Response to “Is percutaneous cholecystostomy in acute cholecystitis safe and effective? Analysis of the adverse effects associated with the technique”

Letter to the Editor:

We have read with great interest the article published by Bejarano González et al.¹ “Is Percutaneous Cholecystostomy in Acute Cholecystitis Safe and Effective? Analysis of the Adverse Effects Associated with the Technique”. We appreciate the results of the study, in which the authors declare that percutaneous cholecystostomy is a safe and effective technique because it is associated with a low incidence of adverse events and mortality, and should be considered as a bridge therapy or definitive alternative in patients who are not candidates for urgent cholecystectomy after the failure of conservative antibiotic treatment¹. However, we would like to add some comments and share our experience in Colombia with the arrival of COVID-19.

As stated by Bejarano González et al.¹, percutaneous cholecystostomy is a resource that the treating physician can make use of when dealing with patients with acute cholecystitis who are not candidates for urgent surgery, have shown poor evolution with antibiotic management, or have comorbidities that increase the risk of subjecting the patient to an invasive procedure. This is also discussed in the recommendations proposed by the Tokyo guidelines, which are used worldwide for the management of patients with cholecystopathies².

With the arrival of the SARS-CoV-2 pandemic in Colombia, medical centers started to see an increase in the cancellation of elective surgeries, including cholecystectomies. However, surgical emergencies at the beginning of the pandemic (March 2019) continued to arrive, so the Colombian Association of Surgery published recommendations for the management of patients with urgent surgical disease. These guidelines recommended early cholecystectomy in patients with ASA I or II cholecystopathies with Tokyo I or II, acute cholecystitis, thereby seeking to reduce prolonged hospitalizations, optimize institutional resources and reduce the risk of nosocomial infection^3,4.

Despite health campaigns to educate the population about COVID-19, the fear of patients of becoming infected in hospitals increased the time between the onset of symptoms, diagnosis, and timely management of acute cholecystitis, which led to an increase in patients with acute cholecystitis and organ dysfunction or Tokyo III. This resulted in an increased use of percutaneous or open cholecystostomies according to the availability of hospital resources in patients who did not progress favorably with antibiotic therapy or had an ASA classification greater than or equal to III, following the recommendation of the Colombian Association of Surgery for the management of patients with urgent surgical disease^2,3.

Finally, we would like to thank the authors for the data provided in their study regarding the safety of the percutaneous cholecystostomy technique. It invites surgeons to use this procedure as a safe and effective alternative in patients who are not candidates for cholecystectomy as an initial treatment measure, which affects the morbidity and mortality of patients with acute cholecystitis. It will also help us propose a similar descriptive observational study in our country.