24-Month Outcomes of Percutaneous Large-Bore Gallstone Removal for Inoperable Calculous Cholecystitis

Sunday, March 30, 2025

3:09 PM – 3:18 PM CT

Location: Music City Center, 205 A

Presenting Author(s)

Neil K. Jain, DO (he/him/his)

Integrated Interventional Radiology Resident
Medstar Georgetown University Hospital, United States

Author/Co-author(s)

Robin Yoon, BS

Medical student
Georgetown University School of Medicine, United States
Wilton Fidelis

Medical Student
Georgetown University School of Medicine, United States
DM

Daniel Marchalik, MD

Attending
MedStar Washington Hospital Center, United States
John B. Smirniotopoulos, MD, MS

Assistant Professor of Radiology
MedStar Georgetown University Hospital, United States

Purpose: Evaluate 24-Month clinical outcomes of large bore (24–30 French) percutaneous cholangioscopy-assisted gallstone extraction for patients with calculous cholecystitis who are poor surgical candidates.

Materials and Methods: An Institutional Review Board (IRB) approved retrospective review was conducted for patients at a large academic center who presented with calculous cholecystitis and were determined to be high-risk surgical candidates. Review parameters included procedural technical and clinical data, average hospital length of stay, and post-intervention symptom reduction. Technical success was defined as the removal of all stones during the procedure. Clinical success was defined as stone-free on 24-month follow-up imaging.

Results:
Fourteen consecutive patients (mean age 74yr, range 52-93yr; 6 male and 8 female) underwent large bore sheath (24–30Fr) access for percutaneous cholangioscopy-assisted gallstone extraction. The size of the gallstones ranged from 1.0–4.0cm. 12 patients had prior transhepatic and 2 patients had transperitoneal cholecystostomy access for an average of 145 days (0-786 days) prior to gallstone extraction.

All patients’ indwelling accesses were upsized to 24Fr or 30Fr sheaths using a balloon-catheter-assisted sheath. 9 patients were under general anesthesia and 5 patients were given conscious sedation. Mean procedure time was 98.5 min (SD 36.8 min) and mean fluoroscopy time was 25.6 min (SD 36.8 min). There was a 100% technical success rate in a single-session stone removal. There were no major complications. 100% were symptom and pain-free post-procedure. Mean hospital stay post-procedure was 1 day. Mean time from percutaneous gallstone extraction to biliary tube removal time was 57 days (range 15 to 135 days).

Of the fourteen patients, six patients had two-year follow-up US or CT. Five patients were deceased at 24 months and 3 patients elected not to follow-up. Of the six patients, no patients had recurrent cholelithiasis on imaging or recurrent cholecystitis.

Conclusion: Image-guided percutaneous large-bore gallstone extraction is a safe and efficacious procedure for gallstone destruction and extraction in patients who are poor surgical candidates with patients remaining symptom free without stone reformation at 24 months.