feb. 1994, doi: https://doi.org/10.1056/NEJM199402103300608

  8. A. Ghahreman, J. L. McCall, and J. A. Windsor, “Cholecystostomy: a review of recent experience.,” Aust. N. Z. J. Surg., vol. 69, no. 12, pp. 837–840, Dec. 1999, doi: https://doi.org/10.1046/j.1440-1622.1999.01712.x

  9. J. R. Gallaher and A. Charles, “Acute Cholecystitis: A Review,” JAMA, vol. 327, no. 10, pp. 965–975, Mar. 2022, doi: https://doi.org/10.1001/jama.2022.2350

  10. C. Palanivelu, K. Jani, and G. S. Maheshkumar, “Single-center experience of laparoscopic cholecystectomy.,” J. Laparoendosc. Adv. Surg. Tech. A, vol. 17, no. 5, pp. 608–614, Oct. 2007, doi: https://doi.org/10.1089/lap.2006.0192

  11. J. M. Beal, “Historical perspective of gallstone disease.,” Surg. Gynecol. Obstet., vol. 158, no. 2, pp. 181–189, Feb. 1984

  12. M. W. Little et al., “Percutaneous cholecystostomy: The radiologist’s role in treating acute cholecystitis,” Clin. Radiol., vol. 68, no. 7, pp. 654–660, 2013, doi: https://doi.org/10.1016/j.crad.2013.01.017

  13. M. W. Jones, R. Genova, and M. C. O’Rourke, “Acute Cholecystitis.,” Treasure Island (FL), 2021.

  14. M. Maneevese, R. Sheth, S. A.-U. Rahman, and J. Kuban, “Bedside Percutaneous Cholecystostomy,” in Bedside Procedures, InTech, 2018.

  15. R. S. Sparkman, “Bobbs centennial: the first cholecystotomy.,” Surgery, vol. 61, no. 6, pp. 965–971, Jun. 1967

  16. . W. Radder, “Ultrasonically guided percutaneous catheter drainage for gallbladder empyema.,” Diagn. Imaging, vol. 49, no. 6, pp. 330–333, 1980

  17. O. Akhan, D. Akıncı, and M. N. Özmen, “Percutaneous cholecystostomy,” Eur. J. Radiol., vol. 43, no. 3, pp. 229–236, 2002, doi: https://doi.org/10.1016/S0720-048X(02)00158-4

  18. S. Nasim, S. Khan, R. Alvi, and M. Chaudhary, “Emerging indications for percutaneous cholecystostomy for the management of acute cholecystitis--a retrospective review.,” Int. J. Surg., vol. 9, no. 6, pp. 456–459, 2011, doi: https://doi.org/10.1016/j.ijsu.2011.04.008

  19. S. Y. Noh, D. Il Gwon, G.-Y. Ko, H.-K. Yoon, and K.-B. Sung, “Role of percutaneous cholecystostomy for acute acalculous cholecystitis: clinical outcomes of 271 patients.,” Eur. Radiol., vol. 28, no. 4, pp. 1449–1455, Apr. 2018, doi: https://doi.org/10.1007/s00330-017-5112-5.

  20. G. Markopoulos, F. Mulita, D. Kehagias, S. Tsochatzis, C. Lampropoulos, and I. Kehagias, “Outcomes of percutaneous cholecystostomy in elderly patients: a systematic review and meta-analysis.,” Prz. Gastroenterol., vol. 16, no. 3, pp. 188–195, 2021, doi: https://doi.org/10.5114/pg.2020.100658

  21. C. S. Loozen et al., “Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial.,” BMJ, vol. 363, p. k3965, Oct. 2018, doi: https://doi.org/10.1136/bmj.k3965.

  22. M. Pisano et al., “2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis,” World J. Emerg. Surg., vol. 15, no. 1, p. 61, Dec. 2020, doi: https://doi.org/10.1186/s13017-020-00336-x

  23. A. M. Devane et al., “Society of Interventional Radiology Quality Improvement Standards for Percutaneous Cholecystostomy and Percutaneous Transhepatic Biliary Interventions,” J. Vasc. Interv. Radiol., vol. 31, no. 11, pp. 1849–1856, 2020, doi: https://doi.org/10.1016/j.jvir.2020.07.015

  24. G. W. Boland, M. J. Lee, J. Leung, and P. R. Mueller, “Percutaneous cholecystostomy in critically ill patients: early response and final outcome in 82 patients.,” AJR. Am. J. Roentgenol., vol. 163, no. 2, pp. 339–342, Aug. 1994, doi: https://doi.org/10.2214/ajr.163.2.8037026

