Fig 2
Cholecystography through indwelling 8-French catheter (white arrow), demonstrating impacted gallstone (dashed arrow). There was no drainage into cystic or common bile ducts.
Source publication
Interventional radiology‐operated percutaneous endoscopy has seen a recent resurgence with potential to return to the scope of Interventional Radiology practice. Endoscopy adds a new dimension to the Interventional Radiology armamentarium by offering a unique opportunity to diagnose and treat conditions under direct visualization with improved mane...
Context in source publication
Context 1
... gallbladder decompression prior to planning of cholecystocopy. b Under ultrasound-guidance, an 8-French locking pigtail catheter (Flexima APDL; Boston Scientific, Marlborough, MA, USA) was inserted transhepatically into the gallbladder fundus along the long-axis. c Cholecystography demonstrated a large filling defect in the gallbladder neck (Fig. 2). d The catheter was locked into position and secured externally with a non-absorbable suture and left to gravity ...
Citations
... Interventional radiologists have many devices and techniques available to treat biliary stones in challenging locations. Some of these techniques include extracorporeal shock wave, electrohydraulic, ultrasonic, and laser lithotripsy [21][22][23][24][25][26][27][28]. In addition, percutaneous choledochoscopy has been shown to assist complex biliary interventions, including lithotripsy and stone removal [28][29][30][31]. ...
OBJECTIVE. The purpose of this study was to quantify abdominal CT predictors of endoscopically refractory, uncontrolled variceal hemorrhage requiring portal venous intervention. MATERIALS AND METHODS. From 2009 to 2018, 64 patients with endoscopically refractory variceal hemorrhage requiring portal venous intervention (variceal hemorrhage group) and 67 patients without hemorrhage but with symptomatic, pressure gradient-proven portal hypertension (control group) underwent CT. CT scans were retrospectively reviewed for the following: varix size, variceal intraluminal protrusion, liver and spleen volumes, and portal vein diameter. RESULTS. Gastric variceal protrusion was found to be a strong CT parameter associated with refractory hemorrhage (mean depth, 0.75 mm in variceal hemorrhage group vs -2.91 mm in control group; p = 0.001). Gastric varix size was also associated with variceal hemorrhage (mean diameter, 8.03 vs 6.51 mm; p = 0.001). However, this trend was not observed in the sizes of the esophageal varices (mean diameter, 6.28 vs 6.43 mm; p = 0.370). Larger spleen volume (mean, 1312 vs 1152 cm3; p = 0.029) and liver volume (mean, 1514 vs 1143 cm3; p = 0.004) were also found to be predictors of variceal hemorrhage. Significant CT threshold findings included gastric variceal protrusion depth more than 0 mm (odds ratio [OR], 6.44), gastric varix size more than 6 mm (OR, 3.89), spleen volume more than 1000 cm3 (OR, 2.63), and liver volume more than 1000 cm3 (OR, 2.82). CONCLUSION. Quantitative imaging parameters on abdominal CT, such as intraluminal protrusion of gastric varices, gastric varix size, and larger spleen and liver volumes, were predictive of portal venous intervention, whereas esophageal varix size was not.
... In addition, interventional topics have been increasing over the last 5 years. We have seen topics of safe IR-led sedation, 4,5 diagnostic and technical experiences through all body systems [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] and have been shown that IR offers low-cost alternatives to traditional surgical procedures. [22][23][24] The selection of articles in this virtual issue highlights some of the interesting historic manuscripts published by Australasian Radiology and is complimented by popular interventional articles over the last few years in JMIRO. ...
La litiasis biliar se conoce como la presencia de cálculos o piedras en la vesícula biliar. Se conocen diferentes factores patógenos asociados a la formación de los cálculos en los que se incluyen antecedentes genéticos relacionados con la hipersecreción hepática de colesterol y bilis. Su tratamiento se basa en la colecistectomía laparoscópica, sin embargo la complicación post operatoria conocida como cálculo biliar “retenido” sintomático basándose en un tratamiento con el uso de drenaje y/o aspiración de las colecciones, pero los avances con la radiología intervencionista permitió medios menos invasivos. Se realizó una búsqueda de artículos con diferentes descriptores relacionados con el tema. Dando como resultado diferentes reportes de casos en los que se reflejan como el uso de la radiología intervencionista en los cálculos biliares ha permitido ser un método menos invasivo en estos casos, así como diferentes enfoques que han buscado los radiólogos intervencionistas para la extracción de los cálculos biliares. Por ello, la radiología intervencionista ofrece una alternativa ideal y prometedora en el manejo de la litiasis y colelitiasis.
