Percutaneous cholecystostomy and endoscopic cholecystolithotripsy in the management of acute cholecystitis

Background: Percutaneous cholecystostomy is a valuable alternative temporar y measure for acute cholecystitis in elderly patients with severe underlyin g cardiopulmonary disease, but the subsequent management of gallbladder cal culi is still controversial. Methods: Eleven patients treated with percutaneous endoscopic cholecystolit hotripsy after percutaneous cholecystostomy were evaluated retrospectively. Results: All patients showed clinical improvement after percutaneous cholec ystostomy. Tract dilation succeeded in 9 patients. Complete stone clearance was achieved in seven patients over one to four sessions (average, two ses sions). Stone extraction could not be completed in two patients because gal lbladder access was lost in one patient, and the other refused further proc edure. There were three complications, with two biliary fistulas and one ma jor bile leakage reading to emergency cholecystectomy. The duration of the entire procedure ranged from 30 to 126 days (mean, 58 days). During the fol low-up (mean 17.2 months), one patient had recurrent cholangitis and the ot hers remained asymptomatic. Conclusions: Percutaneous cholecystolithotripsy after percutaneous cholecys tostomy is a safe alternative in the management of high-risk elderly patien ts with acute cholecystitis.