Percutaneous gallstone removal: long-term follow-up

Percutaneous Cholecystolithotomy Using Cholecystoscopy

The morbidity and mortality of cholecystectomy can increase to 10% in high surgical risk patients. The technique for percutaneous cholecystolithotomy consists of 3 steps: (1) percutaneous cholecystostomy, (2) tract dilation and cholecystolithotomy, and (3) tract evaluation and catheter removal. Cholecystoscopy is critical in guiding the lithotripsy probe for fragmentation of large stones and is useful for locating small stone fragments not seen in cholangiography. Cholecystoscopy is also useful for assessing ambiguous lesions and in distinguishing between stone vs debris or mass. Technical success rate of percutaneous cholecystolithotomy using cholecystoscopy ranges from 93% to 100%. Procedure related complication rate has been reported as 4%-15%. The most common complication is bile leak during the procedure or after catheter removal. Although recurrence rate of gallstones has been reported up to 40%, the symptom recurrence rate is much lower. Therefore, percutaneous cholecystolithotomy using cholecystoscopy can be an alternative to cholecystectomy in high surgical risk patients with symptomatic gallstones.

Interventional radiology-operated percutaneous cholecystoscopy with ultrasonic lithotripsy and stone basket retrieval: A treatment for symptomatic cholelithiasis in non-operative candidates

Interventional radiology-operated percutaneous endoscopy has seen a recent resurgence with potential to return to the scope of Interventional Radiology practice. Endoscopy adds a new dimension to the Interventional Radiology armamentarium by offering a unique opportunity to diagnose and treat conditions under direct visualization with improved maneuverability. Cholecystoscopy (gallbladder endoscopy), as a method for percutaneous removal of gallstones, is an effective treatment option in patients with symptomatic cholelithiasis who are poor candidates for surgical cholecystectomy. This article presents a case of Interventional Radiology-operated cholecystoscopy using ultrasonic lithotripsy and stone basket retrieval with an emphasis on the equipment, technique, and peri-procedural management essential to the procedure, as well as a review of the literature.

Percutaneous transhepatic lithotripsy using a choledochoscope: long-term follow-up in 14 patients

OBJECTIVE

The purpose of our study was to estimate the long-term prognosis of patients with bile duct stones who undergo electrohydraulic lithotripsy guided by choledochoscopy.

SUBJECTS AND METHODS

Since 1987, at our institution, 14 patients with bile duct stones have been treated using percutaneous electrohydraulic lithotripsy guided by choledochoscopy. The procedure was performed 5-7 days after biliary drainage using a 5-mm choledochoscope placed through an 18- to 20-French sheath. All patients underwent follow-up CT, sonography, or both every 6-12 months after treatment.

RESULTS

No complications occurred in the 14 patients who underwent treatment. During a mean follow-up period of 4.8 years (range, 2-9 years), two (14%) of the 14 patients developed recurrent common bile duct stones, and another two (14%) developed recurrent small intrahepatic stones; all patients remained asymptomatic.

CONCLUSION

Percutaneous electrohydraulic lithotripsy can be safely performed using a 5-mm choledochoscope. Recurrent calculi may be seen in 28% of patients.

Choledocholithiasis and gallstone pancreatitis

Gallstones are commonly found within the main bile duct (MBD) of patients undergoing cholecystectomy. Retained MBD stones are a common cause of obstructive symptoms and complications. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy (ES) is the recommended modality for both the detection of such stones and their extraction. Recent trials of ERCP in conjunction with laparoscopic cholecystectomy suggest that it should be reserved for use post-operatively. Gallstones within the MBD are the most common single cause of acute pancreatitis. Initial treatment is supportive, although new agents designed to suppress the systemic inflammatory response are under development and have proved beneficial in clinical trials. Severe cases should be treated with systemic antibiotics and early removal of the obstructing stones by ERCP and ES. Prophylactic cholecystectomy is recommended to prevent further attacks of gallstone pancreatitis.