Abstract No. 12 Systematic Review Analyzing Percutaneous Cholangioscopy and Lithotripsy for Inoperable Calculus Cholecystitis

There is limited available literature on percutaneous gallstone extraction for large stones using lithotripsy in patients with inoperable calculus cholecystitis. The purpose of this study is to provide a comprehensive review of the efficacy and safety profiles for the commonly utilized types of lithotripsy including electrohydraulic lithotripsy (EHL), extracorporeal shock wave lithotripsy (ESWL), ShockPulse lithotripsy (SPL), and laser lithotripsy (LL). This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, Web of Science and CINAHL were utilized for this systematic review. Search terms of interest included: "gallstone", "gallbladder", "cholelithiasis", "cholecystolithiasis", "lithotripsy", "choledocholithiasis", "shockwave", "extracorporeal", "ShockPulse", "holmium", "laser", and "electrohydraulic". Case reports, conference abstracts, editorials, and manuscripts other than English were excluded from the study. The primary outcomes examined include demographics, technical success rate, procedure times, stone recurrence, and adverse events. An initial 1022 articles were screened using Rayyan, where a total of 16 articles met inclusion criteria. 495 patients with inoperable calculus cholecystitis were treated with either EHL (n = 72), ESWL (n = 332), SPL (n = 12), or LL (n = 79). The average technical success for EHL, ESWL, SPL, and LL was 87.5% (SD 12.0), 81.3% (SD 22.3), 100%, and 95.0% (SD 11.8) respectively. ESWL was associated with shorter procedural times on average at 53.6 min (SD 23.4) versus 71.9 min (SD 13.7) in the EHL group, 111.5 min (SD 55.8) in the SPL group, and 153.9 (SD 22.9) in the LL group. The adverse event rate was 4.2% in the EHL group, 5.4% in the ESWL group, zero-percent in the SPL group, and 6.3% in the LL group. The stone recurrence rate within 12 months for patients treated with EHL was 6.9%, 48.5% in the ESWL group, and 4.4% in the LL group. There were no recurrences in the SPL group at a 3 month follow up. EHL, ESWL, SPL, and LL are safe and effective techniques for inoperable calculus cholecystitis. Among the four types of lithotripsy, the SPL cohort demonstrated a superior technical success with the lowest major complication rate and with no recurrent cholelithiasis. One-year stone recurrence was the highest in the ESWL group.