Endoscopy 2009; 41(6): 539-546
DOI: 10.1055/s-0029-1214727
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic gallbladder drainage for acute cholecystitis: technical and clinical results

M.  Mutignani1 , F.  Iacopini1 , V.  Perri1 , P.  Familiari1 , A.  Tringali1 , C.  Spada1 , M.  Ingrosso1 , G.  Costamagna1
  • 1Digestive Endoscopy Unit, Department of Surgery, Università Cattolica A. Gemelli, Rome, Italy
Further Information

Publication History

submitted 5 July 2008

accepted after revision 17 March 2009

Publication Date:
16 June 2009 (online)

Background and study aims: Cholecystectomy is the standard treatment for acute cholecystitis while percutaneous drainage is reserved for high-risk patients. The aim of the present study was to assess the technical success rate and clinical efficacy of endoscopic gallbladder drainage in patients with acute cholecystitis.

Patients and methods: A total of 35 consecutive patients with acute cholecystitis and without residual common bile duct obstruction were retrospectively identified. Patients were stratified according to the pathogenesis and stages of acute cholecystitis, and the morphology of the cystic duct and/or its insertion in the common bile duct. Primary outcomes were technical success and early and late clinical success.

Results: Endoscopic retrograde cholangiopancreatography (ERCP) was performed within the first 72 hours in 19 patients (54 %). Technical success was achieved in 29 patients (83 %); drainage was nasocholecystic in 21 ofthese (72 %), plastic stenting in 6 (21 %), and a combined method in 2 (7 %). The pathogenesis and stage of acute cholecystitis, and the morphology both of the cystic duct and its insertion in the common bile duct, did not influence technical success. Clinical success was achieved in 24 cases (83 %) after a median of 3 days (range 2 – 12). Four patients (14 %) died within 3 days due to septic complications, and one accidentally removed the nasocholecystic drain after 24 hours. Late results, available in 21 patients after a median follow-up of 17 months, showed relapse of acute cholecystitis in 2 (10 %) (both with stents) and of biliary pain in 2 patients (10 %), both of whom had nasocholecystic drainage.

Conclusions: Endoscopic gallbladder drainage seems feasible and effective in resolving acute cholecystitis, but only as a temporary measure because of a 20 % relapse rate in long-term follow-up. Prospective studies are necessary to identify which patients would benefit most from this endoscopic technique in the short and long term.


