Abstract No. 11 Large-Bore Cholecystoscopy for the Treatment of Acute Calculous Cholecystitis

To investigate outcomes of percutaneous large-bore cholecystoscopy with gallstone extraction for the treatment of acute calculous cholecystitis in high-risk surgical candidates. A retrospective review from 2018 - 2021 was conducted of high-risk surgical patients with acute calculous cholecystitis who underwent percutaneous cholecystostomy tube (PCT) placement followed by subsequent large-bore cholecystoscopy and gallstone extraction at a minimum 4-6 weeks after acute presentation. Initial PCT placements were performed with ultrasound or fluoroscopic guidance through transperitoneal or transhepatic approaches. Subsequent cholecystoscopy was performed using a 24/26F Storz rigid endoscope and/or a Spyglass flexible endoscope through a 30 French Teflon sheath, with or without Olympus ShockPulse SE lithotripsy and NCircle Nitinol stone extractor. Baseline demographics, liver function tests, procedural details, and outcomes including technical success, time to tube removal, recurrence, and complications were evaluated. Eleven patients were included in the study with a median patient age of 81 years. Ten patients demonstrated gallbladder and duct patency without residual cholelithiasis after cholecystoscopy and interventions, equaling a technical success rate of 91%. The mean length of hospital stay among all patients was 2.6 ± 2.2 days (median 3, range 0-7). There were two (18%) major procedure-related complications and one (9%) minor complication. One patient (9%) in this cohort died within three months of cholecystoscopy, and two (18%) were instructed to follow up with their original referring institution and were not included in follow-up. Eight patients (89%, excluding those who were not followed) had their PCTs successfully removed without evidence of recurrence within three months. Seven patients (77%) showed no evidence of recurrence within a year. The mean length of time from cholecystoscopy to PCT removal was 30.5 days (median 14, range 2-144, SD 46.8), and the mean length from initial PCT placement to removal was 111 days (median 90, range 9-241, SD 77.7) Large-bore percutaneous cholecystoscopy for gallstone extraction is a safe and effective treatment alternative for acute calculous cholecystitis with high technical success rate and low rate of recurrence up to one year. However, medical comorbidities for which operative cholecystectomy is deferred should be evaluated carefully when considering cholecystoscopy versus long-term PCT management in very high risk patients.