Cholecystogastric Fistula: Diagnostic Challenges and Evolving Therapeutic Approaches—A Systematic Review

Abstract

Background: Cholecystogastric fistula (CGF) is a rare complication occurring in chronic gallstone that presents with non-specific clinical features, diagnostic difficulties and different therapeutic options. This systematic review assessed clinical presentation, diagnosis, management and outcome of CGF.

Methods: The framework of the systematic review was designed based on the guidelines of PRISMA 2020. All of the 12 original case reports from 2013 to 2026 were included in the descriptive synthesis for 12 patients. A structured extraction framework and Joanna Briggs Institute appraisal criteria were used to assess the demographic characteristics, diagnostic investigations, therapeutic interventions, postoperative outcomes and methodological quality.

Results: The mean patient age was 65.3 ± 13.2 years (range: 40–87), and seven patients (58.3%) were female. Common abdominal symptoms were abdominal pain, nausea and vomiting, and complicated presentations included Bouveret syndrome, gastric outlet obstruction and gallbladder empyema. A preoperative diagnosis was made in seven cases (58.3%) and in five cases (41.7%) it was made intraoperatively. 83.3% of the patients had surgery (5 laparoscopy, 5 requiring an open approach, 4 conversions from laparoscopy). The nonsurgical management was offered to two patients. Overall clinical results were satisfactory, with some reporting follow-up.

Conclusion: A diagnostic evaluation and treatment for CGF should be conducted on a case-by-case basis. Minimally invasive techniques seem to be an option in certain patients; otherwise, open surgery is required in more complex patients. More extensive reports and studies are necessary to determine optimal management.