Single-Session Percutaneous Cholangioscopy for High-Risk Patients with Biliary Stone Disease

To evaluate the technical and clinical success, as well as the safety, of single-operator, single-session percutaneous cholangioscopy for the management of biliary stone disease.

Thirty-four non-surgical patients (median age 69 years; 14 female, 20 male) from two tertiary care hospitals underwent 37 percutaneous cholangioscopy-guided stone extraction procedures between March 2023 and August 2025. Patient characteristics, procedural details, technical and clinical success, and complications were retrospectively reviewed.

Twenty-six patients underwent percutaneous cholecystostomy (PC) and eight underwent percutaneous transhepatic biliary drainage (PTBD) prior to cholangioscopy. Primary technical success was 91.2% (31/34; 95% CI, 76.3-98.1)-88.5% in the PC cohort (23/26) and 100% in the PTBD cohort (8/8). After three repeat procedures, secondary technical success reached 100%. Clinical success, defined as the absence of recurrent cholecystitis or biliary colic, was achieved in 91.2% of patients over a median follow-up of 413 days. The median drain dwell time was 113 days, with a median interval of 14 days from stone extraction to drain removal. Two procedure-related complications occurred-one cystic duct injury and one pleural effusion (CIRSE classification 1a and 3b, respectively)-along with one non-procedure-related complication of prolonged delirium (CIRSE classification 3b).

Single-session percutaneous cholangioscopy-guided biliary stone management demonstrates high technical and clinical success with minimal complications and appears to be a viable treatment option for high-risk patients who are not candidates for surgery or peroral endoscopic interventions.