Abstract No. 5 Advances in Minimally Invasive Hepatobiliary Intervention for Non-operative Candidates

Cholangioscopy has been available since the 1970s with limited use in interventional radiology (IR) because of issues with poor percutaneous access options, limited steerability, irrigation capabilities, and requirement for more than one operator. Direct intraluminal visualization of the gallbladder, common bile ducts, and even the ampulla and duodenum has become more practical with the advent of single-operator percutaneous systems such as the Spyglass cholangioscope. Such systems enhance possibilities in diagnosis and treatment, particularly in patients that are non-operative or poor peroral endoscopic candidates because of the severity of illness or previous surgery. This study presents seven innovative minimally invasive percutaneous techniques for the evaluation and treatment of common bile duct diseases using the Spyglass cholangioscope, including electrohydraulic lithotripsy for stone removal, forceps biopsy after failed brush biopsy, ampulla sphincteroplasty, hepatic duct stone retrieval, common bile duct stent inspection, and a unique method for large, bulky cholelith removal. All patients selected for cholangioscopy were non-operative or had limited peroral endoscopic options. •Patient A: Electrohydraulic lithotripsy in a non-operative candidate with choledocholithiasis and ascending cholangitis.•Patient B: Forceps biopsy after a failed brush biopsy in a patient with an altered gastrointestinal tract due to previous surgery.•Patient C: Ampulla sphincteroplasty and common bile duct stricture dilation in a patient who underwent gastric bypass surgery.•Patient D: Hepatic duct stone retrieval with subsequent successful tube removal.•Patient E: Cholangioscopy-confirmed common duct stent patency when fluoroscopy suggested stenosis.•Patient F: Stent inspection through the cholangioscope allowing for necessary adjustments.•Patient G: Large, bulky cholelith removal. Single-operator percutaneous cholangioscopy has revolutionized the evaluation and treatment of hepatobiliary diseases in non-operative or poor endoscopic candidates. By utilizing cholecystostomy and/or biliary tubes with tract maturation, we successfully visualized and treated various biliary conditions, including stone removal, biopsy, sphincteroplasty, and stent management. These minimally invasive techniques offer valuable alternatives to traditional approaches, improving patient outcomes and quality of life.