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Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): Study protocol for a randomized controlled trial

Kirsten Kortram1, Bert van Ramshorst1, Thomas L Bollen2, Marc GH Besselink1, Dirk J Gouma3, Tom Karsten4, Philip M Kruyt5, Grard AP Nieuwenhuijzen6, Johannes C Kelder7, Ellen Tromp7 and Djamila Boerma1*

Author Affiliations

1 Dept. of Surgery, St. Antonius Hospital Nieuwegein

2 Dept. of Radiology, St. Antonius Hospital Nieuwegein

3 Dept. of Surgery, Academic Medical Centre Amsterdam

4 Dept. of Surgery, Onze Lieve Vrouwe Gasthuis Amsterdam

5 Dept. of Surgery, Hospital Gelderse Vallei Ede

6 Dept. of Surgery, Catharina Hospital Eindhoven

7 Dept. of Clinical Epidemiology. St. Antonius Hospital Nieuwegein

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Trials 2012, 13:7  doi:10.1186/1745-6215-13-7

Published: 12 January 2012



Laparoscopic cholecystectomy in acute calculous cholecystitis in high risk patients can lead to significant morbidity and mortality. Percutaneous cholecystostomy may be an alternative treatment option but the current literature does not provide the surgical community with evidence based advice.


The CHOCOLATE trial is a randomised controlled, parallel-group, superiority multicenter trial. High risk patients, defined as APACHE-II score 7-14, with acute calculous cholecystitis will be randomised to laparoscopic cholecystectomy or percutaneous cholecystostomy. During a two year period 284 patients will be enrolled from 30 high volume teaching hospitals. The primary endpoint is a composite endpoint of major complications within three months following randomization and need for re-intervention and mortality during the follow-up period of one year. Secondary endpoints include all other complications, duration of hospital admission, difficulty of procedures and total costs.


The CHOCOLATE trial is designed to provide the surgical community with an evidence based guideline in the treatment of acute calculous cholecystitis in high risk patients.

Trial Registration

Netherlands Trial Register (NTR): NTR2666

Acute cholecystitis; laparoscopic cholecystectomy; percutaneous cholecystostomy; percutaneous drainage