  • 1 Proceedings of the NIH Consensus Development Conference on Gallstones and Laparoscopic Cholecystectomy. Bethesda, Maryland, September 14 – 16, 1992.  Am J Surg. 1993;  165 387-548
  • 2 Bingener-Casey J, Richards M L, Strodel W E. et al . Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review.  J Gastrointest Surg. 2002;  6 800-805
  • 3 Eldar S, Sabo E, Nash E. et al . Laparoscopic cholecystectomy for acute cholecystitis: prospective trial.  World J Surg. 1997;  21 540-555
  • 4 Lau H, Lo C Y, Patil N G. et al . Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis.  Surg Endosc. 2006;  20 82-87
  • 5 Margiotta Jr S J, Willis I H, Wallack M K. Cholecystectomy in the elderly.  Am Surg. 1988;  54 34-39
  • 6 Edlund G, Ljungdahl M. Acute cholecystitis in the elderly.  Am J Surg. 1990;  159 414-416
  • 7 Glenn F. Cholecystostomy in the high risk patient with biliary tract disease.  Ann Surg. 1977;  185 185-191
  • 8 Roslyn J J, Binns G S, Hughes E F. et al . Open cholecystectomy. A contemporary analysis of 42 474 patients.  Ann Surg. 1993;  218 129-137
  • 9 Schwartz S I. Biliary tract surgery and cirrhosis: a critical combination.  Surgery. 1981;  90 577-583
  • 10 Aranha G V, Sontag S J, Greenlee H B. Cholecystectomy in cirrhotic patients: a formidable operation.  Am J Surg. 1982;  143 55-60
  • 11 Bloch R S, Allaben R D, Walt A J. Cholecystectomy in patients with cirrhosis. A surgical challenge.  Arch Surg. 1985;  120 669-672
  • 12 Lo L D, Vogelzang R L, Braun M A. et al . Percutaneous cholecystostomy for the diagnosis and treatment of acute calculous and acalculous cholecystitis.  J Vasc Interv Radiol. 1995;  6 629-634
  • 13 Kiviniemi H, Makela J T, Autio R. et al . Percutaneous cholecystostomy in acute cholecystitis in high-risk patients: an analysis of 69 patients.  Int Surg. 1998;  83 299-302
  • 14 Davis C A, Landercasper J, Gundersen L H. et al . Effective use of percutaneous cholecystostomy in high-risk surgical patients: techniques, tube management, and results.  Arch Surg. 1999;  134 727-731
  • 15 van Sonnenberg E, D’Agostino H B, Goodacre B W. et al . Percutaneous gallbladder puncture and cholecystostomy: results, complications, and caveats for safety.  Radiology. 1992;  183 167-170
  • 16 Welschbillig-Meunier K, Pessaux P, Lebigot J. et al . Percutaneous cholecystostomy for high-risk patients with acute cholecystitis.  Surg Endosc. 2005;  19 1256-1259
  • 17 Feretis C, Apostolidis N, Mallas E. et al . Endoscopic drainage of acute obstructive cholecystitis in patients with increased operative risk.  Endoscopy. 1993;  25 392-395
  • 18 Kalloo A N, Thuluvath P J, Pasricha P J. Treatment of high-risk patients with symptomatic cholelithiasis by endoscopic gallbladder stenting.  Gastrointest Endosc. 1994;  40 608-610
  • 19 Gaglio P J, Buniak B, Leevy C B. Primary endoscopic retrograde cholecysto endoprosthesis: a nonsurgical modality for symptomatic cholelithiasis in cirrhotic patients.  Gastrointest Endosc. 1996;  44 339-342
  • 20 Conway J D, Russo M W, Shrestha R. Endoscopic stent insertion into the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease.  Gastrointest Endosc. 2005;  61 32-36
  • 21 Schlenker C, Trotter J F, Shah R J. et al . Endoscopic gallbladder stent placement for treatment of symptomatic cholelithiasis in patients with end-stage liver disease.  Am J Gastroenterol. 2006;  101 278-283
  • 22 Kjaer D W, Kruse A, Funch-Jensen P. Endoscopic gallbladder drainage of patients with acute cholecystitis.  Endoscopy. 2007;  39 304-308
  • 23 Tsuyuguchi T, Takada T, Kawarada Y. et al . Techniques of biliary drainage for acute cholecystitis: Tokyo Guidelines.  J Hepatobiliary Pancreat Surg. 2007;  14 46-51
  • 24 Chopra S, Dodd 3rd G D, Mumbower A L. et al . Treatment of acute cholecystitis in non-critically ill patients at high surgical risk: comparison of clinical outcomes after gallbladder aspiration and after percutaneous cholecystostomy.  AJR Am J Roentgenol. 2001;  176 1025-1031
  • 25 Trowbridge R L, Rutkowski N K, Shojania K G. Does this patient have acute cholecystitis?.  JAMA. 2003;  289 80-86
  • 26 Davenport D L, Bowe E A, Henderson W G. et al . National Surgical Quality Improvement Program (NSQIP) risk factors can be used to validate American Society of Anesthesiologists Physical Status Classification (ASA PS) levels.  Ann Surg. 2006;  243 636-641
  • 27 Menu Y, Vuillerme M P. Non-traumatic abdominal emergencies: imaging and intervention in acute biliary conditions.  Eur Radiol. 2002;  12 2397-2406
  • 28 Tamada K, Seki H, Sato K. et al . Efficacy of endoscopic retrograde cholecysto endoprosthesis (ERCCE) for cholecystitis.  Endoscopy. 1991;  23 2-3
  • 29 Foerster E C, Matek W, Domschke W. Endoscopic retrograde cannulation of the gallbladder: direct dissolution of gallstones.  Gastrointest Endosc. 1990;  36 444-450
  • 30 Edison S A, Maier M, Kohler B. et al . Direct dissolution of gallstones with methyl tert-butyl ether by endoscopic cannulation of the gallbladder.  Am J Gastroenterol. 1993;  88 1242-1248
  • 31 American S ociety. Principles of training in gastrointestinal endoscopy.  Gastrointest Endosc. 1999;  49 845-853
  • 32 Vracko J, Markovic S, Wiechel K L. Conservative treatment versus endoscopic sphincterotomy in the initial management of acute cholecystitis in elderly patients at high surgical risk.  Endoscopy. 2006;  38 773-778
  • 33 McArthur P, Cuschieri A, Sells R A. et al . Controlled clinical trial comparing early with interval cholecystectomy for acute cholecystitis.  Br J Surg. 1975;  62 850-852
  • 34 Lai P B, Kwong K H, Leung K L. et al . Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.  Br J Surg. 1998;  85 764-767
  • 35 Lo C M, Liu C L, Fan S T, Lai E C, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.  Ann Surg. 1998;  227 461-467
  • 36 Senapati P S, Bhattarcharya D, Harinath G. et al . A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK.  Ann R Coll Surg Engl. 2003;  85 306-312
  • 37 Ito K, Fujita N, Noda Y. et al . Percutaneous cholecystostomy versus gallbladder aspiration for acute cholecystitis: a prospective randomized controlled trial.  AJR Am J Roentgenol. 2004;  183 193-196
  • 38 Cameron I C, Chadwick C, Phillips J. et al . Acute cholecystitis – room for improvement?.  Ann R Coll Surg Engl. 2002;  84 10-13
  • 39 Cheruvu C VN, Eyre-Brook I A. Consequences of prolonged wait before gallbladder surgery.  Ann R Coll Surg Engl. 2002;  84 20-22
  • 40 Spira R M, Nissan A, Zamir O. et al . Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculous cholecystitis.  Am J Surg. 2002;  183 62-66
  • 41 Izbicki J R, State T. Management of acute cholecystitis and the surgeon’s dilemma: the gut shoots both directions.  Endoscopy. 2007;  39 359-360
  • 42 Johlin Jr F C, Neil G A. Drainage of the gallbladder in patients with acute acalculous cholecystitis by transpapillary endoscopic cholecystotomy.  Gastrointest Endosc. 1993;  39 645-651
  • 43 Dumas R, Caroli-Bosc F X, Demarquay J F. et al . Acute inoperable cholecystitis treated by endoscopic naso-vesicular drainage. Study of 15 patients.  Gastroenterol Clin Biol. 1997;  21 854-858

G. CostamagnaMD 

Università Cattolica del Sacro Cuore

Largo A. Gemelli 8
00168, Rome

Fax: +39 06 30156581

Email: gcostamagna@rm.unicatt.it