Standardising minimally invasive management in surgically unfit patients requiring cholecystectomy: Overview of current recommendations and future directions

Table 1 Selected literature on evidence-based practices of percutaneous cholecystostomy and factors influencing its success

Ref.	Type	Results/recommendation
Okamoto et al[4], 2018	Tokyo guidelines	Conservative treatment and biliary drainage to be considered in grade II and grade III acute cholecystitis if the patient cannot withstand surgery
Park et al[25], 2019	Retrospective study	PC to be kept for more than 6 weeks and to be clamped 1 weeks to 2 weeks before removal. For those with the presence of common bile duct stones, calculous cholecystitis, and underlying malignancy, PC must be left for a longer duration and observed for recurrent cholecystitis
Karakas et al[21], 2021	Review	Patients are clinically and radiologically (by ultrasound) assessed 3 days, 1 week, 4 weeks, and 6 weeks after PC. Clinical efficacy of the procedure is assessed on the 3rd day
Devane et al[15], 2020	Society of Interventional Radiology Quality Improvement Standards (guideline)	The majority of PC (> 95%) are indicated for acalculous or calculus cholecystitis in surgically unfit patients, or to provide a route for stone dissolution and extraction. Less than 5% PC are done for decompression of the biliary tree, diversion from bile leak, therapeutic access for bile duct procedures (dilatation, stenting or stone removal). Preprocedural antibiotics are to be given. Transhepatic route is preferred. Flushing of catheters to be done at least once per day to avoid tube occlusion
Abdelhalim et al[22], 2023	Meta analysis of 4 studies, 684 patients	Both transhepatic and transperitoneal approaches are safe. In this meta-analysis, although the overall rate of bleeding was significantly higher with the transhepatic approach, there were confounding factors due to technical differences between the studies
Koushesh et al[20], 2024	Review	Cholecystogram 4 weeks to 6 weeks following placement to evaluate catheter position, tract formation, and cystic duct patency
Lin et al[23], 2025	Retrospective cohort study	Urgent drainage is unnecessary for patients with grade I or II AC. Reductions in hospital stay were observed for patients with grade III AC who underwent PC within 6 hours, and for those with grade II AC who underwent PC within 24 hours of admission
Reinsoo et al[24], 2025	Retrospective cohort study	PC removal within 1 week from placement was non-inferior to delayed removal in terms of AC recurrence or readmission rates. The cumulative risk of recurrent cholecystitis plateaus within the first year after PC tube removal, with rare recurrences beyond this period

AC: Acute cholecystitis; PC: Percutaneous cholecystostomy.