SIR 2024
Gastrointestinal Interventions
Robin Yoon, BS
Medical student
Georgetown University School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Neil K. Jain, DO (he/him/his)
Integrated Interventional Radiology Resident
Medstar Georgetown University Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
John B. Smirniotopoulos, MD
Assistant Professor of Radiology
MedStar Georgetown University Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
To provide and discuss diverse types of percutaneous cholangioscopy-assisted lithotripsy for patients with inoperable calculous cholecystitis secondary to stones >1cm, including electrohydraulic lithotripsy, holmium/thulium laser lithotripsy, and ShockPulse-SE lithotripsy.
Background:
Calculous cholecystitis (CC) is inflammation of the gallbladder that occurs in the setting of occlusion of cystic duct and represents nearly one-third of all surgical emergency hospital admissions. Current gold-standard of CC treatment is surgical cholecystectomy but is often impractical among the ageing patient population with contraindication to surgery. Alternative treatment involves the placement of a percutaneous cholecystostomy tube placement, which serves as a bridge to cholecystectomy until the patient is deemed eligible for surgery. However, most patients (43-94%) who receive cholecystostomy tubes do not undergo cholecystectomy within the subsequent year due to ongoing contraindications to surgery and further complications such as increased gallstone burden and size {4,5}. Interventional Radiology-operated cholangioscopy with intraductal lithotripsy has emerged as an effective modality for large stones ( >1cm) removal in otherwise inoperable CC with high technical success, few complications, short hospital length of stay and recurrence of calculous cholecystitis. Percutaneous cholangioscopy-assisted lithotripsy, precluded by percutaneous cholecystostomy tube, proves to be safe, technically feasible and clinically effective procedure for patients with symptomatic calculous cholecystitis who cannot undergo surgical cholecystectomy.
Clinical Findings/Procedure Details: 1. Provide current management workflow of symptomatic calculous cholecystitis. 2. Explore several commonly used modalities that can be employed for gallstone extraction in inoperable calculous cholecystitis, including electrohydraulic lithotripsy, holmium laser lithotripsy, ShockPulse-SE lithotripsy (dual action between ultrasonic and shockwave). 3. Review clinical and technical success and subsequent post-discharge follow-up clinical evaluation and imaging.
Conclusion and/or Teaching Points: