Safety and Effectiveness of Large-Bore Percutaneous Cholangioscopy-Assisted Gallstone Retrieval for Inoperable Calculous Cholecystitis: A Multi-Institutional Retrospective Study.

Overview

abstract

PURPOSE: To evaluate the safety and effectiveness of large-bore percutaneous biliary access techniques for cholangioscopy-assisted gallstone extraction in patients with a history of acute calculous cholecystitis who are poor surgical candidates. MATERIALS AND METHODS: A retrospective analysis was conducted on patients who underwent percutaneous cholangioscopy for gallstone extraction using large-bore access (24 or 30 French) at two large academic centers from September 2020 and August 2022. Technical success, procedure duration, fluoroscopy time, immediate post-procedure symptom reduction, 3-month symptom-free outcomes, and adverse effects were assessed. RESULTS: Thirty consecutive patients were included. Gallstone removal in a single cholangioscopy session was successful in 93.3% of cases. Large-bore access facilitated the removal of gallstones ranging from 0.5 to 4 cm in diameter, with mean procedure and fluoroscopy times of 105.4 mins 21.7 mins, respectively. This compares to a previous small cholangioscopy study of 13 patients demonstrating mean procedure and fluoroscopy times of 164 mins and 30 mins, respectively. All patients who presented for 3-month follow-up remained symptom-free without gallstone recurrence on imaging. The overall adverse event rate was 6.7%, one Grade C and one Grade D based on the SIR adverse events grading system, both managed appropriately, leading to patient discharge home. CONCLUSION: Large-bore percutaneous biliary access for cholangioscopy-assisted gallstone extraction is a safe and effective technique for managing symptomatic cholelithiasis in poor surgical candidates. Further prospective studies are warranted to validate these findings and evaluate long-term treatment outcomes.