European Radiology

, Volume 28, Issue 4, pp 1449–1455 | Cite as

Role of percutaneous cholecystostomy for acute acalculous cholecystitis: clinical outcomes of 271 patients

  • Seung Yeon Noh
  • Dong Il Gwon
  • Gi-Young Ko
  • Hyun-Ki Yoon
  • Kyu-Bo Sung



To examine the outcomes of percutaneous cholecystostomy (PC) in patients with acute acalculous cholecystitis (AAC).


The study population comprised 271 patients (mean age, 72 years; range, 22–97 years, male, n=169) with AAC treated with PC with or without subsequent cholecystectomy. Clinical data from total 271 patients were analysed, and outcomes were assessed according to whether the catheter was removed or remained indwelling. Patient survival and recurrence rates were calculated.


Symptom resolution and significant improvement of laboratory test values were achieved in 235 patients (86.7%) within 4 days after PC. Complications occurred in six patients (2.2%). Interval elective cholecystectomy was performed in 127 (46.8%) patients. Among the remaining 121 patients, successful removal of the PC catheter was achieved in 88 patients (72.7%) at a mean of 30 days (range, 4–365 days). Of the catheter removal group, 86/88 (97.7%) were successfully treated with the initial PC, whereas two (2.3%) experienced recurrence of cholecystitis. Cumulative recurrence rates were 1.1%, 2.7%, and 2.7% at 1, 2, and 8 years, respectively.


The good therapeutic outcomes of PC and low recurrence rate suggest that PC can be a definitive treatment option in the majority of AAC patients.

Key Points

Many patients with AAC are too ill to undergo cholecystectomy.

PC in AAC patients shows low complication and recurrence rate.

PC solely can be a definitive treatment option in the majority of AAC patients


Acalculous cholecystitis Cholecystitis, Acute Cholecystostomy Gallbladder Radiology, Interventional 



Acute acalculous cholecystitis


Alanine aminotransferase


American Society of Anaesthesiologists


Aspartate aminotransferase


C-reactive protein




International normalisation ratio


Magnetic resonance cholangiopancreatography


Percutaneous cholecystostomy


White blood cell



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Ji Hoon Shin.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• performed at one institution


