Abstract No. 132 Predictors and Outcomes Following Percutaneous Gallstone Lithotripsy, Lithectomy, and Dual Cholecystoduodenal Stenting

To evaluate outcomes of percutaneous gallstone lithotripsy/lithectomy with dual cholecystoduodenal (CD) stenting in patients with calculous cholecystitis who are not surgical candidates. All patients with prior acute calculous cholecystitis who underwent percutaneous cholecystostomy followed by lithectomy [with or without lithotripsy and dual CD stenting] from March 2022 through August 2023 were included. All procedures involved fluoroscopy/endoscopy guidance. Patient demographics, reason for surgical ineligibility, and pertinent procedural data were collected. Gallstone characteristics on pre-procedural imaging were recorded including number of stones, size of largest stone, location of stones, and whether the stones were calcified. 25 patients (14 female) with a median age of 66 years (range: 30-94) were included in this study. Cardiopulmonary comorbidity was the most common reason a patient was not a surgical candidate (56%). Median duration of percutaneous cholecystostomy prior to extraction/lithotripsy was 104 days (range: 28-280). Lithotripsy/lithectomy was performed in 20 patients (80%) with lithectomy alone in 5 (20%). Technical success (>50% gallstones removed) was achieved in 20 patients (80%). Dual CD stents were placed in 20 patients (80%). 15 patients (60%) were "drain-free" immediately following the procedure, i.e., no longer required a percutaneous drain. External drains were removed later in 5 patients, resulting in 20 patients (80%) ultimately drain-free. Mean procedure time and radiation dose was 140 minutes (range: 61-254) and 801 mGy (range: 27-2571), respectively. Direct procedure-related adverse events occurred in 4 patients (16%). Median follow-up time was 238 days (95% CI: 29.2-530.2). There were no known cases of recurrent cholecystitis. Larger gallstone size correlated to longer procedure times (R = 0.46; p = 0.038), which was the only statistically significant pre-procedural imaging characteristic which impacted procedure time. Lithectomy with/without lithotripsy and dual CD stenting is a safe and effective procedure to make patients "drain-free." Pre-procedural imaging characteristics may be helpful in developing a predictive scoring system for procedural difficulty and likelihood of success. Including a greater number of cases, perhaps from a multi-institutional approach, would be helpful in formulating a reliable scoring system.