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According to the recently updated Tokyo Guidelines, laparoscopic cholecystectomy still represents the gold standard for the treatment of acute cholecystitis. However, fragile patients, due to comorbidities or poor clinical conditions, have a high surgical risk. In such cases, percutaneous or endoscopic gallbladder drainage is considered the treatment of choice. In particular, endoscopic ultrasound-guided gallbladder drainage with the placement of specifically designed stents is now considered an alternative option. In addition, the opening of an access door to the lumen of the gallbladder could offer new opportunities for the endoscopic treatment of gallbladder diseases. The purpose of this review is to provide an update on the latest available evidence in the literature regarding the endoscopic ultrasound-guided gallbladder drainage. Keywords: endoscopic ultrasound-guided gallbladder drainage, lumen-apposing metal stent, acute cholecystitis, percutaneous gallbladder drainage; cholecystostomy

To compare the efficacy and safety of various pus drainage methods for lung abscess via network meta-analysis. Randomized controlled trials (RCTs) from PubMed, Embase, Scopus, Web of Science, VIP, Wanfang, and CNKI were searched up to April 2025. Study quality was assessed using the Cochrane Risk of Bias Tool (v5.4.0). Bayesian network meta-analysis was conducted using Rstudio (v4.4.1). A total of 23 RCTs (1,453 patients) evaluating four drainage techniques were included. Effective rate: CT-guided percutaneous drainage + antibiotics ranked highest (77% probability), outperforming antibiotics alone (OR = 5.4) and conventional postural drainage + antibiotics (OR = 7.4). Hospital stay: Ultrasound-guided drainage + antibiotics ranked best (89% probability), significantly reducing stay versus conventional postural drainage + antibiotics (MD = -19 days). Symptom resolution: Ultrasound-guided drainage + antibiotics ranked highest for cough (SUCRA 97%) and fever resolution (SUCRA 97%). Lesion reduction: Modified postural drainage + antibiotics ranked highest (98% probability), surpassing conventional postural drainage + antibiotics (OR = 0.48) and antibiotics alone (OR = 0.15). Comprehensive analysis indicates that ultrasound-guided percutaneous drainage combined with antibiotics demonstrates the highest probability of improvement in key outcome measures, including time to fever resolution, length of hospital stay, and time to cough resolution, potentially showcasing a comprehensive potential for clinical benefit. CT-guided percutaneous drainage combined with conventional antibiotic therapy may be the most effective in terms of the effective rate, while modified postural drainage combined with conventional antibiotic therapy may be the most prominent in increasing the number of lesion reduction. Furthermore, conventional antibiotic therapy alone was inferior to pus drainage procedures combined with conventional antibiotics across multiple outcome measures and was associated with a higher incidence of adverse reactions. However, due to the limited number of available studies, these findings can only be considered preliminary. Future validation through a substantial number of multicenter, large-sample, double-blind randomized controlled trials is warranted. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251127786.

PurposeThe purpose of the study was to evaluate the efficacy and safety of percutaneous drainage for palliation of symptoms and sepsis in patients with cystic or necrotic tumors in the abdomen and pelvis.Materials and methodsThis is a single center retrospective study of 36 patients (18 men, mean age = 51.1 years) who underwent percutaneous drainage for management of cystic or necrotic tumors in the non-postoperative setting over an 11-year period. Nineteen patients with intraabdominal fluid collections associated with primary malignancies included: cervical (n = 7), colorectal (n = 3), urothelial (n = 3), and others (n = 6). The 17 patients with fluid collections associated with intraabdominal metastases stemmed from the following primary malignancies: oropharyngeal squamous cell carcinoma (n = 3), colorectal (n = 3), ovarian (n = 2), lung (n = 2), melanoma (n = 2) along with others (n = 5). Indications for percutaneous drainage were as follows: pain (36/36; 100%); fever and/or leukocytosis (34/36; 94%), and mass effect (21/36; 58%). Seven patients underwent additional sclerosis with absolute alcohol. Criteria for drainage success were temporary or definitive relief of symptoms and sepsis control.ResultsSuccessful sepsis control was achieved in all patients with sepsis (34/34; 100%) and 30/36 (83%) patients had improvement in pain. Duration of catheterization ranged from 2 to 90 days (mean = 22 days). There were four cases of fluid re-accumulation and one patient developed catheter tract seeding. Alcohol ablation was successful in two patients (2/7; 29%). Nearly all patients (34/36; 94%) died during the follow-up period.ConclusionsPercutaneous drainage was effective for palliative treatment of symptomatic cystic and necrotic tumors in the majority of patients in this series.

