This 2017 peer reviewed journal article from Surgical Endoscopy addressed the use of conservative treatment in patients diagnosed with acute cholecystitis. Cholecystectomy, surgically removing the gallbladder, has been widely accepted as treatment in medical practice. Despite it being the treatment of choice, as it prevents future episodes of gallstone related disease, there are complications associated with it, particularly in high risk patients. This systematic review was performed to investigate the current evidence regarding conservative treatment of acute cholecystitis (i.e. non-invasive management via supportive care, with or without antibiotics). This includes whether conservative treatment is effective and safe, and what the recurrence rate of gall-stone related disease was in the long-term follow-up.
The authors systematically searched Medline, Embase and Cochrane Library, and ultimately over 1800 patients were included in 10 randomized controlled trials and 14 non-randomized studies. The results indicated that conservative treatment was successful in 87% of patients with acute calculous cholecystitis and in 96% of patients with mild disease. In the long term, 22% of patients developed recurrent gallstone- related disease. Based on the research conducted in this study, conservative treatment seems feasible and safe, particularly in patients with mild disease. Long term follow up indicated that less than a quarter of patients appear to develop recurrent gallstone-related disease, though it should be noted that this is based on somewhat limiting data. The results of this study are clinically significant because it provides evidence supporting alternative treatment that prevents surgical risk for patients with acute cholecystitis.
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