What are the treatment options for acalculous cholecystitis?

Updated: Feb 14, 2019
  • Author: Homayoun Shojamanesh, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

When the diagnosis of acalculous cholecystitis is established, immediate intervention is indicated because of the high risk of rapid deterioration and gallbladder perforation.

In patients with acalculous cholecystitis who are high-risk surgical candidates (ie, end-stage liver disease), Gu et al reported that endoscopic gallbladder stent placement as an effective palliative treatment. [8] This involves placement of a double pigtail stent between the gallbladder and the duodenum during endoscopic retrograde cholangiopancreatography (ERCP). However, the definitive treatment of acalculous cholecystitis is cholecystectomy for patients who are able to tolerate surgery.

In selected patients with acute acalculous cholecystitis (AAC), nonsurgical treatment (such as antibiotics or percutaneous cholecystostomy) may be an effective alternative to surgery. [8, 14] In the study by Gu et al, data from 69 patients with AAC was compared with those from 415 patients with acute calculous cholecystitis (ACC). The investigators found that among those patients who underwent nonsurgical therapy, the posttreatment recurrence rate was just 2.7% in the AAC group, compared with 23.2% in the ACC patients. [8]

In a retrospective study of 15 nonsurgical patients who underwent endoscopic ultrasonography-guided transmural gallbladder drainage (EUS-GBD) with a lumen-apposing metal stent (LAMS) for different biliary conditions including 4 cases of acalculous cholecystitis, technical success was achieved in 14 of the 15 patients (93%), with clinical success in all 15 patients (median follow-up, 160 days). [15]


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