Abstract No. 10 ▪ FEATURED ABSTRACT Single-Institution Retrospective Analysis and One-Year Follow-Up of the Efficacy of Fluoroscopic-Guided Large-Bore Gallstone Extraction for Inoperable Calculous Cholecystitis

The objective of this study is to assess the one-year follow-up and efficacy of image-guided percutaneous large-bore (24–30 French) gallstone extraction for a subset of patients who are poor surgical candidates. This is an institutional review board–approved retrospective review of patients at a large academic center who presented with calculous cholecystitis and were determined to be high-risk surgical candidates. Review parameters included procedural technical and clinical data, 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 one-year follow-up imaging. Nineteen patients (mean age, 72.5yr, range 46–93yr; 9 male and 10 female) underwent large-bore sheath (24–30Fr) cholangioscopy-assisted gallstone extraction. The size of the gallstones ranged from 0.5–4.0 cm. 16 patients had prior transhepatic and 3 patients had transperitoneal cholecystostomy access for an average of 137 days (0-786 days) prior to gallstone extraction. All patients' indwelling accesses were upsized to 24Fr or 30Fr sheaths using either the NephroMax balloon sheath system or the X-Force balloon dilation catheter. 13 patients were under general anesthesia and 6 patients were given conscious sedation. Mean procedure time was 92.2 min (SD 34.5 min) and mean fluoroscopy time was 21.0 min (SD 16.4 min). There was a 100% technical success rate in a single-session stone removal. There were no major complications. 100% were symptom and pain-free post-procedure. Mean hospital stay post-procedure was 1 day. Mean percutaneous gallstone extraction to biliary tube removal time was 46 days (range 15 to 119 days). Of the 19 patients, nine patients had one-year follow-up US or CT. Seven patients did not reach their one-year follow-up period, two patients were deceased, and one did not follow up. Of the nine patients, one had recurrent cholelithiasis and 0% had recurrent cholecystitis on imaging. Image-guided percutaneous large-bore gallstone extraction is a safe and efficacious procedure for gallstone destruction and extraction in patients who are poor surgical candidates. The majority of patients were stone-free on one-year follow-up imaging after percutaneous fluoroscopic-guided large-bore gallstone extraction.