There is an increasing number of percutaneous cholecystostomies carried out in the last years in patients unfit for surgery. The access can be subcostal or intercostal, transhepatic or transperitoneal. Generally, a direct approach using ultrasound is preferred to CT- or fluoroscopy guidance. Lack of prospective, randomized, controlled trials limits the ability to define the specific role of percutaneous cholecystostomy. A randomized prospective trial reported inferior results of percutaneous catheter drainage when compared to laparoscopic cholecystectomy, regarding the rate of major complications in high risk patients with acute cholecystitis.