Related Experiment Video
Updated: Jun 15, 2025
A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
Published on: September 13, 2022
Safety and Effectiveness of Large-Bore Percutaneous Cholangioscopy-Assisted Gallstone Retrieval for Inoperable
John B Smirniotopoulos1, Neil Jain2, Matthew Lamberti3
1Division of Interventional Radiology, Department of Radiology, MedStar Washington Hospital Center, Washington, DC; Division of Interventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, Washington, DC.
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 F) at 2 large academic centers from September 2020 and August 2022. Technical success, procedure duration, fluoroscopy time, immediate postprocedural symptom reduction, 3-month symptom-free outcomes, and adverse events (AEs) 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 minutes and 21.7 minutes, respectively. All patients who presented for 3-month follow-up remained symptom-free without gallstone recurrence on imaging. The overall AE rate was 6.7%, one Grade 2 and one Grade 3 based on the Society of Interventional Radiology (SIR) AE grading system, both managed successfully, leading to patient discharge home.
Conclusions:
Large-bore percutaneous biliary access for cholangioscopy-assisted gallstone extraction is a safe and effective technique for managing symptomatic cholelithiasis in poor surgical candidates.
