{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T12:55:47Z","timestamp":1774270547098,"version":"3.50.1"},"reference-count":30,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T00:00:00Z","timestamp":1668384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Acute cholecystitis is a frequent cause of admission to the emergency department, especially in old and frail patients. Percutaneous drainage (PT-GBD) and endosonographic guided drainage (EUS-GBD) could be an alternative option for relieving symptoms or act as a definitive treatment instead of a laparoscopic or open cholecystectomy (LC, OC). The aim of the present study was to compare different treatment groups. Materials and Methods: This is a five-year monocentric retrospective study including patients \u226565 years old who underwent an urgent operative procedure. A descriptive analysis was conducted comparing all treatment groups. A propensity score was estimated based on the ACS score, incorporated into a predictive model, and tested by recursive partitioning analysis. Results: 163 patients were included: 106 underwent a cholecystectomy (81 laparoscopic (LC) and 25 Open (OC)), 33 a PT-GBD and 21 EUS-GBD. The sample was categorized into three prognostic groups according to the adverse event occurrence rate. All patients treated with EUS-GBD or LC resulted in the low risk group, and the adverse event rate (AE) was 10\/96 (10.4%). The AE was 4\/28 (14.2%) and 21\/36 (58.3%) in the middle- and high-risk groups respectively (p &lt; 0.001). These groups included all the patients who underwent an OC or a PT-GBD. The PT-GBD group had a lower clinical success rate (55.5%) and higher RR (16,6%) when compared with other groups. Conclusions: Surgery still represents the gold standard for AC treatment. Nevertheless, EUS-GBD is a good alternative to PT-GBD in terms of clinical success, RR and AEs in all kinds of patients.<\/jats:p>","DOI":"10.3390\/medicina58111647","type":"journal-article","created":{"date-parts":[[2022,11,15]],"date-time":"2022-11-15T02:28:58Z","timestamp":1668479338000},"page":"1647","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Endosonography-Guided Versus Percutaneous Gallbladder Drainage Versus Cholecystectomy in Fragile Patients with Acute Cholecystitis\u2014A High-Volume Center Study"],"prefix":"10.3390","volume":"58","author":[{"given":"Hayato","family":"Kurihara","sequence":"first","affiliation":[{"name":"Emergency Surgery Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7600-9664","authenticated-orcid":false,"given":"Francesca M.","family":"Bunino","sequence":"additional","affiliation":[{"name":"Emergency Surgery and Trauma Section, Department of Surgery, IRCCS\u2014Humanitas Research Hospital, 20089 Rozzano, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0485-4903","authenticated-orcid":false,"given":"Alessandro","family":"Fugazza","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS\u2014Humanitas Research Hospital, 20089 Rozzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6818-0448","authenticated-orcid":false,"given":"Enrico","family":"Marrano","sequence":"additional","affiliation":[{"name":"General Surgery, Hospital Universitari Parc Taul\u00ed, 08208 Sabadell, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Mauri","sequence":"additional","affiliation":[{"name":"Emergency Surgery and Trauma Section, Department of Surgery, IRCCS\u2014Humanitas Research Hospital, 20089 Rozzano, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4689-480X","authenticated-orcid":false,"given":"Martina","family":"Ceolin","sequence":"additional","affiliation":[{"name":"Emergency Surgery and Trauma Section, Department of Surgery, IRCCS\u2014Humanitas Research Hospital, 20089 Rozzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ezio","family":"Lanza","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, IRCCS\u2014Humanitas Research Hospital, 20089 Rozzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0715-8233","authenticated-orcid":false,"given":"Matteo","family":"Colombo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS\u2014Humanitas Research Hospital, 20089 Rozzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Facciorusso","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Foggia, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Repici","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy"},{"name":"Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS\u2014Humanitas Research Hospital, 20089 Rozzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1021-0031","authenticated-orcid":false,"given":"Andrea","family":"Anderloni","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1002\/jhbp.509","article-title":"Tokyo Guidelines 2018: Initial management of acute biliary infection and flowchart for acute cholangitis","volume":"25","author":"Miura","year":"2017","journal-title":"J. Hepato-Biliary-Pancreat. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1002\/jhbp.515","article-title":"Tokyo Guidelines 2018: Diagnostic criteria and severity grading of acute cholecystitis (with videos)","volume":"25","author":"Yokoe","year":"2017","journal-title":"J. Hepato-Biliary-Pancreat. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13017-019-0224-7","article-title":"2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population","volume":"14","author":"Pisano","year":"2019","journal-title":"World J. Emerg. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3965","DOI":"10.1136\/bmj.k3965","article-title":"Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): Multicentre randomised clinical trial","volume":"2018","author":"Loozen","year":"2018","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1136\/gutjnl-2019-319996","article-title":"Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: An international randomised multicentre controlled superiority trial (DRAC 1)","volume":"69","author":"Teoh","year":"2020","journal-title":"Gut"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.gie.2020.06.066","article-title":"EUS-guided gallbladder drainage versus laparoscopic cholecystectomy for acute cholecystitis: A propensity score analysis with 1-year follow-up data","volume":"93","author":"Teoh","year":"2020","journal-title":"Gastrointest. Endosc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s13017-020-00336-x","article-title":"2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis","volume":"15","author":"Pisano","year":"2020","journal-title":"World J. Emerg. