Multi-institutional Retrospective Study of Percutaneous Cholangioscopy-Assisted Lithotripsy for Inoperable Calculous Cholecystitis.
Multi-institutional Retrospective Study of Percutaneous Cholangioscopy-Assisted Lithotripsy for Inoperable Calculous Cholecystitis.
- 2023
CONCLUSIONS: Fluoroscopy-guided percutaneous rigid lithotripsy is a safe and effective procedure for gallstone destruction and extraction in patients who are poor surgical candidates with large lumen-occupying cholelithiasis. Copyright � 2022 SIR. Published by Elsevier Inc. All rights reserved. MATERIALS AND METHODS: Multi-institutional institutional review board approved retrospective review of patients who presented with calculous cholecystitis and were not determined to be surgical candidates. All patients underwent percutaneous cholecystostomy tube placement for acute infection, which was later exchanged for a large sheath for ShockPulse (Olympus, Tokyo, Japan) lithotripsy and stone destruction. Review parameters included procedural technical and clinical data, including clinical presentation, mean length of hospital stay, and postintervention symptom reduction. PURPOSE: This study aimed to assess the safety and efficacy of percutaneous lithotripsy for gallstone eradication in patients with calculous cholecystitis with stones >1 cm. RESULTS: Twelve patients (mean age, 74.6 years; range, 52-94 years; 6 men and 6 women) underwent large-bore sheath (24-30 F) cholangioscopy-assisted gallstone destruction via rigid lithotripsy. The size of the gallstones ranged from 1.2 to 4.0 cm. All patients had prior cholecystostomy access for a mean of 25 weeks before gallstone extraction to ensure tract maturation via transhepatic or transperitoneal access. The technical success rate in single-session stone removal was 100%, with no major procedure-related adverse events. All patients were symptom- and pain-free after the procedure. The mean procedure time was 111.5 minutes, and the mean fluoroscopy time was 19.2 minutes. The median length of hospital stay was 1 day after the procedure. The mean time from percutaneous lithotripsy to biliary tube removal was 35 days (range, 17-45 days).
English
1051-0443
10.1016/j.jvir.2022.12.024 [doi] S1051-0443(22)01421-X [pii]
*Biliary Tract
*Cholecystitis
*Cholecystitis, Acute
*Cholecystostomy
*Gallstones
*Lithotripsy
Aged
Cholecystitis, Acute/su [Surgery]
Cholecystitis, Acute/th [Therapy]
Cholecystitis/su [Surgery]
Cholecystostomy/ae [Adverse Effects]
Cholecystostomy/mt [Methods]
Female
Gallstones/co [Complications]
Gallstones/dg [Diagnostic Imaging]
Gallstones/th [Therapy]
Humans
Lithotripsy/ae [Adverse Effects]
Lithotripsy/mt [Methods]
Male
Retrospective Studies
Treatment Outcome--Curated
MedStar Washington Hospital Center
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
MedStar Health
Office of Physician Wellbeing
Radiology
Radiology/Interventional Integrated Residency
Journal Article
CONCLUSIONS: Fluoroscopy-guided percutaneous rigid lithotripsy is a safe and effective procedure for gallstone destruction and extraction in patients who are poor surgical candidates with large lumen-occupying cholelithiasis. Copyright � 2022 SIR. Published by Elsevier Inc. All rights reserved. MATERIALS AND METHODS: Multi-institutional institutional review board approved retrospective review of patients who presented with calculous cholecystitis and were not determined to be surgical candidates. All patients underwent percutaneous cholecystostomy tube placement for acute infection, which was later exchanged for a large sheath for ShockPulse (Olympus, Tokyo, Japan) lithotripsy and stone destruction. Review parameters included procedural technical and clinical data, including clinical presentation, mean length of hospital stay, and postintervention symptom reduction. PURPOSE: This study aimed to assess the safety and efficacy of percutaneous lithotripsy for gallstone eradication in patients with calculous cholecystitis with stones >1 cm. RESULTS: Twelve patients (mean age, 74.6 years; range, 52-94 years; 6 men and 6 women) underwent large-bore sheath (24-30 F) cholangioscopy-assisted gallstone destruction via rigid lithotripsy. The size of the gallstones ranged from 1.2 to 4.0 cm. All patients had prior cholecystostomy access for a mean of 25 weeks before gallstone extraction to ensure tract maturation via transhepatic or transperitoneal access. The technical success rate in single-session stone removal was 100%, with no major procedure-related adverse events. All patients were symptom- and pain-free after the procedure. The mean procedure time was 111.5 minutes, and the mean fluoroscopy time was 19.2 minutes. The median length of hospital stay was 1 day after the procedure. The mean time from percutaneous lithotripsy to biliary tube removal was 35 days (range, 17-45 days).
English
1051-0443
10.1016/j.jvir.2022.12.024 [doi] S1051-0443(22)01421-X [pii]
*Biliary Tract
*Cholecystitis
*Cholecystitis, Acute
*Cholecystostomy
*Gallstones
*Lithotripsy
Aged
Cholecystitis, Acute/su [Surgery]
Cholecystitis, Acute/th [Therapy]
Cholecystitis/su [Surgery]
Cholecystostomy/ae [Adverse Effects]
Cholecystostomy/mt [Methods]
Female
Gallstones/co [Complications]
Gallstones/dg [Diagnostic Imaging]
Gallstones/th [Therapy]
Humans
Lithotripsy/ae [Adverse Effects]
Lithotripsy/mt [Methods]
Male
Retrospective Studies
Treatment Outcome--Curated
MedStar Washington Hospital Center
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
MedStar Health
Office of Physician Wellbeing
Radiology
Radiology/Interventional Integrated Residency
Journal Article