  25. M. Lublin and D. N. Danforth, “Iatrogenic gallbladder perforation: conservative management by percutaneous drainage and cholecystostomy.,” Am. Surg., vol. 67, no. 8, pp. 760–763, Aug. 2001

  26. M. A. Khasawneh et al., “Successful laparoscopic cholecystectomy after percutaneous cholecystostomy tube placement.,” J. Trauma Acute Care Surg., vol. 78, no. 1, pp. 100–104, Jan. 2015, doi: https://doi.org/10.1097/TA.0000000000000498

  27. M. Elsharif, A. Forouzanfar, K. Oaikhinan, and N. Khetan, “Percutaneous cholecystostomy… why, when, what next? A systematic review of past decade,” Ann. R. Coll. Surg. Engl., vol. 100, no. 8, pp. 618–631, Nov. 2018, doi: https://doi.org/10.1308/rcsann.2018.0150

  28. I. J. Patel et al., “Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations,” J. Vasc. Interv. Radiol., vol. 30, no. 8, pp. 1168-1184.e1, Aug. 2019, doi: https://doi.org/10.1016/j.jvir.2019.04.017

  29. C. Duncan, S. J. Hunt, T. Gade, R. D. Shlansky-Goldberg, and G. J. Nadolski, “Outcomes of Percutaneous Cholecystostomy in the Presence of Ascites.,” J. Vasc. Interv. Radiol., vol. 27, no. 4, pp. 562–6.e1, Apr. 2016, doi: https://doi.org/10.1016/j.jvir.2015.12.004

  30. S. R. Choudhury, P. Gupta, S. Garg, N. Kalra, M. Kang, and M. S. Sandhu, “Image-guided percutaneous cholecystostomy: a comprehensive review,” Irish J. Med. Sci. (1971 -), 2021, doi: https://doi.org/10.1007/s11845-021-02655-7.

  31. M. Yokoe et al., “Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos).,” Journal of hepato-biliary-pancreatic sciences, vol. 25, no. 1. Japan, pp. 41–54, Jan. 2018, doi: https://doi.org/10.1002/jhbp.515.

  32. W. K. Bae et al., “[Microbiologic study of the bile culture and antimicrobial susceptibility in patients with biliary tract infection].,” Korean J. Gastroenterol., vol. 51, no. 4, pp. 248–54, Apr. 2008, [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmed/18516004.

  33. J. Liu et al., “Acute cholecystitis associated with infection of Enterobacteriaceae from gut microbiota,” Clin. Microbiol. Infect., vol. 21, no. 9, pp. 851.e1-851.e9, Sep. 2015, doi: https://doi.org/10.1016/j.cmi.2015.05.017

  34. M. A. Chehab et al., “Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for,” J. Vasc. Interv. Radiol., vol. 29, no. 11, pp. 1483-1501.e2, Nov. 2018, doi: https://doi.org/10.1016/j.jvir.2018.06.007

  35. W. E. A. Saad, M. J. Wallace, J. C. Wojak, S. Kundu, and J. F. Cardella, “Quality Improvement Guidelines for Percutaneous Transhepatic Cholangiography, Biliary Drainage, and Percutaneous Cholecystostomy,” J. Vasc. Interv. Radiol., vol. 21, no. 6, pp. 789–795, Jun. 2010, doi: https://doi.org/10.1016/j.jvir.2010.01.012.

  36. A. A. Hatjidakis et al., “Maturation of the tract after percutaneous cholecystostomy with regard to the access route.,” Cardiovasc. Intervent. Radiol., vol. 21, no. 1, pp. 36–40, 1998, [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmed/9518138.

  37. D. Ginat and W. E. A. Saad, “Cholecystostomy and Transcholecystic Biliary Access,” Tech. Vasc. Interv. Radiol., vol. 11, no. 1, pp. 2–13, Mar. 2008, doi: https://doi.org/10.1053/j.tvir.2008.05.002

  38. A. Venara, V. Carretier, J. Lebigot, and E. Lermite, “Technique and indications of percutaneous cholecystostomy in the management of cholecystitis in 2014,” J. Visc. Surg., vol. 151, no. 6, pp. 435–439, Dec. 2014, doi: https://doi.org/10.1016/j.jviscsurg.2014.06.003

  39. K. Gulaya, S. Desai, and K. Sato, “Percutaneous Cholecystostomy: Evidence-Based Current Clinical Practice,” Semin. Intervent. Radiol., vol. 33, no. 04, pp. 291–296, Oct. 2016, doi: https://doi.org/10.1055/s-0036-1592326

