Abstract No. 9 One-Year Follow-Up of Percutaneous Cholangioscopy-Assisted Rigid ShockPulse Lithotripsy for Inoperable Calculous Cholecystitis: A Multi-institutional Retrospective Review

The purpose of this study is to assess the one-year follow-up data for recurrent cholelithiasis on patients who had percutaneous Rigid ShockPulse lithotripsy for calculous cholecystitis. This is a multi-institutional institutional review board–approved retrospective review of patients who presented with calculous cholecystitis and were determined to be poor surgical candidates at two large academic institutions. All patients underwent percutaneous cholecystostomy tube placement for relief of acute infection and later upsized to a large-bore sheath for shock pulse lithotripsy and stone destruction. Review parameters included procedural technical and clinical data, including details of clinical presentation, 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 12-month follow-up imaging. Twelve patients (mean age, 74.6yr, range 52-94yr; 6 male and 6 female) underwent cholangioscopy-assisted gallstone destruction via rigid ShockPulse lithotripsy for stones larger than 1 cm (1.2–4.0 cm). All patients had prior cholecystostomy access for an average of 172 days (range 0-722 days) prior to gallstone extraction to ensure tract maturation via transhepatic and transperitoneal access. There was a 100% technical success rate in single-session stone removal with no major procedure-related complications. 100% were symptom and pain-free post-procedure. Mean procedure time was 111 min (SD 55.7 min) and mean fluoroscopy time was 19.2 min (SD 13.5 min). Mean hospital stay post-procedure was 1 day. Mean percutaneous shock pulse lithotripsy to biliary tube removal time was 35 days (range 17 to 44 days). Of the total 12 patients, eight patients presented for one-year follow-up imaging, two patients died, and two patients never followed up. Of the eight patients, one patient demonstrated cholelithiasis without evidence of acute cholecystitis. Fluoroscopic-guided percutaneous Rigid ShockPulse lithotripsy is a safe and efficacious procedure for gallstone destruction and extraction in patients who are poor surgical candidates with large lumen-occupying cholelithiasis. Most patients were stone-free on one-year follow-up imaging after percutaneous lithotripsy.