Clinical predictors of recurrent cholecystitis in non-operative management: A systematic review & meta-analysis

Introduction: Gallstone disease is prevalent and carries substantial implications for morbidity and healthcare resource utilization. While early laparoscopic cholecystectomy (LC) is often preferred, its feasibility may be limited in some cases. As a result, many patients undergo conservative management.

Aims: To conduct a systematic review of the current literature to identify studies reporting on clinical predictors of recurrence in patients who undergo non-operative management of acute cholecystitis.

Methods: A systematic review was performed as per PRISMA and MOOSE guidelines. Studies comparing variables in patients who had acute cholecystitis recurrence (ACR) were included.

Results: Three studies were included in the review. There were 678 patients in total with a 28.5 % recurrence rate. Age, history of biliary disease, and severity of cholecystitis were identified as potential predictors of ACR. Biochemical results, such as inflammatory markers, white cells, and albumin levels, may also play a role. Radiological findings, including gallbladder wall thickness and stone characteristics, showed potential as predictors.

Conclusion: Identifying patients at risk of recurrent cholecystitis is important in guiding clinical decision-making. While certain findings show promise as predictors, the available evidence is limited and inconclusive. Larger studies are needed to develop risk stratification tools for better management of gallstone disease.