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

Table 3 Comparison of percutaneous cholecystostomy and laparoscopic cholecystectomy, endoscopic trans papillary gallbladder drainage or endoscopic ultrasound-guided gallbladder drainage

Ref.	Sample	Results/recommendation
Zehetner et al[54], 2014	Retrospective matched pair analysis, PC = 23, LC = 23	PC failed to show a significant reduction in morbidity compared with LC and was associated with a significantly longer hospital stay
Loftus et al[55], 2017	Retrospective cohort analysis, PC = 114, cholecystectomy = 234	Persistent systemic inflammation and higher long-term mortality with PC than with cholecystectomy
Loozen et al[56], 2018	Multicentre RCT, PC = 68, LC = 66	Laparoscopic cholecystectomy is superior to percutaneous catheter drainage for acute calculous cholecystitis. Cholecystectomy not only reduced the rate of major complications, but also reduced utilisation of healthcare resources and costs by more than 30%
Siddiqui et al[40], 2019	Multicentre retrospective study, PC (n = 146), ET-GBD (n = 124), EUS-GBD (n = 102)	Technical and clinical success were higher in both PC and EUS-GBD compared to the ET-GBD group. Hospital stay was lower with the EUS-GBD group. Complications and higher surgical interventions in the PC group
Mu et al[62], 2021	RCT, PC (n = 11), EN-GBD (n = 11)	The EN-GBD group presented less pain and less surgical difficulties (less haemorrhage, abdominal drain placement) during cholecystectomy procedures. Similar adverse events
Nassar et al[57], 2022	Meta analysis. 14 studies, PC = 11565, early cholecystectomy = 205361	Early cholecystectomy is preferred over PC. However, patient and disease-specific factors should be considered to avoid unfavourable outcomes with early LC
Kaneta et al[58], 2022	Retrospective study, PC = 26, ET-GBD = 7	No significant difference was observed between the ET-GBD and PC groups in terms of surgery duration or bleeding amount when surgery was performed after gallbladder drainage for acute cholecystitis. Therefore, ET-GBD was considered a useful preoperative drainage method that did not require a drainage bag
Tyberg et al[48], 2023	Retrospective cohort study, PC = 93, EUS-GBD = 46	EUS-GBD had a significantly shorter interval between gallbladder drainage and cholecystectomy, shorter surgical procedure times, and shorter length of stay for the cholecystectomy compared with PC
Boregowda et al[59], 2023	Meta analysis, 11 studies, PC = 698, EUS-GBD = 477	EUS-GBD is a safe and effective alternative to PC for treating acute cholecystitis in non-surgical patients with fewer adverse events and a lower reintervention rate than PC
Fanciulli et al[60], 2025	Meta analysis, 27 studies, 16 comparing PC and cholecystectomy, 11 comparing PC and PC with delayed cholecystectomy	Cholecystectomy is associated with better outcomes, including lower mortality and readmission rates, compared to both PC alone and PC followed by CC. The combined approach did not show a significant advantage over immediate CC
Pawa et al[61], 2025	Retrospective study, PC = 57, EUS-GBD = 57	EUS-GBD is superior to PC, requiring fewer gallbladder-related procedures and lower rates of adverse events. It has emerged as the preferred non-surgical alternative in the management of patients with AC who are poor surgical candidates
Hu et al[41], 2025	Meta-analysis of 17 trials and 2254 patients, PT-GBD vs ET-GBD vs EUS-GBD	Technical and clinical success lower in ET-GBD compared to other groups. Procedure related adverse events are similar across the groups

PC: Percutaneous cholecystostomy; LC: Laparoscopic cholecystectomy; RCT: Randomized controlled trial; ET-GBD: Endoscopic trans papillary gallbladder drainage; EUS-GBD: Endoscopic ultrasound-guided gallbladder drainage; EN-GBD: Endoscopic naso-gallbladder drainage; PT-GBD: Percutaneous transhepatic gallbladder drainage; CC: Cholecystectomy; AC: Acute cholecystitis.