SP 2.09 A Systematic review and Meta-analysis of Outcomes Following Percutaneous Cholecystostomy in Acalculous versus Calculous Acute Cholecystitis
Ahmar Ahmad, Farzana Rahman, Nnaemeka Chidumije, Saleh RommanAbstract
Aims
Percutaneous cholecystostomy (PC) is often reserved for critically ill patients with acute cholecystitis who are unfit for surgery. Acalculous cholecystitis carries a different systemic risk profile from calculous disease, yet both are frequently treated with PC. This review aimed to determine whether outcomes after PC differ by aetiology.
Methods
A systematic review was conducted in accordance with PRISMA guidance. MEDLINE, EMBASE, and Cochrane Library were searched from inception to January 2026. Observational studies reporting outcomes following PC stratified by acalculous versus calculous cholecystitis were included. The primary outcome was interval cholecystectomy. Secondary outcomes included early all-cause mortality (in-hospital or 30-day), recurrence, readmission, and procedure-related complications. Random-effects meta-analysis was performed where ≥3 studies reported comparable outcomes.
Results
Eleven studies were included. Eight studies (n=633) reported interval cholecystectomy. Acalculous cholecystitis was associated with a significantly lower likelihood of interval cholecystectomy compared with calculous disease (risk ratio [RR] 0.69, 95% confidence interval [CI] 0.53–0.90; I²=3%; p=0.006). Five studies (n=540) reporting in-hospital or 30-day mortality demonstrated significantly higher early all-cause mortality in acalculous compared with calculous cholecystitis following PC (RR 1.74, 95% CI 1.19–2.54; I²=0%; p=0.004). Other outcomes were synthesised narratively.
Conclusions
While acalculous disease is associated with higher early all-cause mortality, survivors are significantly less likely to require interval cholecystectomy, suggesting PC may more often represent definitive management in selected acalculous cases. Future prospective studies with standardised outcomes and risk adjustment are needed to guide aetiology-specific post-PC pathways, rather than a uniform 'bridge to surgery' approach.