Abstract No. 215 Percutaneous cholecystolithotomy: a single-institution experience with SpyGlass DS cholangioscopy

Abstract

Percutaneous cholecystolithotomy using cholecystoscopy can be an alternative to cholecystectomy in high surgical risk patients with calculous cholecystitis. The purpose of this study is to describe our experience of percutaneous cholecystolithotomy using Spyglass direct visualization cholangioscopy (SpyGlass DS, 10F, Boston Scientific). The Institutional Review Board approved this retrospective study with a waiver of informed consent. Between January 1, 2018, and September 9, 2020, 18 patients (M:F = 13:5, mean 73 years) underwent percutaneous cholecystolithotomy using SpyGlass DS cholangioscopy for calculous cholecystitis. Percutaneous cholecystolithotomy was performed with SpyGlass DS cholangioscopy after placement of 16F sheath. Stone fragmentation was performed with EHL probe and stones were removed using baskets or saline flushing technique. Procedure details, technical success, complications, and clinical follow up were retrospectively analyzed. Eighteen patients underwent 28 percutaneous cholecystolithotomy procedures using SpyGlass DS cholangioscopy including seven patients for a second and three patients for a third cholecystolithotomy session. Conscious sedation was used in the majority of cases 86% (n = 24) versus general anesthesia 14% (n = 4) for the procedure. The median time interval between cholecystostomy tube placement and 1st cholecystolithotomy was 78 days. Overall technical success rate (removal of all stones) was 78% (14/18 patients) after repeat cholecystolithotomy. The median time from cholecystostomy tube placement to final tube removal was 111 days. Cause of technical failure were large, impacted stones (n = 3) and cystic duct occlusion (n = 1). There were three procedure related complications (acute pancreatitis causing mortality (n = 1), fistula to the skin requiring surgical excision (n = 1), bile leak requiring replacement of cholecystostomy tube due to gallbladder dyskinesia (n = 1)). There is no recurrence of symptomatic cholecystitis in patients with technical success. Three patients died because of reasons unassociated with the procedure during follow up. Percutaneous cholecystolithotomy using SpyGlass DS cholangioscopy can be performed with smaller sheath (16F) than conventional cholangioscopy (24F sheath) and can be a very useful alternate minimally invasive technique for gallstone management with high technical success rates.