Long-Term Outcomes of Combined Cystic Duct Embolization and Chemical Gallbladder Ablation in High-Risk Patients with Acute Cholecystitis.

PURPOSE: To evaluate long-term effectiveness, safety, and recurrence rates of combined cystic duct embolization (CDE) and chemical gallbladder ablation (CGA) in high-risk patients with acute cholecystitis (AC) unsuitable for surgery.

MATERIALS AND

METHODS

In this retrospective cohort study (2013-2025), 19 high-risk patients (mean age, 77.7 years [SD ± 19.3]) underwent CDE followed by CGA using 3% Aethoxysklerol or Glubran with ethiodized oil. All patients initially underwent percutaneous cholecystostomy. Technical failure was defined as the inability to catheterize the cystic duct. Clinical success was defined as the resolution of symptoms without recurrence. Freedom from recurrent cholecystitis was estimated using Kaplan-Meier analysis.

RESULTS

Technical success was achieved in 17 (89.5%) of 19 patients; 2 failures were due to inability to cannulate the cystic duct (technical failure). Among the 17 patients treated, clinical success was achieved in 14 (82.4%). Clinical failure occurred in 3 patients (17.6%): 1 with persistent bile leakage and 2 with late recurrent cholecystitis (manifesting as perforation in 1 case and cholangitis in another). No procedure-related mortality occurred. Kaplan-Meier analysis demonstrated a sustained high probability of freedom from recurrent cholecystitis over a median follow-up of 43.2 months.

CONCLUSIONS

CDE combined with CGA appears to be a viable and effective minimally invasive option for AC in nonsurgical patients, yielding high long-term success. However, late recurrence is possible, necessitating careful patient selection and long-term surveillance.