  40. C. Dewhurst, R. A. Kane, J. N. Mhuircheartaigh, O. Brook, M. Sun, and B. Siewert, “Complication Rate of Ultrasound-Guided Percutaneous Cholecystostomy in Patients With Coagulopathy,” Am. J. Roentgenol., vol. 199, no. 6, pp. W753–W760, Dec. 2012, doi: https://doi.org/10.2214/AJR.11.8445

  41. M. D. Beland, L. Patel, S. H. Ahn, and D. J. Grand, “Image-Guided Cholecystostomy Tube Placement: Short- and Long-Term Outcomes of Transhepatic Versus Transperitoneal Placement.,” AJR. Am. J. Roentgenol., vol. 212, no. 1, pp. 201–204, Jan. 2019, doi: https://doi.org/10.2214/AJR.18.19669

  42. J. R. Kallini, D. C. Patel, N. Linaval, E. H. Phillips, and R. J. Van Allan, “Comparing clinical outcomes of image-guided percutaneous transperitoneal and transhepatic cholecystostomy for acute cholecystitis,” Acta radiol., vol. 62, no. 9, pp. 1142–1147, Sep. 2021, doi: https://doi.org/10.1177/0284185120959829

  43. P. E. Jenkins, A. MacCormick, J. Zhong, G. C. Makris, N. Gafoor, and D. Chan, “Transhepatic or transperitoneal technique for cholecystostomy: results of the multicentre retrospective audit of cholecystostomy and further interventions (MACAFI),” Br. J. Radiol., Jan. 2023, doi: https://doi.org/10.1259/bjr.20220279

  44. S. Narayanan, S. N. Keshava, V. Moses, M. Ahmed, A. Padmanabhan, and P. Joseph, “Image Guided Percutaneous Cholecystostomy–A Single Center Experience,” J. Clin. Interv. Radiol. ISVIR, vol. 4, no. 01, pp. 20–26, Apr. 2020, doi: https://doi.org/10.1055/s-0040-1705263

  45. L. Reppas et al., “Two-Center Prospective Comparison of the Trocar and Seldinger Techniques for Percutaneous Cholecystostomy,” Am. J. Roentgenol., vol. 214, no. 1, pp. 206–212, Jan. 2020, doi: https://doi.org/10.2214/AJR.19.21685

  46. N.-A. Arkoudis et al., “US-guided trocar versus Seldinger technique for percutaneous cholecystostomy (TROSELC II trial).,” Abdom. Radiol. (New York), Apr. 2023, doi: https://doi.org/10.1007/s00261-023-03916-y.

  47. K. Kajiwara et al., “CT fluoroscopy-guided percutaneous drainage: comparison of the one step and the Seldinger techniques.,” Minim. Invasive Ther. Allied Technol., vol. 26, no. 3, pp. 162–167, Jun. 2017, doi: https://doi.org/10.1080/13645706.2016.1261901

  48. S. H. Park et al., “Percutaneous Cholecystostomy Using a Central Venous Catheter Is Effective for Treating High-Risk Patients With Acute Cholecystitis,” Surg. Laparosc. Endosc. Percutan. Tech., vol. 15, no. 4, pp. 202–208, Aug. 2005, doi: https://doi.org/10.1097/01.sle.0000174551.71801.5a

  49. T. Tsuyuguchi et al., “TG13 indications and techniques for gallbladder drainage in acute cholecystitis (with videos),” J. Hepatobiliary. Pancreat. Sci., vol. 20, no. 1, pp. 81–88, Jan. 2013, doi: https://doi.org/10.1007/s00534-012-0570-2

  50. K. Ito et al., “Percutaneous Cholecystostomy Versus Gallbladder Aspiration for Acute Cholecystitis: A Prospective Randomized Controlled Trial,” Am. J. Roentgenol., vol. 183, no. 1, pp. 193–196, Jul. 2004, doi: https://doi.org/10.2214/ajr.183.1.1830193

  51. S. Chopra et al., “Treatment of Acute Cholecystitis in Non-Critically Ill Patients at High Surgical Risk,” Am. J. Roentgenol., vol. 176, no. 4, pp. 1025–1031, Apr. 2001, doi: https://doi.org/10.2214/ajr.176.4.1761025

  52. K. Tsutsui et al., “Usefulness of single and repetitive percutaneous transhepatic gallbladder aspiration for the treatment of acute cholecystitis,” J. Gastroenterol., vol. 42, no. 7, pp. 583–588, Jul. 2007, doi: https://doi.org/10.1007/s00535-007-2061-9

  53. S. Komatsu et al., “Role of percutaneous transhepatic gallbladder aspiration in the early management of acute cholecystitis,” J. Dig. Dis., vol. 15, no. 12, pp. 669–675, Dec. 2014, doi: https://doi.org/10.1111/1751-2980.12198

