What are the treatment options for patient with biliary colic and acute cholecystitis who are not good candidates for cholecystectomy?

Updated: Jan 18, 2017
  • Author: Peter A D Steel, MBBS, MA; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Patients who are not good surgical risks but who are toxic may benefit from percutaneous gallbladder drainage and placement of a cholecystostomy or T-tube if common bile duct stones are suspected. (Note that a propensity score analysis of 1996-2010 Medicare data of 8818 elderly patients [age ≥66 years] with grade III acute cholecystitis revealed an association between those who underwent cholecystostomy tube placement [n = 565; 6.4%] with lower rates of definitive treatment with cholecystectomy and higher rates of mortality and readmissions. [39] ) The alternative is ERCP to attempt endoscopic opening of the common bile duct or cystic duct.

Delayed surgical intervention can be used for patients who have high-risk medical conditions and are unstable for surgery and in patients in whom the diagnosis in doubt. Mortality may be up to 15% in patients with acute cholecystitis who were at high risk (as per Acute Physiology and Chronic Health Evaluation [APACHE] criteria). [40]

In patients younger than 60 years, the mortality rate for emergent cholecystectomy is approximately 3%, whereas mortality in early or elective cholecystectomy approaches 0.5%.


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