Percutaneous transhepatic cholangioscopy-guided holmium laser lithotripsy for bile duct stones in elderly patients

To evaluate the safety and efficacy of percutaneous transhepatic endoscopic holmium laser lithotripsy (PTEHL) for bile duct stones in elderly patients aged ≥80 years.

This retrospective study included 50 patients (mean age 86.4 ± 4.5 years) who underwent PTEHL from January 2023 to December 2024. Inclusion criteria were age ≥ 80 years, presence of intra- and/or extrahepatic bile duct stones, and indication for PTEHL. Outcomes assessed included stone clearance, adverse events, and hospitalization duration. Adverse events were categorized according to the CIRSE classification.

PTEHL was performed once in 48 patients, while 2 patients required two sessions. Final outcomes showed that all patients achieved complete (72%) or near-complete stone clearance (28%), with no requirement for any additional subsequent treatment. Thirteen patients (26%) experienced adverse events, mostly minor; only one moderate adverse event (biliopleural fistula) was recorded. No procedure-related mortality occurred. Multivariate analysis revealed that the presence of cholangitis and combined intra- and extrahepatic stones were significantly associated with incomplete clearance. Mean hospital stay was 14.8 ± 8.0 days and was significantly longer in patients with cholangitis (p = 0.001).

PTEHL may represent a feasible minimally invasive treatment option for elderly patients with biliary stone.