Abstract No. 288: Efficacy of Percutaneous Transcystic Cholangioscopy for CBD Stone Management via Existing Cholecystostomy: Early Results from Cholangioscopy Registry
Abstract No. 289: Percutaneous Cholangioscopy in Practice: Trends and Outcomes from the National Cholangioscopy Registry.
Two Featured Abstracts highlighting early results from the National Cholangioscopy Registry will be presented at SIR 2025, detailing the safety and efficacy of various percutaneous cholangioscopy (PCS) procedures in biliary disease management.
A landmark registry
The National Cholangioscopy Registry included 527 patients who underwent 851 PCS procedures. Their overall results are detailed in Abstract No. 289, Percutaneous Cholangioscopy in Practice: Trends and Outcomes from the National Cholangioscopy Registry. The registry, which was supported with funding from SIR Foundation, pulled data from 17 clinical sites across the United States, thereby providing researchers with insights into procedural effectiveness and emerging trends.
“Despite the growing interest in PCS as a minimally invasive alternative for managing biliary diseases, large-scale multicenter data have been scarce,” said Arun Kamireddy, MD, MBBS.
While endoscopic techniques like endoscopic retrograde cholangiopancreatography (ERCP) are well established, PCS data is largely limited to small, single-institution experiences, despite the vital role it plays in treating patients with altered anatomy or failed endoscopic access, he said.
“We recognized the need for robust data to better inform clinical decision-making and potentially shape future guidelines,” Dr. Kamireddy said. “Our objective was to provide insights into procedural indications, technical and clinical success rates, anesthesia practices and complication profiles, ultimately defining the role of PCS in contemporary interventional radiology practice.”
The study, which represents the largest multicenter analysis of PCS to date, found that PCS is a highly effective and safe procedure, with technical success achieved in 97.1% of cases and clinical success in 86.4%.
“These results affirm PCS as a reliable alternative for managing biliary stones and strictures, especially in complex clinical scenarios,” Dr. Kamireddy said.
Notably, researchers found that both reusable and disposable scopes yielded comparable outcomes, which has implications for cost-effectiveness and infection control.
“Additionally, the relatively low complication rate (3.6%) and high rate of successful tube removal (71.8%) highlight the favorable post-procedural outcomes associated with PCS,” Dr. Kamireddy said. “By providing multicenter, real-world data, our study not only validates the utility of PCS but also sets the stage for standardizing procedural practices across institutions.”
In addition to documenting the experiences of over 500 patients who underwent PCS procedures, researchers also submitted an abstract specifically evaluating the safety and efficacy of percutaneous transcystic cholangioscopy (PTC) to manage common bile duct (CBD) stones.
Managing CBD stones
Abstract No. 288, Efficacy of Percutaneous Transcystic Cholangioscopy for CBD Stone Management via Existing Cholecystostomy: Early Results from Cholangioscopy Registry, details the outcomes of 30 patients who received PTC—many of whom had comorbidities that made them unfit for surgery.
Many patients who undergo gallbladder decompression via a cholecystostomy tube also have CBD stones that require further intervention, Dr. Kamireddy said. Traditional management options include percutaneous transhepatic access or repeat endoscopic procedures, both of which can be technically challenging.
“Our study evaluated the safety and efficacy of PTC for managing common bile duct stones using a pre-existing cholecystostomy tube,” said Dr. Kamireddy. “Given the growing use of disposable, smaller profile cholangioscopes and advanced stone retrieval techniques, we wanted to assess whether this transcystic approach could provide a minimally invasive, time-saving and cost-effective alternative to standard percutaneous or endoscopic methods.”
Researchers found that this was a highly effective approach, with a 95.3% technical success rate and a procedural success rate of 87.5%.
“The ability to access the CBD through the cystic duct without requiring new transhepatic access reduces procedure-related risks, shortens procedural times and minimizes radiation exposure,” Dr. Kamireddy said. “Importantly, 83.3% of patients successfully had their cholecystostomy tube removed, signifying that this technique not only facilitates immediate stone clearance but also contributes to long-term management success.”
In addition, researchers believe the low complication rate (1.6%), and the complete absence of pancreatitis further supports the technique’s safety, reinforcing that it should be considered a primary approach in select patients, particularly those with prior failed ERCP or contraindications for surgery.
“This study underscores the importance of optimizing existing access routes rather than creating new ones whenever possible,” Dr. Kamireddy said. “By utilizing the pre-existing cholecystostomy tube and the natural cystic duct pathway, this approach minimizes unnecessary interventions, reduces costs and enhances patient safety.”
Dr. Kamireddy will present his findings during SIR 2025 on Wednesday, April 2, at 10:30 a.m. during the Cholangioscopy session.
