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Percutaneous Transhepatic Cholangioscopy in Hepatolithiasis Associated With Decompensated Cirrhosis: A Retrospective
Qianyu Yan1, Jie Zhang1, Rui Chen1
1Research Center of Biliary Disease, West China Hospital, Sichuan University, Chengdu, China.
Insights
Percutaneous transhepatic cholangioscopy (PTCS) effectively removes stones in hepatolithiasis patients with decompensated cirrhosis. This procedure improves liver function, reducing the need for liver transplantation in many cases.
Area of Science:
- Hepatobiliary surgery
- Gastroenterology
- Interventional Endoscopy
Background:
- Hepatolithiasis with decompensated cirrhosis presents complex treatment challenges.
- Liver transplantation is often indicated but limited by ethical and operational factors.
- Percutaneous transhepatic cholangioscopy (PTCS) offers an alternative approach.
Purpose of the Study:
- To evaluate the efficacy of PTCS for stone extraction in hepatolithiasis patients with decompensated cirrhosis.
- To assess the impact of PTCS on liver function and the need for liver transplantation.
Main Methods:
- Retrospective review of 21 patients with hepatolithiasis and decompensated cirrhosis undergoing PTCS.
- Patients had MELD scores indicating liver transplant necessity prior to PTCS.
- Stone extraction performed via one-step (n=19) or two-step (n=2) PTCS.
Main Results:
- 100% technical success rate with 90.48% stone clearance.
- Model for End-stage Liver Disease (MELD) scores significantly decreased post-PTCS, reaching lowest levels at 6 months.
- Stone recurrence was 28.57%; 13 patients survived without transplantation, 3 with transplantation, and 5 died (23.81% mortality).
Conclusions:
- PTCS is a safe and effective treatment for hepatolithiasis in patients with decompensated cirrhosis.
- The procedure significantly improves liver function, potentially obviating the need for liver transplantation.
- PTCS demonstrates a favorable outcome profile in this challenging patient cohort.
Background:
Multiple and complicated hepatolithiasis can be associated with decompensated cirrhosis. Endoscopic retrograde cholangiopancreatography is unavailable for multiple and complicated hepatolithiasis, and the mainstay for decompensated cirrhosis is liver transplantation. However, due to the ethical factors and the complexity of operation, liver transplantation cannot be widely operated. This study aimed to evaluate percutaneous transhepatic cholangioscopy in the extraction of stones and the recompensation of cirrhosis in patients with hepatolithiasis associated with decompensated cirrhosis.
Methods:
Between January 2021 and February 2024, we retrospectively reviewed the clinical data of 21 patients with multiple and complicated hepatolithiasis associated with decompensated cirrhosis. Before PTCS, the 21 patients were all assessed by the Model for End-stage Liver Disease as having indications for liver transplantation. One-step PTCS (n = 19) and two-step PTCS (n = 2) were used to remove the stones.
Results:
The technical success rate was 100%, and most stones were cleared 90.48% (19/21). After 3 months of PTCS, MELD score of the patients had significantly decreased (10.81 ± 3.31 vs. 17.24 ± 3.40, p < 0.05), and it was lowest at 6 months after the operation (9.94 ± 4.31). After a median follow-up period of 18 months (up to 40 months), the stone recurrence rate was 28.57% (6/21), 13 patients survived without liver transplantation, three patients underwent liver transplantation and survived, and five patients died of liver failure or cancer (mortality rate 23.81%).
Conclusions:
PTCS can significantly improve patients' liver function in hepatolithiasis associated with decompensated cirrhosis.
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