Nonsurgical Treatment of Gallbladder Stones with Percutaneous Transhepatic Cholecystoscopy

Kim, Jin Hong; Park, Chan Wook; Moon, Jong Ho; Lee, Joon Seong; Choi, Jae Dong; Lee, Moon Sung; Cho, Sung Won; Shim, Chan Sup

Abstract

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.