Safety and Usefulness of Percutaneous Transhepatic Cholecystoscopy (PTCCS) in High-Risk Surgical Patients Manifesting Acute Cholecystitis / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of the present study is to identify the diagnostic and therapeutic usefulness of percutaneous transhepatic cholecystoscopic examination (PTCCS) in high-risk surgical patients manifesting acute cholecystitis. METHODS: Between January 1992 and June 1998, 33 consecutive patients who underwent percutaneous transhepatic cholecystostomy (PC) and subsequent PTCCS for the management of acute cholecystitis were included. RESULTS: PC and subsequent PTCCS were successfully accomplished in all of 33 patients. During PTCCS, minor complication (2 of minor bleeding during electrohydraulic lithotripsy, 2 of tube dislodgement and 1 of bile leakage to peritoneum) occurred in five patients. PTCCS revealed 26 cases of gallstones, 3 cases of sludge ball, 3 cases of gallbladder carcinoma and 1 case of clonorchiasis related with acute cholecystitis. Three cases of the gallbladder cancers which were not predicted radiologically were incidentally found during PTCCS. For 26 patients with gallstones, PTCCS and concomitant stone removal were successfully carried out in one to four consecutive sessions (mean 2.2 sessions). Gallstones recurred in three (3/22, 14%) patients during the mean follow-up period of 27 months. All of them remain asymptomatic. CONCLUSIONS: PTCCS may be justified in the management of acute cholecystitis in selected patients with high surgical risk.

Percutaneous transhepatic cholecystoscopy in treating cholecystolithiasis / 中华消化内镜杂志

Objective To evaluate the significance of percutaneous transhepatic cholecystoscopy ( PTCCS) in managing cholecystolitheasis. Methods From September 1999 to November 2001, eighty - six patients with symptomatic gallstones were allocated into this study. At first percutaneous transhepatic gallbladder drainage ( PTGBD) was carried out, one week later the formed fistula was dilated by bouginage to 16-22Fr in diameter, thereafter cholecystoscope was inserted into gallbladder through the dilated fistula to extract the stones using basket or electrohydraulic lithotripsy (EHL). Results PTGBD was attempted successfully in 82 out of 86 cases, PTCCS was performed in 80 of them. The amount of stones ranged from 1 to 76, single stone in 28 patients, stones more than two in 52 , with stone size ranged from 5 to 32 mm, and stones greater than 15mm in 45 cases. The stones were removed only using basket in 28, and by EHL in 54 cases due to their large size. The overall stone removal rate was 97. 5 % (78/80) . Complication of peritonitis appeared in 4 cases (4. 7% ) requiring emergent surgical intervention. The follow - up period with an average of 16. 4 months, gallstones recurred in 2 cases (2.5%). Stones were assayed by intra - red spectrom-etry in 30 of 54 patients with EHL, cholesterol stone existed in 24 of them. Conclusion PTCCS is relatively a safe and effective procedure for those patients with high risk on surgical cholecystectomy, or unsuitable to receive laparoscopic cholecystectomy. If the patients were selected strictly along the rules of indication, the complication and stone recurrence can be avoided.

Nonsurgical Treatment of Gallbladder Stones with Percutaneous Transhepatic Cholecystoscopy / 대한소화기내시경학회지

With the technical development of ultrasonically guided punture of the gallbladder, percutaneous transhepatic cholecystoscopy(PTCCS) was first performed in 1981 by Inui et al. and Ichikawa et al. This procedure useful for preoperative, accurate diagnosis of carcinoma and nonsurgical treatment of high-risk patients with gallbladder stones. PTCCS-lithotripsy(PTCCS-L) is one of the non-surgical treatment modalities for gallbladder stones, and is a safe, reliable and technically easy therapeutic procedure through improvement in PTCCS-L manipulation and the development of new devices for this technique. PTCCS-L is performed when the patients with gallbladder stones cannot be operated on because of the risk of complications, such as renal failure, congestive heart failure etc. In this report, we present the proeedures of PTCCS-L for the the nonoperative treatment of gallbladder stones in the patient with cholangitis and cholecystitis because of common bile duct stone and gallbladder stones. Since a sinus tract of about 5 mm in diameter was needed to pass an endoscope, the sinus tract of percutaneous cholecystostomy was dilated immediately upto 18 French in diameter in a single step following percutaneous cholecystostomy itself, using a dilator set containing 10, 14, 16 and 18 French dilators and 18 French sheath. And then PTCCS-L with electrohydraulic lithotripter was successfully performed with a complete removal of gallbladder stones. There- after endoscopic sphincterotomy and mechanical lithotripsy was successfully done for the removal of common bile duct stone. There has been no recurrence of gall stones for up to 1 year.