Chemical Cholecystectomy: A Novel Percutaneous Ablation Strategy for Acute Calculous Cholecystitis in Poor Surgical Candidates

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±19.3 years) underwent CDE followed by CGA using 3% Aethoxysklerol or Glubran with Lipiodol. 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 of 19 patients (89.5%); two 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 three patients (17.6%): one with persistent bile leakage, and two with late recurrent cholecystitis (manifesting as perforation in one 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 non-surgical patients, yielding high long-term success. However, late recurrence is possible, necessitating careful patient selection and long-term surveillance.