There has been a progressive increase in the use of percutaneous cholecystostomy (PC) in acute cholecystitis (AC) over the last decades due to population aging, and the support of guidelines (Tokyo Guidelines (TG), World Society of Emergency Surgery (WSES) Guidelines) as a valid therapeutical option. However, there are many unanswered questions about the management of PCs. An international consensus on indications and PC management using Delphi methodology with contributions from experts from three surgical societies (EAHPBA, ANS, WSES) have been performed. A two-round Delphi consensus, which included 27 questions, was sent to key opinion leaders in AC. Participants were asked to indicate their ‘agreement/disagreement’ using a 5-point Likert scale. Survey items with less than 70% consensus were excluded from the second round. For inclusion in the final recommendations, each survey item had to have reached a group consensus (≥ 70% agreement) by the end of the two survey rounds. 54 completed both rounds (82% of invitees). Six questions got > 70% and are included in consensus recommendations: In patients with acute cholecystitis, when there is a clear indication of PC, it is not necessary to wait 48 h to be carried out; Surgery is the first therapeutic option for the TG grade II acute cholecystitis in a patient suitable for surgery; Before PC removal a cholangiography should be done; There is no indication for PC in Tokyo Guidelines (TG) grade I patients; Transhepatic approach is the route of choice for PC; and after PC, laparoscopic cholecystectomy is the preferred approach (93.1%). Only six statements about PC management after AC got an international consensus. An international guideline about the management of PCs are necessary.

中文翻译：

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急性胆囊炎经皮胆汁造口术管理国际德尔菲共识 （E-AHPBA、ANS、WSES 学会）


由于人口老龄化，过去几十年来，经皮胆囊造瘘术 （PC） 在急性胆囊炎 （AC） 中的应用逐渐增加，并且指南（东京指南 （TG）、世界急诊外科学会 （WSES） 指南）支持作为有效的治疗选择。但是，关于 PC 的管理仍有许多悬而未决的问题。在来自三个外科学会 （EAHPBA、ANS、WSES） 的专家的贡献下，使用 Delphi 方法就适应症和 PC 管理达成了国际共识。向 AC 的关键意见领袖发送了两轮 Delphi 共识，其中包括 27 个问题。参与者被要求使用 5 点李克特量表表明他们的“同意/不同意”。共识率低于 70% 的调查项目被排除在第二轮调查之外。为了纳入最终建议，每个调查项目必须在两轮调查结束时达成小组共识（≥ 70% 的同意）。54 人完成了两轮比赛（占受邀者的 82%）。六个问题获得 > 70%，并包含在共识建议中：在急性胆囊炎患者中，当有明确的 PC 迹象时，无需等待 48 小时即可进行;手术是适合手术的患者 TG II 级急性胆囊炎的首选治疗选择;在去除 PC 之前，应进行胆管造影;东京指南 （TG） I 级患者没有 PC 的适应症;经肝入路是 PC 的首选途径;PC 后，腹腔镜胆囊切除术是首选方法 （93.1%）。在 AC 之后，只有 6 种关于 PC 管理的声明获得了国际共识。有必要制定有关 PC 管理的国际指南。