Abstract
Acute cholecystitis, often caused by gallstones obstructing the cystic duct, is a potentially life-threatening condition that requires timely intervention. High-risk patients, particularly those with significant comorbidities, may not be suitable candidates for laparoscopic cholecystectomy, necessitating alternative drainage techniques such as percutaneous cholecystostomy (PC) and endoscopic gallbladder drainage (EGD). This systematic review aims to compare the efficacy, safety, and outcomes of PC and EGD in managing acute cholecystitis in high-risk surgical patients. A comprehensive literature search was conducted across multiple databases, including PubMed, Medline, Embase, Cochrane Library, and Scopus, from inception to October 2024. Studies were included if they assessed the outcomes of PC versus EGD in high-risk patients with acute cholecystitis. Data extraction focused on primary outcomes such as complication rates, reintervention needs, symptom resolution, hospital stay duration, and mortality. A qualitative synthesis was conducted due to heterogeneity in the study designs. Four randomized controlled trials and cohort studies were included, encompassing a total of 238 high-risk patients. Laparoscopic cholecystectomy showed significantly better outcomes compared to percutaneous drainage in reducing major complications, reintervention rates, and recurrent biliary disease. Endoscopic drainage techniques, including naso-gallbladder drainage and gallbladder stenting, demonstrated similar clinical success rates with fewer complications than percutaneous methods, particularly in patients with concurrent biliary conditions. The findings suggest that while percutaneous drainage provides rapid symptom relief, it is associated with higher reintervention rates. Endoscopic techniques offer fewer complications and are particularly beneficial for patients with suspected choledocholithiasis. However, the choice of drainage method should be based on individual patient profiles, taking into account overall health status and comorbidities. Both percutaneous and endoscopic drainage methods are effective in managing acute cholecystitis in high-risk patients, with distinct advantages depending on patient-specific factors. Further research is needed to explore long-term outcomes and hybrid approaches that may optimize care for these patients.