SIR 2024
Gastrointestinal Interventions
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.
Robin Yoon, BS
Medical student
Georgetown University School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Matthew L. Lamberti, BS
Medical Student
Georgetown University School of Medicine
Disclosure information not submitted.
Daniel Marchalik, MD
Attending
MedStar Washington Hospital Center
Disclosure information not submitted.
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.
Nineteen patients (mean age 72.5yr, range 46–93yr; 9 male and 10 female) underwent large bore sheath (24–30Fr) cholangioscopy assisted gallstone extraction. The size of the gallstones ranged from 0.5–4.0cm. 16 patients had prior transhepatic and 3 patients had transperitoneal cholecystostomy access for an average of 137 days (0-786 days) prior to gallstone extraction.
All patients’ indwelling accesses were upsized to 24Fr or 30Fr sheaths using either the NephroMax balloon sheath system or the X-Force balloon dilation catheter. 13 patients were under general anesthesia and 6 patients were given conscious sedation. Mean procedure time was 92.2 min (SD 34.5 min) and mean fluoroscopy time was 21.0 min (SD 16.4 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 percutaneous gallstone extraction to biliary tube removal time was 46 days (range 15 to 119 days).
Of the nineteen patients, nine patients had one-year follow-up US or CT. Seven patients did not reach their one-year follow-up period, two patients were deceased, and one did not follow up. Of the nine patients, one had recurrent cholelithiasis and 0% had recurrent cholecystitis on imaging.
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. The majority of patients were stone-free on one-year follow-up imaging after percutaneous fluoroscopic-guided large-bore gallstone extraction.