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1016\/j.jamcollsurg.2013.07.385","article-title":"Development and Evaluation of the Universal ACS NSQIP Surgical Risk Calculator: A Decision Aid and Informed Consent Tool for Patients and Surgeons","volume":"217","author":"Bilimoria","year":"2013","journal-title":"J. Am. Coll. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Church, S., Rogers, E., Rockwood, K., and Theou, O. (2020). A scoping review of the Clinical Frailty Scale. BMC Geriatr., 20.","DOI":"10.1186\/s12877-020-01801-7"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"193","DOI":"10.2147\/CEG.S203626","article-title":"Endoscopic Ultrasound-Guided Gallbladder Drainage: Current Perspectives","volume":"13","author":"Fugazza","year":"2020","journal-title":"Clin. Exp. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.ijsu.2015.04.083","article-title":"Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis","volume":"18","author":"Coccolini","year":"2015","journal-title":"Int. J. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"678","DOI":"10.5946\/ce.2019.186","article-title":"Practical Approaches for High-Risk Surgical Patients with Acute Cholecystitis: The Percutaneous Approach versus Endoscopic Alternatives","volume":"53","author":"Rerknimitr","year":"2020","journal-title":"Clin. Endosc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.gie.2019.11.021","article-title":"International multicenter comprehensive analysis of adverse events associated with lumen-apposing metal stent placement for pancreatic fluid collection drainage","volume":"91","author":"Fugazza","year":"2019","journal-title":"Gastrointest. Endosc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.gie.2015.01.003","article-title":"Polidocanol injection decreases the bleeding rate after colon polypectomy: A propensity score analysis","volume":"82","author":"Facciorusso","year":"2015","journal-title":"Gastrointest. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3388","DOI":"10.1002\/sim.5753","article-title":"A tutorial on propensity score estimation for multiple treatments using generalized boosted models","volume":"32","author":"McCaffrey","year":"2013","journal-title":"Stat. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2837","DOI":"10.1002\/sim.5705","article-title":"The performance of different propensity score methods for estimating marginal hazard ratios","volume":"32","author":"Austin","year":"2012","journal-title":"Stat. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1037\/a0016973","article-title":"An introduction to recursive partitioning: Rationale, application, and characteristics of classification and regression trees, bagging, and random forests","volume":"14","author":"Strobl","year":"2009","journal-title":"Psychol. Methods"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/S0895-4356(01)00341-9","article-title":"Internal validation of predictive models: Efficiency of some procedures for logistic regression analysis","volume":"54","author":"Steyerberg","year":"2001","journal-title":"J. Clin. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1002\/(SICI)1097-0258(19970515)16:9<965::AID-SIM509>3.0.CO;2-O","article-title":"A comparison of goodness-of-fit tests for the logistic regression model","volume":"15","author":"Hosmer","year":"1997","journal-title":"Stat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1007\/s00464-011-2035-0","article-title":"Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients","volume":"26","author":"McKay","year":"2011","journal-title":"Surg. Endosc."},{"key":"ref_23","first-page":"188","article-title":"Outcomes of percutaneous cholecystostomy in elderly patients: A systematic review and meta-analysis","volume":"15","author":"Markopoulos","year":"2020","journal-title":"Gastroenterol. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.jamcollsurg.2016.12.021","article-title":"Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis","volume":"224","author":"Dimou","year":"2017","journal-title":"J. Am. Coll. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5200","DOI":"10.1007\/s00464-016-4894-x","article-title":"Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: A systematic review and pooled analysis","volume":"30","author":"Anderloni","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_26","first-page":"535","article-title":"Through the LAMS towards the future: Current uses and outcomes of lumen-apposing metal stents","volume":"31","author":"Mussetto","year":"2018","journal-title":"Ann. Gastroenterol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1055\/a-0929-6603","article-title":"Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: A systematic review and meta-analysis","volume":"51","author":"Luk","year":"2019","journal-title":"Endoscopy"},{"key":"ref_28","first-page":"656","article-title":"Long-term outcomes after endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis","volume":"30","author":"Choi","year":"2014","journal-title":"Endoscopy"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s11605-019-04194-0","article-title":"Clinical and Survival Outcomes Using Percutaneous Cholecystostomy Tube Alone or Subsequent Interval Cholecystectomy to Treat Acute Cholecystitis","volume":"24","author":"Fleming","year":"2019","journal-title":"J. Gastrointest. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"E1100","DOI":"10.1055\/s-0043-118828","article-title":"EUS-guided gallbladder drainage using a lumen-apposing self-expandable metal stent in patients with coagulopathy or anticoagulation therapy: A case series","volume":"5","author":"Anderloni","year":"2017","journal-title":"Endosc. Int. Open"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1647\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:17:51Z","timestamp":1760145471000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1647"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,14]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["medicina58111647"],"URL":"https:\/\/doi.org\/10.3390\/medicina58111647","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,14]]}}}