A new IR procedure is safe and effective for patients with calculous cholecystitis—gallbladder infection caused by gallstones—who are poor surgical candidates.
Georgetown University IRs in Washington, DC, have shown that their technique—percutaneous fluoroscopic- and cholangioscopic-guided large-bore gallstone extraction—had technical and clinical success in gallstone removal.
Their findings will be presented as a 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,” during Sunday’s Scientific Session 1, Hepatobiliary, from 3–4:30 p.m. MT.
The abstract will be presented by Neil K. Jain, DO, a fourth-year IR resident at Georgetown. Dr. Jain presented the safety and efficacy results on the procedure at the previous two SIR conferences. Now, he’s presenting on the 1-year follow-up of the efficacy.
The percutaneous fluoroscopic- and cholangioscopic-guided gallstone extraction is a relatively new procedure on its own, but Georgetown IRs are using a larger access (24–30 French) with the technique in order to remove more gallstones in fewer sessions.
“This access type is unique in terms of the size,” explained John Smirniotopoulos, MD, a vascular and interventional radiologist at MedStar Washington Hospital Center, MedStar Georgetown University Hospital as well as an assistant professor of radiology at MedStar Georgetown University Hospital. “We’re one of only a few institutions that are doing it, but we believe that it allows for a more efficient and expeditious way of removing gallstones, therefore requiring fewer procedure encounters for patients.”
Dr. Jain will present the results of a retrospective review of 19 patients at Georgetown University Hospital who presented with calculous cholecystitis and were determined to be high-risk surgical candidates. Technical success was defined as the removal of all stones, and clinical success was defined as stone free on 1-year follow-up imaging.
The findings showed there were no major complications, and patients were able to have their cholecystostomy tube removed between 15 and 119 days following the procedure (mean removal time was 46 days). Patients were stone free 1 year later based on imaging, and none had recurrent cholecystitis.
While surgeons would often prefer to remove the gallbladder laparoscopically, some patients have comorbidities that are contraindicated for surgery, Dr. Smirniotopoulos said. In those cases, IRs may perform a percutaneous cholecystostomy tube placement—inserting a biliary catheter to drain the bile. The gallstones are not removed upon initial placement due to infection.
With this procedure, patients need to drain their bag multiple times a day over several months. Once the infection is cleared, contrast dye is injected to ensure the blockage is gone. If so, an IR can begin the slow method of removing the drain. That entails putting a cap on the drain and leaving it as a safety measure for a few months to see if the patient has any symptoms, before removing the drain.
“The problem with that is we know, based on surgical data, there’s anywhere between 20–30% of recurrent infection of a gallbladder if these stones are left in place,” Dr. Smirniotopoulos said. “If there’s persistent obstruction of the stones, those patients are subject to living with a drain and getting it exchanged every 3 months.”
Patients with gallbladder infections who cannot undergo surgery would all get a bag and go on antibiotics to help drain the infected bile. “We have this population that otherwise was routinely getting their drain exchanged and living with a bag,” Dr. Smirniotopoulos said, “and now we have a method of getting rid of the stones and subsequently getting rid of the bag.”
The new technique “has found its place to help these patients out, get their stones out, get them drain free to improve their quality of life and reduce risk of recurrent infection of the gallbladder,” he said.