  1. 1.
    Treinen C, Lomelin D, Krause C, Goede M, Oleynikov D (2015) Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies. Langenbecks Arch Surg 400:421–427CrossRefPubMedGoogle Scholar
  2. 2.
    Owen CC, Jain R (2005) Acute Acalculous Cholecystitis. Curr Treat Options Gastroenterol 8:99–104CrossRefPubMedGoogle Scholar
  3. 3.
    Kassar O, Kallel F, Ghorbel M, Bellaaj H, Mnif Z, Elloumi M (2015) Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia. Leuk Res Rep 4:39–41PubMedPubMedCentralGoogle Scholar
  4. 4.
    Huffman JL, Schenker S (2010) Acute acalculous cholecystitis: a review. Clin Gastroenterol Hepatol 8:15–22CrossRefPubMedGoogle Scholar
  5. 5.
    Ryu JK, Ryu KH, Kim KH (2003) Clinical features of acute acalculous cholecystitis. J Clin Gastroenterol 36:166–169CrossRefPubMedGoogle Scholar
  6. 6.
    Fox MS, Wilk PJ, Weissmann HS, Freeman LM, Gliedman ML (1984) Acute acalculous cholecystitis. Surg Gynecol Obstet 159:13–16PubMedGoogle Scholar
  7. 7.
    Johnson LB (1987) The importance of early diagnosis of acute acalculus cholecystitis. Surg Gynecol Obstet 164:197–203PubMedGoogle Scholar
  8. 8.
    Anderson JE, Inui T, Talamini MA, Chang DC (2014) Cholecystostomy offers no survival benefit in patients with acute acalculous cholecystitis and severe sepsis and shock. J Surg Res 190:517–521CrossRefPubMedGoogle Scholar
  9. 9.
    Chang YR, Ahn YJ, Jang JY et al (2014) Percutaneous cholecystostomy for acute cholecystitis in patients with high comorbidity and re-evaluation of treatment efficacy. Surgery 155:615–622CrossRefPubMedGoogle Scholar
  10. 10.
    Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L (2003) Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg 7:642–645CrossRefPubMedGoogle Scholar
  11. 11.
    Suzuki K, Bower M, Cassaro S, Patel RI, Karpeh MS, Leitman IM (2015) Tube cholecystostomy before cholecystectomy for the treatment of acute cholecystitis. Jsls 19:e2014.00200CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Berber E, Engle KL, String A et al (2000) Selective use of tube cholecystostomy with interval laparoscopic cholecystectomy in acute cholecystitis. Arch Surg 135:341–346CrossRefPubMedGoogle Scholar
  13. 13.
    Leveau P, Andersson E, Carlgren I, Willner J, Andersson R (2008) Percutaneous cholecystostomy: a bridge to surgery or definite management of acute cholecystitis in high-risk patients? Scand J Gastroenterol 43:593–596CrossRefPubMedGoogle Scholar
  14. 14.
    Cull JD, Velasco JM, Czubak A, Rice D, Brown EC (2014) Management of acute cholecystitis: prevalence of percutaneous cholecystostomy and delayed cholecystectomy in the elderly. J Gastrointest Surg 18:328–333CrossRefPubMedGoogle Scholar
  15. 15.
    McKay A, Abulfaraj M, Lipschitz J (2012) Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Surg Endosc 26:1343–1351CrossRefPubMedGoogle Scholar
  16. 16.
    Morse BC, Smith JB, Lawdahl RB, Roettger RH (2010) Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy. Am Surg 76:708–712PubMedGoogle Scholar
  17. 17.
    Nikfarjam M, Shen L, Fink MA et al (2013) Percutaneous cholecystostomy for treatment of acute cholecystitis in the era of early laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 23:474–480CrossRefPubMedGoogle Scholar
  18. 18.
    Barie PS, Eachempati SR (2003) Acute acalculous cholecystitis. Curr Gastroenterol Rep 5:302–309CrossRefPubMedGoogle Scholar
  19. 19.
    Berger H, Pratschke E, Arbogast H, Stabler A (1989) Percutaneous cholecystostomy in acute acalculous cholecystitis. Hepatogastroenterology 36:346–348PubMedGoogle Scholar
  20. 20.
    Chung YH, Choi ER, Kim KM et al (2012) Can percutaneous cholecystostomy be a definitive management for acute acalculous cholecystitis? J Clin Gastroenterol 46:216–219CrossRefPubMedGoogle Scholar
  21. 21.
    Eggermont AM, Lameris JS, Jeekel J (1985) Ultrasound-guided percutaneous transhepatic cholecystostomy for acute acalculous cholecystitis. Arch Surg 120:1354–1356CrossRefPubMedGoogle Scholar
  22. 22.
    Kirkegard J, Horn T, Christensen SD, Larsen LP, Knudsen AR, Mortensen FV (2015) Percutaneous cholecystostomy is an effective definitive treatment option for acute acalculous cholecystitis. Scand J Surg 104:238–243CrossRefPubMedGoogle Scholar
  23. 23.
    Shirai Y, Tsukada K, Kawaguchi H, Ohtani T, Muto T, Hatakeyama K (1993) Percutaneous transhepatic cholecystostomy for acute acalculous cholecystitis. Br J Surg 80:1440–1442CrossRefPubMedGoogle Scholar
