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Peroral cholecystoscopy with electrohydraulic lithotripsy for treatment of symptomatic cholelithiasis in end-stage liver disease (with videos).
Gastrointest Endosc. 2008 Jan; 67(1):132-5.GE

Abstract

BACKGROUND

Patients with end-stage liver disease have an increased risk of symptomatic gallstone disease, as well as complications associated with cholecystectomy. We hypothesized that peroral transpapillary cholecystoscopy with electrohydraulic lithotripsy of gallbladder stones is technically feasible and beneficial in patients who are high operative risks.

DESIGN

Observational, descriptive.

PATIENTS

Patients with Child's class C cirrhosis and with gallstone symptoms who were awaiting liver transplantation.

INTERVENTIONS

Gallbladder stenting, dilation of the cystic duct, cholecystoscopy, electrohydraulic lithotripsy, ursodiol therapy.

MAIN OUTCOME MEASUREMENTS

Gallbladder access and visualization, stone clearance, symptom relief, and complications.

RESULTS

The gallbladder wall and stones were adequately visualized. Electrohydraulic lithotripsy achieved stone clearance after two sessions. Mild postprocedure pancreatitis occurred after the first treatment. The patient remained symptom free, stent free, and stone free until a liver transplantation, which was performed 25 months later.

LIMITATIONS

Proof of concept performed in a single patient.

CONCLUSIONS

Peroral transpapillary cholecystoscopy is technically feasible. Electrohydraulic lithotripsy of gallbladder stones under direct vision can achieve stone clearance. Patients with cirrhosis who are awaiting transplantation and other high-risk surgical candidates with symptomatic gallstone disease may benefit from this treatment option. Studies to assess the efficacy and safety of this novel technique are needed before routine clinical use can be recommended.

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Authors+Show Affiliations

Chen YK
Denver, Colorado, USA.
Nichols MT
No affiliation info available
Antillon MR
No affiliation info available

MeSH

Cholangiopancreatography, Endoscopic RetrogradeCholecystolithiasisCystic DuctEndoscopy, Digestive SystemFluoroscopyHumansLithotripsyLiver CirrhosisMaleMiddle AgedSphincterotomy, EndoscopicStents

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18155435

Citation

Chen, Yang K., et al. "Peroral Cholecystoscopy With Electrohydraulic Lithotripsy for Treatment of Symptomatic Cholelithiasis in End-stage Liver Disease (with Videos)." Gastrointestinal Endoscopy, vol. 67, no. 1, 2008, pp. 132-5.
Chen YK, Nichols MT, Antillon MR. Peroral cholecystoscopy with electrohydraulic lithotripsy for treatment of symptomatic cholelithiasis in end-stage liver disease (with videos). Gastrointest Endosc. 2008;67(1):132-5.
Chen, Y. K., Nichols, M. T., & Antillon, M. R. (2008). Peroral cholecystoscopy with electrohydraulic lithotripsy for treatment of symptomatic cholelithiasis in end-stage liver disease (with videos). Gastrointestinal Endoscopy, 67(1), 132-5.
Chen YK, Nichols MT, Antillon MR. Peroral Cholecystoscopy With Electrohydraulic Lithotripsy for Treatment of Symptomatic Cholelithiasis in End-stage Liver Disease (with Videos). Gastrointest Endosc. 2008;67(1):132-5. PubMed PMID: 18155435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peroral cholecystoscopy with electrohydraulic lithotripsy for treatment of symptomatic cholelithiasis in end-stage liver disease (with videos). AU - Chen,Yang K, AU - Nichols,Matthew T, AU - Antillon,Mainor R, PY - 2007/06/08/received PY - 2007/08/11/accepted PY - 2007/12/25/pubmed PY - 2008/3/13/medline PY - 2007/12/25/entrez SP - 132 EP - 5 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 67 IS - 1 N2 - BACKGROUND: Patients with end-stage liver disease have an increased risk of symptomatic gallstone disease, as well as complications associated with cholecystectomy. We hypothesized that peroral transpapillary cholecystoscopy with electrohydraulic lithotripsy of gallbladder stones is technically feasible and beneficial in patients who are high operative risks. DESIGN: Observational, descriptive. PATIENTS: Patients with Child's class C cirrhosis and with gallstone symptoms who were awaiting liver transplantation. INTERVENTIONS: Gallbladder stenting, dilation of the cystic duct, cholecystoscopy, electrohydraulic lithotripsy, ursodiol therapy. MAIN OUTCOME MEASUREMENTS: Gallbladder access and visualization, stone clearance, symptom relief, and complications. RESULTS: The gallbladder wall and stones were adequately visualized. Electrohydraulic lithotripsy achieved stone clearance after two sessions. Mild postprocedure pancreatitis occurred after the first treatment. The patient remained symptom free, stent free, and stone free until a liver transplantation, which was performed 25 months later. LIMITATIONS: Proof of concept performed in a single patient. CONCLUSIONS: Peroral transpapillary cholecystoscopy is technically feasible. Electrohydraulic lithotripsy of gallbladder stones under direct vision can achieve stone clearance. Patients with cirrhosis who are awaiting transplantation and other high-risk surgical candidates with symptomatic gallstone disease may benefit from this treatment option. Studies to assess the efficacy and safety of this novel technique are needed before routine clinical use can be recommended. SN - 0016-5107 UR - https://www.unboundmedicine.com/medline/citation/18155435/Peroral_cholecystoscopy_with_electrohydraulic_lithotripsy_for_treatment_of_symptomatic_cholelithiasis_in_end_stage_liver_disease__with_videos__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(07)02587-4 DB - PRIME DP - Unbound Medicine ER -