Percutaneous transcystic cholangioscopy for combined treatment of gallbladder and bile duct stones

Percutaneous transhepatic cholangioscopy for diagnosis and therapy of biliary diseases in older patients

OBJECTIVE

To describe the use of percutaneous cholangioscopy in older patients with complex diagnostic and therapeutic bile duct disorders.

DESIGN

Case series.

SETTING

Tertiary care center.

PATIENTS

Fourteen patients with a mean age of 74 (SD +/- 9) years (range, 60-91 years) underwent percutaneous cholangioscopy. Eleven of these patients presented with endoscopically irretrievable bile duct stones. These 11 patients represent 4.1% of a group of 342 patients (age > or = 60 years) with a mean age of 76 (SD +/- 9) years who were treated endoscopically because of common bile duct stones between January 1993 and January 1996. Three patients presented with obstructive jaundice resulting from a bile duct stricture. In these three patients, brushing cytology of the strictures had proved to be negative.

INTERVENTION

After creation and dilatation of a percutaneous transhepatic tract, cholangioscopy was carried out with a flexible cholangioscope. All procedures were performed under mild sedation and analgesia. Stone disintegration was obtained by electrohydraulic lithotripsy, applied through the working channel of the cholangioscope.

RESULTS

Complete stone disintegration and removal was obtained after one to three cholangioscopic sessions in all 11 patients with stones. A histological diagnosis of malignancy was obtained in the three patients with biliary strictures.

CONCLUSIONS

Percutaneous cholangioscopy is a well tolerated and promising technique in our diagnostic and therapeutic strategy in older patients with complex biliary disorders not responsive to peroral endoscopic diagnosis or treatment.