Mohan SL, Vaithiyam V. Standardising minimally invasive management in surgically unfit patients requiring cholecystectomy: Overview of current recommendations and future directions. World J Gastrointest Surg 2026; 18(10): 118978 [DOI: 10.4240/wjgs.118978]
Corresponding Author of This Article
Venkatesh Vaithiyam, DM, MD, Assistant Professor, Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Second Floor, Academic Block, New Delhi 110002, India. venkateshvaithiyam172@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
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editorial
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Mohan SL, Vaithiyam V. Standardising minimally invasive management in surgically unfit patients requiring cholecystectomy: Overview of current recommendations and future directions. World J Gastrointest Surg 2026; 18(10): 118978 [DOI: 10.4240/wjgs.118978]
World J Gastrointest Surg. Oct 27, 2026; 18(10): 118978 Published online Oct 27, 2026. doi: 10.4240/wjgs.118978
Standardising minimally invasive management in surgically unfit patients requiring cholecystectomy: Overview of current recommendations and future directions
Supraja Laguduva Mohan, Venkatesh Vaithiyam
Supraja Laguduva Mohan, Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
Venkatesh Vaithiyam, Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi 110002, India
Author contributions: Mohan SL performed the literature review and wrote the original draft; Vaithiyam V contributed to the conceptualisation, writing, reviewing, and editing; both authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Venkatesh Vaithiyam, DM, MD, Assistant Professor, Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Second Floor, Academic Block, New Delhi 110002, India. venkateshvaithiyam172@gmail.com
Received: January 16, 2026 Revised: February 3, 2026 Accepted: March 10, 2026 Published online: October 27, 2026 Processing time: 271 Days and 0.2 Hours
Abstract
Percutaneous cholecystostomy (PC) is a minimally invasive radiological intervention that can rapidly decompress the gallbladder, provide symptomatic relief, and decrease systemic inflammation in surgically unfit patients with acute cholecystitis. It has its own risks and complications, including catheter dependence, migration, blockage, and leakage. Several recent studies and trials have reported that laparoscopic cholecystectomy (LC) yields better long-term outcomes than PC or PC with delayed LC. We read with interest the study published in the World Journal of Gastrointestinal Surgery by Hassanesfahani et al, who highlighted the importance of early PC, standardized catheter management protocols, and definitive interval LC for selected patients in improving the long-term outcomes of PC. We agree that evidence-based protocols for patient selection, timing of PC, interval to LC, catheter checks, and catheter removal should be incorporated into routine practice. In addition, endoscopic techniques, such as trans papillary gallbladder drainage and endoscopic ultrasound-guided stenting, are emerging as alternatives to PC, with lower readmission and complication rates. Depending on the availability of specialised personnel, endoscopic procedures should be preferred over PC for managing patients with acute cholecystitis who are unfit for surgery. This editorial reviews current recommendations and provides a framework for nonsurgical gallbladder drainage based on the available evidence.
Core Tip: Percutaneous cholecystostomy (PC) has traditionally been the primary treatment for surgically unfit patients with acute cholecystitis; however, endoscopic gallbladder drainage techniques, such as endoscopic transpapillary drainage and endoscopic ultrasound-guided drainage, are emerging as effective alternatives with fewer reinterventions and enhanced patient comfort. While endoscopic procedures are preferred over PC whenever possible, PC with standardized protocols is still beneficial, especially due to wider availability, bedside feasibility and as it can be performed under local anaesthesia without the requirement of sedation or general anaesthesia. A multidisciplinary and standardized approach is crucial for optimizing the outcomes.
