Percutaneous cholecystocutaneous stent-graft placement for large-bore cholecystolithotomy: initial experience in 13 patients.

To evaluate the feasibility and safety of percutaneous cholecystocutaneous stent-graft placement for large-bore cholecystolithotomy.

Materials and Methods:

Non-operative patients with calculous cholecystitis initially treated with cholecystostomy tube drainage who underwent percutaneous cholecystocutaneous stent-graft placement for cholecystolithotomy access from November 2022 to June 2024 were reviewed.  Stent-grafts (Viabahn, Gore, DE, USA) were deployed in the cholecystostomy tube tract and balloon dilated prior to cholecystoscopic guided cholecystolithotomy.  Stent-grafts were removed at the end of the procedures and replaced with drainage catheters.  Clinical and procedural data was recorded.  Technical success was defined as uncomplicated deployment and removal of a cholecystocutaneous stent-graft during cholecystolithomy.  Clinical success was defined as the absence of biliary tract symptoms after cholecystostomy tube removal.  Adverse events were classified according to the SIR system.

Results:

Thirteen patients underwent percutaneous cholecystocutaneous stent-graft placement for cholecystolithotomy during the study period. Mean age was 60 +/- 10 years (range 43-79). Median ASA score was 3 (range 3-4) and median WHO performance status was 3 (range 1-4).  Median modified frailty index was 4 (range 1-5).  7 patients had transhepatic and 6 patients had transperitoneal cholecystostomy tube access. Cholecystostomy tubes were in situ for a mean duration of 58 +/- 35 days (range 7-113) prior to the procedure. 3 patients had a single gallstone and 10 patients had multiple gallstones. Mean size of the largest gallstone was 1.7 +/- 0.7 cm (range 1-3). The median length and diameter of the stent grafts were 10 cm (range 10-15) and 8 mm (range 8-9) respectively. Mean procedure duration was 169 +/- 69 minutes (range 80-322).  All gallstones were removed in a single cholecystolithotomy session in 7 patients.  5 patients required 2 sessions and 1 patient required 3 sessions.  Subsequent sessions did not require large-bore access.  Mean duration of follow up was 263 +/- 164 days (range 29-569). Technical success was achieved in 12/13 patients; one stent graft unraveled during removal and required forceps retrieval.  Clinical success was achieved in all patients.  One SIR class B adverse event occurred: self-limiting pancreatitis requiring hospital admission.

Conclusion:

Cholecystocutaneous stent-graft placement for large-bore cholecystolithotomy is feasible and safe and may be an alternative to large-bore sheath placement.