# Endoscopic management of acute cholecystitis in high‐risk surgical patients: A comprehensive review article

## TL;DR

This paper reviews endoscopic drainage methods for treating acute cholecystitis in high-risk patients who cannot undergo surgery.

## Contribution

The study provides a comprehensive comparison of three gallbladder drainage techniques for high-risk patients.

## Key findings

- Three drainage methods are compared: percutaneous, endoscopic transpapillary, and endoscopic ultrasound.
- Each method has distinct advantages and disadvantages depending on patient conditions.
- No single drainage strategy is universally optimal for all high-risk patients.

## Abstract

Acute cholecystitis is frequently encountered in daily clinical practice, and early cholecystectomy is the standard therapy. In high‐risk surgical patients, such as those with advanced age, deteriorated performance status, or underlying diseases, conservative treatment is typically preferred to manage acute cholecystitis. However, in patients with a disease that is refractory to conservative treatment, drainage procedures are necessary to control the infection. At present, there are three basic approaches for gallbladder drainage: percutaneous transhepatic gallbladder drainage, endoscopic transpapillary gallbladder drainage, and endoscopic ultrasound gallbladder drainage. Each of these methods has advantages and disadvantages. Therefore, the appropriate treatment method is determined on a case‐by‐case basis, and no consistent strategy for gallbladder drainage has been established. This review aimed to summarize the characteristics of each drainage method and compare the clinical outcomes of the three procedures for acute cholecystitis in high‐risk surgical patients.