Predictors and Outcomes Following Percutaneous Gallstone Lithotripsy, Lithectomy, and Dual Cholecystoduodenal Stenting

Objective: To evaluate the outcomes of percutaneous gallstone lithotripsy/lithectomy with dual cholecystoduodenal stenting (CDS) in acute calculous cholecystitis (ACC) patients ineligible for surgery. Materials and Methods: Thirty patients with ACC who underwent percutaneous cholecystostomy (PC) followed by lithectomy (with or without lithotripsy/dual CDS) under fluoroscopy and endoscopy guidance from March 2022 to December 2023 were included in this retrospective study. Demographics, reasons for surgical ineligibility, and procedural data were collected. Gallstone characteristics on preprocedural imaging were recorded, including the number of stones, the size of the largest stone, and the calcification status. Results: Eighteen (60%) patients were female [median age 66 (30 to 94)]. Cardiopulmonary comorbidities were the most common reason for surgical ineligibility [15 (50%)]. The median duration between PC and the index lithectomy procedure was 100 days (28 to 280). Lithotripsy/lithectomy was performed in 22 patients (73%), with lithectomy alone in 8 (27%). CDS was performed concurrently in 24 patients (80%). Technical success, defined as a >50% decrease in gallstone burden and dual CDS, was achieved in 23 patients (77%). PC tubes were removed in 25 (83%) patients: immediately postprocedure in 19 (63%) and on follow-up in 6 (20%). Larger gallstone size correlated with longer procedure times (R=0.45; P =0.026). Uncomplicated acute pancreatitis occurred in 4 (13%) patients. Clinical success, defined as the absence of cholecystitis recurrence, was 100%, with a median follow-up of 364 days (range, 301 to 573). Conclusions: Percutaneous lithectomy with/without lithotripsy and dual CDS is a safe and effective procedure for managing ACC in poor surgical candidates to enable them to live drain-free.