Safety and effectiveness of percutaneous electrohydraulic and laser lithotripsy in the management of biliary stones: a multicenter retrospective from the National Percutaneous Cholangioscopy Registry

Wednesday, April 2, 2025

11:33 AM – 11:42 AM CT

Location: Music City Center, 202 A

Presenting Author(s)

Alec Jost, MD

Resident
Johns Hopkins Hospital, United States

Author/Co-author(s)

BR

Brett Riedinger, MD

Interventional Radiology Resident
Indiana University School of Medicine, United States
AH

Antoinette Hu, MD

Surgery Resident
Penn State Health, United States
Ali Husnain, MD (he/him/his)

Postdoctoral Research Fellow
Northwestern University, United States
Ali Kord, MD, MPH

Assistant Professor of Radiology
University of Cincinnati Medical Center, United States
AG

Andrew Gunn, MD

Vice Chair, Interventional Affairs
University of Alabama At Birmingham, United States
Ahsun Riaz, MD

Interventional Radiologist
Northwestern University, United States
EP

Eric Pauli, MD

Surgeon
Penn State Health, United States
MJ

Matthew Johnson, MD

Interventional Radiologist
Indiana University, United States
Harjit Singh, MD, FSIR

Professor of Radiology and Radiological Science
Johns Hopkins Hospital, United States

Purpose: Percutaneous lithotripsy (PeL) is a valuable modality in the treatment of biliary obstruction secondary to stones. Percutaneous electrohydraulic lithotripsy (PeEHL) and percutaneous laser lithotripsy (PeLL) represent subtypes of PeL. Limited evidence exists regarding the safety and efficacy of PeL overall, as well as the similarities and differences between PeEHL and PeLL. This abstract utilizes aggregate data from the National Percutaneous Cholangioscopy Registry to provide clinical information on the outcomes and adverse events associated with PeL overall as well as the similarities and differences in the outcomes and adverse events of PeLL relative to PeEHL.

Materials and Methods: Data from six participating centers regarding 82 PeEHL procedures in 71 patients and 161 PeLL procedures in 96 patients from the National Percutaneous Cholangioscopy Registry was extracted and analyzed. Data points pertaining to patient demographics, technical/procedural/clinical success, complete stone clearance rate, and adverse events were included.

Results: Procedural success, defined as at least partial stone removal or cholangioscopic appearance warranting no further need for intervention, occurred in 90.2% of PeEHL and 96.9% of PeLL cases, a difference with statistical significance (p value = .03). However, clinical success, defined as improvement in clinical symptoms (e.g. abdominal pain, fever, jaundice, nausea and vomiting), imaging findings, and/or laboratory values, was achieved in 92% of PeEHL and 96% of PeLL cases. This difference was without statistical significance (p value =.12). Major adverse events occurred in 3.1% of PeLL cases and 3.3% of PeEHL cases, a difference without statistical significance (p value = .82).

Conclusion: Retrospective review of NCPR data supports PeL as a valuable treatment in certain cases of biliary obstruction secondary to stones. PeEHL and PeLL demonstrated similar clinical success and adverse event rates, suggesting that either platform can be a reasonable treatment option in the hands of an appropriately trained operator. Percutaneous lithotripsy is often reserved for patients with difficult-to-access biliary stones, complex anatomy, or those who have failed prior therapy such as ERCP. Further study is needed to clarify optimal technique and equipment selection, as well as to characterize the role of lithotripsy in the long-term management of biliary stones.