%0 Journal Article %T Percutaneous cholecystostomy for acute cholecystitis: not so safe after all %J Archive of "Canadian Journal of Surgery". %D 2018 %R 10.1503/cjs.1861041 %X I read with interest the paper by Molavi and colleagues,1 entitled ¡°Clinical and operative outcomes of patients with acute cholecystitis who are treated initially with image-guided cholecystostomy.¡± Any examination of the use of percutaneous cholecystostomy and resultant outcomes is appreciated. However, a large, multi-centre, randomized controlled trial (the CHOCOLATE trial), referenced by Molavi and colleagues, has been conducted to address whether percutaneous cholecystostomy had advantages over early laparoscopic cholecystectomy for high-risk patients (APACHE-II score 7¨C15) with acute cholecystitis. What is omitted from Molavi and colleagues¡¯ discussion is the fact that in 2016 the CHOCOLATE trial had to be terminated prematurely after interim analysis had raised concerns about the negative effects of percutaneous cholecystostomy. There was a markedly significantly lower rate of the primary composite endpoint (major complications, readmission, reintervention and death) in high-risk patients treated with early laparoscopic cholecystectomy compared with percutaneous cholecystostomy. Consequently, I question the characterization by Molavi and colleagues of percutaneous cholecystostomy as a safe procedure with low morbidity (despite not reporting all morbidities or outcomes in their review). The question is: safe compared to what %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066385/