Percutaneous Transhepatic Cholangioscopic Lithotripsy Research Articles

NONOPERATIVE TREATMENT OF ACUTE CALCULOUS CHOLECYSTITIS WITH SPECIAL REFERENCE TO PTGBCSL

The efficacy of non-operative treatment, especially PTGBCSL (Percutaneous Transhepatic Cholangioscopic Lithotripsy of the Gallbladder) for acute calculous cholecystitis has been studied. Among 57 patients with acute calculous cholecystitis treated at the department in a past 17-year period, 37 patients underwent elective operation and 20 patients were treated non-operatively. Of the 20 patients, 4 underwent PTGBA and 5, PTGBCSL. Five patients undergoing PTGBCSL were very old and had some coexisting disease. Complete lithotripsy was successfully attained by PTGBCSL in all the 5 patients, without severe complications. There has been no recurrence of gallstones up to now. PTGBCSL is a less-invasive technique capable of bringing complete lithotripsy without severe complications. It is indicated for aged patients with some risk factors. As the gallbladder is preserved in PTGBCSL, there remains a possibility of recurrence of gallstones. Some reports point out that the longer the course after lithotripsy passes, the more increase the recurrent cases. So complete follow-up is mandatory.

Combined endoscopic sphincterotomy and percutaneous transhepatic cholangioscopic lithotripsy

Endoscopic sphincterotomy (ES) has gained worldwide acceptance as a treatment for bile duct stones. However, large stones (over 2.5 cm in diameter) have remained an indication for surgery when endoscopic lithotripsy has failed. Percutaneous transhepatic choledochoscopic lithotripsy (PTCL) has been used in Japan for the treatment of intrahepatic stones. We have employed a combined technique of ES and PTCL in the management of difficult cases previously amenable to major surgical intervention only. This technique was used successfully to treat large extrahepatic stones and intrahepatic stones, impacted basket and stone, and the medically compromised patient with choledocholithiasis.