Purpose:
The aim of this study is to assess the safety and efficacy of percutaneous ShockPulse lithotripsy for gallstone eradication in patients with calculous cholecystitis with stones greater than 1cm.
Materials and methods:
Multi-institutional Institutional Review Board (IRB) approved retrospective review of patients who presented with calculous cholecystitis and were not determined to be surgical candidates. All patients underwent percutaneous cholecystostomy tube placement for acute infection which was later exchanged for a large sheath for ShockPulse lithotripsy and stone destruction. Review parameters included procedural technical and clinical data, including clinical presentation, mean hospital length of stay, and post-intervention symptom reduction.
Results:
Twelve patients (mean age 74.6yr, range 52-94yr; 6 male and 6 female) underwent large bore sheath (24 - 30 French) cholangioscopy assisted gallstone destruction via rigid ShockPulse lithotripsy. The size of the gallstones ranged from 1.2-4.0 cm. All patients had prior cholecystostomy access for mean 25 weeks prior to gallstone extraction to ensure tract maturation via transhepatic or transperitoneal access. There was a 100% technical success rate in single-session stone removal with no major procedure-related complications. All patients were symptom and pain-free post-procedure. Mean procedure time was 111.5 minutes, and mean fluoroscopy time was 19.2 min. Median hospital stay was 1-day post-procedure. Mean time from percutaneous ShockPulse lithotripsy to biliary tube removal time was 35 days (17 to 45 days).
Conclusion:
Fluoroscopic-guided percutaneous rigid ShockPulse lithotripsy is a safe and efficacious procedure for gallstone destruction and extraction in patients that are poor surgical candidates with large lumen-occupying cholelithiasis.
Laparoscopic cholecystectomy is considered the standard treatment option for symptomatic cholelithiasis and acute cholecystitis. However, in non-surgical candidates or patients meeting criteria of severe presentation, percutaneous cholecystostomy is the recommended approach to management, generally with the intent of eventual cholecystectomy. Should interval cholecystectomy not be an option, additional novel percutaneous techniques for stone extraction and/or gallbladder ablation have shown success in the recent literature and, along with cholecystostomy, are presented in this review.
OBJECTIVE. The purpose of this article was to evaluate the feasibility and efficacy of percutaneous fluoroscopic-guided stone retrieval from the cystic duct and antegrade common bile duct (CBD) stone advancement into the duodenum exclusively through a cholecystostomy tube. MATERIALS AND METHODS. Twenty-one patients with acute cholecystitis and choledocholithiasis or an impacted cystic duct stone who underwent percutaneous cholecystostomy tube placement were retrospectively enrolled in this study. The patients had a contra-indication for cholecystectomy (17 patients because of comorbidities and one who declined surgery) or had failed endoscopic retrograde stone removal attempts (three patients). RESULTS. The 21 patients underwent subsequent percutaneous CBD (17 patients) and cystic duct (9 patients) stone removal on follow-up sessions through the percutaneous cholecystostomy track using moderate sedation. A total of 32 stone removal procedures were performed. Seventeen patients underwent balloon dilatation sphincterotomy, after which the CBD stones were pushed forward into the duodenum using a compliant balloon. Seven patients also had stone removal from the cystic duct by a stone retrieval basket. The primary technical success rate for removal of all CBD and cystic duct stones was 76%. The secondary technical success rate was 100%. The clinical success rate was 74%. All patients tolerated the procedures well without major complication. The clinical follow-up interval ranged from 2 to 2310 days (median, 30 days), with no incidence of postprocedural complications. CONCLUSION. Percutaneous transcholecystic common bile and cystic duct stone removal through an existing cholecystostomy access is a safe and effective procedure that is well tolerated.