  54. S. Rassameehiran, P. Tantrachoti, and K. Nugent, “Percutaneous Gallbladder Aspiration for Acute Cholecystitis,” Baylor Univ. Med. Cent. Proc., vol. 29, no. 4, pp. 381–384, Oct. 2016, doi: https://doi.org/10.1080/08998280.2016.11929476

  55. J. Bundy, R. N. Srinivasa, J. J. Gemmete, J. J. Shields, and J. F. B. Chick, “Percutaneous Cholecystostomy: Long-Term Outcomes in 324 Patients,” Cardiovasc. Intervent. Radiol., vol. 41, no. 6, pp. 928–934, Jun. 2018, doi: https://doi.org/10.1007/s00270-018-1884-5

  56. K. W. Pang et al., “Outcomes of Percutaneous Cholecystostomy for Acute Cholecystitis,” World J. Surg., vol. 40, no. 11, pp. 2735–2744, Nov. 2016, doi: https://doi.org/10.1007/s00268-016-3585-z

  57. A. Winbladh, P. Gullstrand, J. Svanvik, and P. Sandström, “Systematic review of cholecystostomy as a treatment option in acute cholecystitis,” HPB, vol. 11, no. 3, pp. 183–193, 2009, doi: https://doi.org/10.1111/j.1477-2574.2009.00052.x

  58. P. Mueller, E. van Sonnenberg, and J. Ferrucci, “Percutaneous biliary drainage: technical and catheterrelated problems in 200 procedures,” Am. J. Roentgenol., vol. 138, no. 1, pp. 17–23, Jan. 1982, doi: https://doi.org/10.2214/ajr.138.1.17

  59. D. Macchini et al., “Timing of percutaneous cholecystostomy tube removal: systematic review.,” Minerva Chir., vol. 71, no. 6, pp. 415–426, Dec. 2016

  60. M. Antalek, A. Riaz, and A. A. Nemcek, “Gallbladder: Role of Interventional Radiology,” Semin. Intervent. Radiol., vol. 38, no. 03, pp. 330–339, Aug. 2021, doi: https://doi.org/10.1055/s-0041-1731371

  61. E. A. McGillicuddy et al., “Non-operative management of acute cholecystitis in the elderly.,” Br. J. Surg., vol. 99, no. 9, pp. 1254–1261, Sep. 2012, doi: https://doi.org/10.1002/bjs.8836

  62. J. N. Wise, D. A. Gervais, A. Akman, M. Harisinghani, P. F. Hahn, and P. R. Mueller, “Percutaneous Cholecystostomy Catheter Removal and Incidence of Clinically Significant Bile Leaks: A Clinical Approach to Catheter Management,” Am. J. Roentgenol., vol. 184, no. 5, pp. 1647–1651, May 2005, doi: https://doi.org/10.2214/ajr.184.5.01841647

  63. H. Kamezaki et al., “Safety and Efficacy of Early Tube Removal Following Percutaneous Transhepatic Gallbladder Drainage: an Observational Study,” Surg. Laparosc. Endosc. Percutan. Tech., vol. 30, no. 2, pp. 164–168, Apr. 2020, doi: https://doi.org/10.1097/SLE.0000000000000761

Download references

Acknowledgements

None.

Funding

No funding was received for the preparation of this manuscript.

Author information

Authors and Affiliations

  1. 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital “Attikon”, Rimini 1, Haidari, 124 62, Athens, Greece

    Nikolaos-Achilleas Arkoudis, Ornella Moschovaki-Zeiger, Lazaros Reppas, Stavros Grigoriadis, Efthymia Alexopoulou, Elias Brountzos, Nikolaos Kelekis & Stavros Spiliopoulos

  2. Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece

    Lazaros Reppas

Authors
  1. Nikolaos-Achilleas Arkoudis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ornella Moschovaki-Zeiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lazaros Reppas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stavros Grigoriadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Efthymia Alexopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elias Brountzos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nikolaos Kelekis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stavros Spiliopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NAA and OMZ wrote the original draft, extracted, and prepared the figures. LR, SG, EA and EB assisted with the literature search, conceptualization, and visualization of the manuscript. NK and SS provided supervision and assisted with review and editing. All authors were involved in the preparation, editing, and approval of the final manuscript.

Corresponding author

Correspondence to Nikolaos-Achilleas Arkoudis.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arkoudis, NA., Moschovaki-Zeiger, O., Reppas, L. et al. Percutaneous cholecystostomy: techniques and applications. Abdom Radiol 48, 3229–3242 (2023). https://doi.org/10.1007/s00261-023-03982-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-023-03982-2

Keywords

Search

Navigation