Endoscopic Therapy of Acute Cholecystitis

Acute cholecystitis is typically addressed by cholecystectomy. Patients who are critically ill often undergo a percutaneous cholecystostomy as a temporizing measure and eventually undergo definitive surgery. In a small select group of patients in whom these options are undesirable, such as cirrhotics awaiting liver transplant, or those with a terminal illness in whom a percutaneous tube is unacceptable, there is a growing experience with internal drainage of the gallbladder. The gallbladder can be drained into the gut either at endoscopic cholangiography (ERCP) via the major papilla or transluminally during endoscopic ultrasonography (EUS). There is a growing body of literature, mainly comprised of small case series that have described experience with transpapillary drainage and when successful, it appears this is a safe and efficacious alternative. The experience with EUS guided drainage of the gallbladder is limited, is potentially associated with a higher risk of complications and should be performed only if absolutely necessary until there is a broader experience.