Interventional procedure overview of endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis when surgery is not an option

Indications and current treatment

Acute cholecystitis is inflammation of the gallbladder. The most common cause of acute cholecystitis is gallstones (calculous cholecystitis) blocking the duct that drains the gallbladder (cystic duct). This means bile cannot drain from the gallbladder, causing pain, nausea, vomiting and fever.

Acalculous cholecystitis is a less common, but usually more serious, cause of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder. It can be caused by accidental damage to the gallbladder during major surgery, serious injuries or burns, sepsis, severe malnutrition or HIV or AIDS.

Initial treatment usually involves fasting, pain relief and antibiotics if there is an infection. The gallbladder can be surgically removed (open or laparoscopic cholecystectomy) to prevent acute cholecystitis returning, and to reduce the risk of developing complications, such as gangrenous cholecystitis and peritonitis.

People who cannot have surgery may be able to have percutaneous cholecystostomy. This involves inserting a drainage catheter in the gallbladder through a small entry hole made in the abdominal wall. Endoscopic transpapillary gallbladder drainage is a less common alternative treatment. It involves inserting a plastic stent through the ampulla and cystic duct into the gallbladder endoscopically.