SIR 2024
Gastrointestinal Interventions
Christopher Neely, MD
Resident
Northwestern Memorial Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Ali Husnain, MD (he/him/his)
Research Specialist
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Allison Reilland, n/a
Clinical Nurse
Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital
Disclosure information not submitted.
Kristine Stiff, RN
Nurse Clinician
Interventional Radiology, Northwestern Medicine
Disclosure information not submitted.
Bartley Thornburg, MD
Assitant Professor of Radiology
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Riad Salem, MD, FSIR, MBA
Professor
Northwestern Memorial Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Aziz Aadam, MD
Director of Interventional Endoscopy
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Ahsun Riaz, MD
Associate Professor, Interventional Radiology
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
All patients with prior acute calculous cholecystitis who underwent percutaneous cholecystostomy followed by lithectomy [with or without lithotripsy and dual CD stenting] from March 2022 through August 2023 were included. All procedures involved fluoroscopy/endoscopy guidance. Patient demographics, reason for surgical ineligibility, and pertinent procedural data were collected. Gallstone characteristics on pre-procedural imaging were recorded including number of stones, size of largest stone, location of stones, and whether the stones were calcified.
Results: 25 patients (14 female) with a median age of 66 years (range: 30-94) were included in this study. Cardiopulmonary comorbidity was the most common reason a patient was not a surgical candidate (56%). Median duration of percutaneous cholecystostomy prior to extraction/lithotripsy was 104 days (range: 28-280). Lithotripsy/lithectomy was performed in 20 patients (80%) with lithectomy alone in 5 (20%). Technical success ( >50% gallstones removed) was achieved in 20 patients (80%). Dual CD stents were placed in 20 patients (80%). 15 patients (60%) were “drain-free” immediately following the procedure, i.e., no longer required a percutaneous drain. External drains were removed later in 5 patients, resulting in 20 patients (80%) ultimately drain-free. Mean procedure time and radiation dose was 140 minutes (range: 61-254) and 801 mGy (range: 27-2571), respectively. Direct procedure-related adverse events occurred in 4 patients (16%). Median follow-up time was 238 days (95% CI: 29.2-530.2). There were no known cases of recurrent cholecystitis. Larger gallstone size correlated to longer procedure times (R = 0.46; p = 0.038), which was the only statistically significant pre-procedural imaging characteristic which impacted procedure time.
Conclusion:
Lithectomy with/without lithotripsy and dual CD stenting is a safe and effective procedure to make patients “drain-free.” Pre-procedural imaging characteristics may be helpful in developing a predictive scoring system for procedural difficulty and likelihood of success. Including a greater number of cases, perhaps from a multi-institutional approach, would be helpful in formulating a reliable scoring system.