  24. 24.
    Simorov A, Ranade A, Parcells J et al (2013) Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study. Am J Surg 206:935–940 discussion 940-931CrossRefPubMedGoogle Scholar
  25. 25.
    Ganpathi IS, Diddapur RK, Eugene H, Karim M (2007) Acute acalculous cholecystitis: challenging the myths. HPB (Oxford) 9:131–134CrossRefGoogle Scholar
  26. 26.
    Kalliafas S, Ziegler DW, Flancbaum L, Choban PS (1998) Acute acalculous cholecystitis: incidence, risk factors, diagnosis, and outcome. Am Surg 64:471–475PubMedGoogle Scholar
  27. 27.
    Hatzidakis A, Venetucci P, Krokidis M, Iaccarino V (2014) Percutaneous biliary interventions through the gallbladder and the cystic duct: What radiologists need to know. Clin Radiol 69:1304–1311CrossRefPubMedGoogle Scholar
  28. 28.
    Hatjidakis AA, Karampekios S, Prassopoulos P et al (1998) Maturation of the Tract After Percutaneous Cholecystostomy with Regard to the Access Route. Cardiovasc Intervent Radiol 20:36–40CrossRefPubMedGoogle Scholar
  29. 29.
    Ginat D, Saad WE (2008) Cholecystostomy and transcholecystic biliary access. Tech Vasc Interv Radiol 11:2–13CrossRefPubMedGoogle Scholar
  30. 30.
    Sheiman RG, Stuart K (2004) Percutaneous cystic duct stent placement for the treatment of acute cholecystitis resulting from common bile duct stent placement for malignant obstruction. J Vasc Interv Radiol 15:999–1001CrossRefPubMedGoogle Scholar
  31. 31.
    Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202CrossRefPubMedGoogle Scholar
  32. 32.
    Akhan O, Akinci D, Ozmen MN (2002) Percutaneous cholecystostomy. Eur J Radiol 43:229–236CrossRefPubMedGoogle Scholar
  33. 33.
    van Overhagen H, Meyers H, Tilanus HW, Jeekel J, Lameris JS (1996) Percutaneous cholecystectomy for patients with acute cholecystitis and an increased surgical risk. Cardiovasc Intervent Radiol 19:72–76CrossRefPubMedGoogle Scholar
  34. 34.
    vanSonnenberg E, D’Agostino HB, Goodacre BW, Sanchez RB, Casola G (1992) Percutaneous gallbladder puncture and cholecystostomy: results, complications, and caveats for safety. Radiology 183:167–170CrossRefPubMedGoogle Scholar
  35. 35.
    Barie PS, Eachempati SR (2010) Acute acalculous cholecystitis. Gastroenterol Clin North Am 39:343–357 xCrossRefPubMedGoogle Scholar
  36. 36.
    Parithivel VS, Gerst PH, Banerjee S, Parikh V, Albu E (1999) Acute acalculous cholecystitis in young patients without predisposing factors. Am Surg 65:366–368PubMedGoogle Scholar
  37. 37.
    Winbladh A, Gullstrand P, Svanvik J, Sandstrom P (2009) Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford) 11:183–193CrossRefGoogle Scholar
  38. 38.
    Davis CA, Landercasper J, Gundersen LH, Lambert PJ (1999) Effective use of percutaneous cholecystostomy in high-risk surgical patients: techniques, tube management, and results. Arch Surg 134:727–731 discussion 731-722CrossRefPubMedGoogle Scholar
  39. 39.
    D’Agostino HB, vanSonnenberg E, Sanchez RB, Goodacre BW, Casola G (1991) Imaging of the percutaneous cholecystostomy tract: observations and utility. Radiology 181:675–678CrossRefPubMedGoogle Scholar
  40. 40.
    Wise JN, Gervais DA, Akman A, Harisinghani M, Hahn PF, Mueller PR (2005) Percutaneous cholecystostomy catheter removal and incidence of clinically significant bile leaks: a clinical approach to catheter management. AJR Am J Roentgenol 184:1647–1651CrossRefPubMedGoogle Scholar
  41. 41.
    McClain T, Gilmore BT, Peetz M (1997) Laparoscopic cholecystectomy in the treatment of acalculus cholecystitis in patients after thermal injury. J Burn Care Rehabil 18:141–146CrossRefPubMedGoogle Scholar
  42. 42.
    Welschbillig-Meunier K, Pessaux P, Lebigot J et al (2005) Percutaneous cholecystostomy for high-risk patients with acute cholecystitis. Surg Endosc 19:1256–1259CrossRefPubMedGoogle Scholar
  43. 43.
    Kim JE, Choi DS, Bae K, Cho JM, Jeong CY, Kim HO (2017) Added value of point shear-wave elastography in the diagnosis of acute cholecystitis. Eur Radiol 27:1517–1526CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Seung Yeon Noh
    • 1
  • Dong Il Gwon
    • 1
  • Gi-Young Ko
    • 1
  • Hyun-Ki Yoon
    • 1
  • Kyu-Bo Sung
    • 1
  1. 1.Department of Radiology and Research Institute of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSongpa-guKorea

Personalised recommendations