Ultrasound-guided percutaneous cholecystostomy for acute cholecystitis: a systematic review and meta-analysis

TL;DR

This study reviews the effectiveness and safety of ultrasound-guided cholecystostomy in high-risk patients with acute cholecystitis.

Contribution

The paper provides a meta-analysis of ultrasound-guided percutaneous cholecystostomy outcomes with specific focus on technical and clinical success rates.

Findings

Ultrasound-guided cholecystostomy has a pooled technical success rate of 99.3%.

Clinical success is reported at 97.6%, though definitions vary across studies.

Major adverse events occur in 1.7% of cases with no significant heterogeneity.

Abstract

Ultrasound-guided percutaneous cholecystostomy (US-PC) is widely used in high-risk surgical patients with acute cholecystitis. Still, success and safety rates specific to US guidance are not always distinguished within mixed 'image-guided' series.

To estimate technical success, clinical success, and major complication rates of US-PC. Methods. Primary studies explicitly reporting US-PC or with separable data were included. Primary outcomes: technical success, clinical success (as defined by the study), and major adverse events (AEs). Single-arm meta-analysis using random-effects (logit, continuity correction); heterogeneity by I2 and prediction interval. Results. Four eligible single-arm studies for technical success (N = 466). Pooled technical success 99.3% (95%CI 97.8–99.8; I2 = 0%). Three studies (N = 223) reported clinical success: pooled 97.6% (95%CI 83.4–99.7; I2≈64% due to varying definitions). Two studies (N = 293) reported major AEs: pooled 1.7% (95%CI 0.7–4.1; I2 = 0%). Thirty-day mortality is available from one large study (6.2%). Conclusions. In high-risk patients, US-PC demonstrates very high technical success and low major complication rates; clinical success is high but variably defined across studies. Further direct comparisons and standardized definitions are warranted.

The online version contains supplementary material available at 10.1007/s40477-026-01119-x.

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