[This corrects the article DOI: 10.3389/fmed.2024.1453533.].

Ultrasound guidance in biliary interventions has become the standard tool to facilitate percutaneous biliary drainage as well as percutaneous gall bladder drainage. Monitoring of the needle tip whilst penetrating the tissue in real time using ultrasound allows precise manoeuvres and exact targeting without radiation exposure. Without the need for fluoroscopy, ultrasound-guided drainage procedures can be performed bedside as a sometimes life-saving procedure in patients with severe cholangitis/cholecystitis when they are critically ill in intensive care units and cannot be transported to a fluoroscopy suite. This article describes the current data background and guidelines and focuses on specific sonographic aspects of both the procedures of percutaneous biliary drainage and gallbladder drainage.

Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of “high risk” patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.

BackgroundA pancreatic pseudocyst is a collection of fluid surrounded by a well-defined wall that contains no solid material. Studies on outcomes of pancreatic pseudocyst drainage have largely been limited to small cohorts. This study aims to take a population based approach to evaluate differences in inpatient outcomes among laparoscopic, percutaneous, and endoscopic drainage for pancreatic pseudocysts.MethodsThe National Inpatient Sample database was used to identify inpatient stays for pancreatic pseudocysts in which a single drainage approach was conducted. Baseline characteristic differences were compared with Rao-Scott chi squared and Mann–Whitney U tests. Propensity score matching controlling for clinical and demographic covariates followed by multivariable regression was used to pairwise compare drainage outcomes. Primary outcomes were length of stay, total charge, mortality, and disposition. Secondary outcomes were procedure related complication rates.ResultsAmong a total of 35,640 weighted pancreatic pseudocyst cases, 3235 underwent drainage via a single procedure. Percutaneous was the most frequent drainage method performed (44.5%) and was more likely to be performed at nonteaching hospitals than laparoscopic (17% vs 9%, p = 0.04). Percutaneous drainage was associated with longer LOS (aIRR 1.42, 95% CI 1.07–1.86, p = 0.01) versus endoscopic and lower rates of routine disposition (aOR 0.45, 95% CI 0.23–0.89, p = 0.02) relative to endoscopic and laparoscopic (aOR 0.41, 95% CI 0.27–0.61, p < 0.01) drainage. There were no differences in primary outcomes in laparoscopic versus endoscopic drainage. Percutaneous drainage was associated with higher rates of septic shock than laparoscopic drainage (aOR 2.59, 95% CI 1.15–5.82, p = 0.02).ConclusionsEndoscopic and laparoscopic pancreatic pseudocyst drainage are associated with the least short term procedure related complications and more favorable in-hospital outcomes compared to percutaneous approaches. However, percutaneous drainage was the most commonly performed method in the 2017 NIS database.

