Can percutaneous cholecystostomy be a definitive management for both acute calculous and acalculous cholecystitis?

To The Editor: We commend Chung et al for an interesting original article reporting on the safety, efficacy, and long-term outcome of percutaneous cholecystostomy (PC) as of a definitive treatment for acute acalculous cholecystitis (AAC). They concluded that PC is an effective procedure and a good alternative for patients unfit to undergo immediate surgery because of the existence of severe sepsis or an underlying comorbidity. This is an excellent article with a strong impact on clinical practice. Traditionally, acute cholecystitis is mainly treated by surgical approach 1–3 but, in patients with poor general condition surgical treatment may carry a high risk of complications associated with major morbidity and mortality. Only limited data are available on PC treatment of AAC and little is known about the safety of PC in critically ill patients. Therefore, Chung’s study, which evaluates the feasibility and clinical outcome of PC in patients with AAC is of a high importance. However, AAC comprises <10% of all cases of acute cholecystitis. In over 90% of cases, acute cholecystitis is caused by cholecystolithiasis. Therefore, it is important to answer whether PC should be limited only to AAC. We had several cases of acute cholecystitis in patients with poor general condition, caused by cholecystolithiasis, which were successfully treated by PC and so we wish to add some comments regarding this topic. Our initial intention was for PC to be used as a temporizing measure whereas, awaiting resolution of sepsis and optimization of comorbidities before performing elective surgery. But, majority of those cases required no further surgical treatment after PC. Therefore, we believe that ultrasound-guided PC should be considered a reasonable option in the therapeutic spectrum for both acalculous and calculous cholecystitis and a good alternative for patients unfit to undergo immediate surgery because of severe sepsis or an underlying comorbidity.