Percutaneous Transhepatic Cholecystoscopic Lithotomy in the Management of Acute Cholecystitis Caused by Gallbladder Stones

Abstract

Percutaneous transhepatic cholecystic drainage (PTCCD) with percutaneous transhepatic cholecystoscopic lithotomy (PTCCSL) were performed in 53 patients with acute cholecystitis caused by gallbladder stones and studied stone removal rates, complications, endoscopic findings, and stone recurrence. The stones were successfully removed in 96% of the patients, and there were no serious complications. The coexistence of cancer was confirmed in three patients, and all cases were accurately diagnosed on the basis of uitrasonographic, endoscopic, and biopsy findings. The mean duration of follow-up after stone removal was 42 months, and the stone recurrence rate was 2.5%. Among the 39 patients followed up for at least 1 year, the gallbladder could be preserved with no evidence of sludge in patients in whom drainage was performed early after the onset of symptoms, those with a normal gallbladder after PTCCSL, and those with normal gallbladder contractility after PTCCSL. Sludge was present in patients with evidence of extensive areas of yellowish white fibers on percutaneous transhepatic cholecystoscopy. If instituted early after the onset of symptoms, PTCCD combined with PTCCSL was considered useful in the treatment of patients with acute cholecystitis associated with gallbladder stones.

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

“…While useful in smaller stones, unfortunately, fluoroscopic percutaneous extraction is limited by stone size. With the advent of cholecystolithotripsy, Picus et al ., in 1992, reported their experience with percutaneous cholecystoscopy and electrohydraulic lithotripsy in 58 high‐risk patients with acute cholecystitis or biliary colic, adopting similar techniques described previously by surgeons and gastroenterologists . Complete stone removal was achieved in 97% over a mean of 1.6 sessions, with major and minor complication rates of 9% and 3% respectively .…”

“…Other studies by non‐Interventional Radiology groups have reported comparable outcomes using similar techniques. Ohashi et al., in 1998, reported a 96% technical success rate (mean sessions: 2.5) in 53 average‐risk patients with acute cholecystitis. Complications occurred in 4%, and recurrent calculous cholecystitis occurred in 2.5% (mean follow‐up: 42 months).…”

“…Additionally, although many patients undergo general anaesthesia to reduce risks from large‐volume saline infusion during endoscopy, moderate conscious sedation with local analgesia is a viable alternative when general anaesthesia is contraindicated . Lastly, it is important to note that while cholecystoscopic removal of gallstones historically carries a 2.5–40% risk of recurrent cholelithiasis and/or cholecystitis, the addition of ursodeoxycholic acid 300 mg twice daily for at least 6 months postoperatively can be used as an adjuvant to prevent gallstone reformation …”

“…With the advent of cholecystolithotripsy, Picus et al, 7 in 1992, reported their experience with percutaneous cholecystoscopy and electrohydraulic lithotripsy in 58 high-risk patients with acute cholecystitis or biliary colic, adopting similar techniques described previously by surgeons and gastroenterologists. 8,11,12 Complete stone removal was achieved in 97% over a mean of 1.6 sessions, with major and minor complication rates of 9% and 3% respectively. 7 A follow-up to this study, by Courtois et al, 13 secondary to acute gastrointestinal haemorrhage in another patient.…”

Percutaneous cholecystoscopy and internal rendezvous for removal of gallstones and common bile duct stones (with video)

“…5, 6 We performed percutaneous endoscopic cholecystolithotomy to remove difficult, impacted cystic duct stones with complete gallbladder clearance. Because retrograde cannulation was not possible even after precut papillotomy, an internal rendezvous through the gallbladder allowed successful ERCP with clearance of choledocholithiasis.…”