Diagnostic and Interventional Radiology
Interventional Radiology - Original Article

Safety and feasibility of single use cholecystoscopy for guiding laser or mechanical cholelithotripsy, and mechanical cholelithotomy

1.

Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Georgia, USA

2.

Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Connecticut, USA

3.

Department of Surgery, Bassett Medical Center, Cooperstown, New York, USA

4.

Department of Radiology, Mt. Auburn Hospital/Harvard Medical School, Massachusetts, USA

Diagn Interv Radiol 2020; 1: -
Read: 216 Published: 05 April 2021

PURPOSE: Patients with acute calculus cholecystitis and contraindications to cholecystectomy receive cholecystostomy drainage catheters, many of which remain in place until end of life. This study aims to assess safety, feasibility, and early clinical outcomes of percutaneous cholecystoscopy using the LithoVue endoscope, laser/mechanical cholelithotripsy, and mechanical cholelithotomy for management of symptomatic cholelithiasis.

METHODS: This was a single-institute retrospective analysis of 17 patients with acute calculus cholecystitis who had contraindications to cholecystectomy, underwent cholecystostomy catheter placement between 2015-2017, and stone removal between 2017-2018. The LithoVue 7.7-9.5 Fr endoscope was used in combination with laser/mechanical cholelithotripsy, mechanical retrograde, balloon-assisted anterograde cholelithotomy to remove gallstones and common bile duct stones. Surgical contraindications ranged from cardiopulmonary disease to morbid obesity to neoplastic processes. Timing and number of interventions, as well as technical and clinical successes were assessed.

RESULTS: The median time interval from cholecystostomy catheter placement to cholelithotripsy was 58 days, after an average of two tube exchange procedures. Technical and clinical success were achieved in all patients (stone free gallbladder and cholecystostomy tube removal). On average, three sessions of cholecystoscopy, laser and mechanical cholelithotripsy were required for complete gallstone extraction. The mean interval time between the first cholelithotripsy session and removal of cholecystostomy was 71.8 ± 60.8 days. There were neither procedure related major nor minor complications. 

CONCLUSION: Percutaneous cholecystoscopy using the LithoVue endoscope, in combination with laser/mechanical cholelithotripsy and mechanical cholelithotomy, is feasible, safe, well tolerated, and was able to remove the cholecystostomy tube in the patients with contraindication to cholecystectomy.
 

EISSN 1305-3612