Acute cholecystitis

Abstract

Acute cholecystitis represents an inflammation of the gallbladder caused by obstruction of the cystic duct. The diagnosis is based on the combination of clinical, laboratory, and imaging findings and the disease can be classified according to severity in mild, moderate, or severe form. The gold standard of treatment is laparoscopic cholecystectomy; however in the case of high-risk patients who are considered unfit for surgery, different less-invasive approaches, to drain the gallbladder and reduce inflammation, could be proposed. In the last decades, several non-surgical therapeutic approaches have been developed to treat patients with acute cholecystitis which are not candidate for surgery such as percutaneous cholecystostomy, including percutaneous transhepatic gallbladder drainage (PTGBD) and aspiration (PTGBA), transpapillary drainage of the gallbladder, and EUS-guided transmural gallbladder stent placement. In particular EUS-guided gallbladder drainage, using ultrasound guidance and the placement of specially designed metal stents is emerging as an effective and safe alternative.