Abstract Background Intra-abdominal abscess (IAA) is a serious complication of Crohn’s disease (CD). Management strategies include medical therapy, percutaneous drainage (PD), and initial surgery, but the optimal approach is debated. We performed a systematic review and meta-analysis to compare these strategies. Methods A systematic search of 4 electronic databases was conducted. The primary outcome was the need for surgical intervention (resection or reoperation). Secondary outcomes included recurrence and complications. Data were pooled using random-effects models. Results Twenty-three studies were included. Compared with initial surgery, both PD (odds ratio [OR], 5.28; 95% confidence interval [CI], 1.65-16.91) and medical management (antibiotics alone ± corticosteroids) (OR, 4.40; 95% CI, 1.25-15.45) were associated with significantly higher odds of requiring surgical intervention, relative to the reoperation rate in the surgery group. PD was associated with significantly lower odds of overall postintervention complications compared with initial surgery (OR, 0.48; 95% CI, 0.23 to 0.96), with no significant difference in length of stay. Adjunctive exclusive enteral nutrition was associated with a significant reduction in the need for subsequent surgery (OR, 0.26; 95% CI, 0.10 to 0.67). Pooled proportions for requiring subsequent surgery were 48% for medical management, 47% for PD, and 21% for the reoperation rate in the initial surgical group. Conclusion Initial surgical management is the most definitive treatment for CD-related IAA, with the lowest reoperation rates. PD serves as a less invasive bridge to surgery that reduces postintervention complications. Medical management alone is less effective and should be reserved for select patients. Lay Summary This meta-analysis on Crohn’s-related intra-abdominal abscesses finds initial surgery is most definitive. Percutaneous drainage serves as a safer bridge to surgery, reducing complications, while medical management alone is least effective and reserved for select cases.

This ESR Essentials article intends to provide detailed, step-by-step, information on the role of imaging in the diagnosis, procedural management, and follow-up of patients with fluid collections. Evidence-based medicine recommendations for the positioning of percutaneous drainages and/or for diagnostic/therapeutic aspiration of fluid collections are provided. Although medical history, clinical symptoms, physical examination, and laboratory tests can raise suspicions regarding a collection, an imaging assessment is usually necessary for the diagnosis. Radiologists can easily identify fluid collections that are clinically suspected by using a wide range of imaging modalities, such as ultrasound, CT, MRI, and cone-beam CT. Consequently, these imaging methods (either alone or combined), can be used to aspirate the collection or for the placement of a drainage catheter. The choice of imaging technique to be used is influenced by the location of the collection, operator preference, size, and content of the collection. In addition, it is of utmost importance to underline the role of the interventional radiologist in the management and follow-up of patients with percutaneous drains, in collaboration with surgeons, clinicians, and diagnostic radiologists. Key Points Indications for percutaneous imaging-guided drainage are supported by clinical findings, laboratory tests, and pre-procedural imaging . Deciding between aspiration or drain insertion should follow patient assessment and fluid collection characterization . The interventional radiologist should be part of the entire patient care process including follow-up .

Ruptured liver abscess is a critical condition with high morbidity and mortality, especially in patients with systemic comorbidities. This 18-month observational cohort study at Safdarjung Hospital, New Delhi, evaluated the prognostic value of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in predicting outcomes for patients with radiologically confirmed ruptured liver abscesses. A total of 69 patients (88.4% male, mean age 44 years) were included. The most common presenting symptoms were abdominal pain (100%) and fever (76.8%). Treatment modalities included percutaneous catheter drainage (PCD) in 46.4% of patients, open surgical drainage in 34.8%, and conservative management in the remainder. Patients undergoing surgical drainage had significantly higher APACHE II scores (mean 9 ± 4) than those treated with PCD (mean 7 ± 3; p  = 0.041). The overall mortality rate was 21%, with mortality significantly higher in the surgical group (45.8%) compared to the PCD group (3.1%; p  = 0.000). An APACHE II score > 9 was strongly associated with increased mortality and the need for surgery ( p  = 0.010). Colonic involvement was seen in 41.6% of surgical cases, with 10 cases presenting with colonic perforation. Higher APACHE II scores correlated with longer hospital stays and more severe complications. The study concludes that the APACHE II score is an effective prognostic tool for assessing disease severity and guiding treatment in ruptured liver abscess cases. PCD is favoured for stable patients, while surgical intervention is necessary for those with high APACHE II scores, failed drainage, or colonic involvement, emphasizing the importance of early risk stratification. This study has its limitations of being single centric with a sample size of 69 patients.