Percutaneous cholecystolithotomy and lithotripsy for managing acute calculous cholecystitis in non-surgical candidates: a systematic review and meta-analysis.

Background/aims: This study aimed to review and update the evidence regarding the efficacy and safety of percutaneous cholecystolithotomy/lithotripsy (PCCL) for managing acute calculous cholecystitis (ACC) in non-surgical candidates.

Methods: A systematic search of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase was conducted. We included studies focusing on the use of PCCL in patients deemed ineligible for surgery owing to ACC and reporting outcomes such as technical success, stone clearance, recurrence, and length of hospital stay. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Meta-analysis of 13 studies showed a technical success rate of 97%, with stone and cholecystitis recurrence in 10% and 1% of cases, respectively. The pooled average length of hospital stay was 2.79 days. Complications included retained stones (3%), duct perforations (6%), catheter displacement (5%), bleeding (4%), and bile leakage (5%). A sensitivity analysis confirmed the robustness of these results.

Conclusions: PCCL demonstrated high efficacy with minimal recurrence and low complication rates in managing ACC in non-surgical candidates. Further randomized controlled trials are necessary to compare its efficacy and safety with standard care approaches, such as cholecystectomy or percutaneous cholecystostomy.