Purpose
Evaluate 3-month outcomes of Gallstone Organ-Sparing Cholangioscopy and Percutaneous Extraction (GO-SCOPE) with de novo access in patients with calculous biliary colic seeking gallbladder preservation.
Materials and Methods
This study is an institutional review board–approved, prospectively collected, and retrospectively analyzed cohort of patients presenting to a large academic center with calculous biliary colic. All patients met standard criteria for cholecystectomy following surgical evaluation, but elected to undergo GO-SCOPE. Data collected included procedural and clinical parameters, hospital length of stay, incidence of repeat cholangioscopy, time to cholecystostomy tube removal, and post-procedural symptom improvement. Technical success was defined as complete removal of all visualized stones during the procedure. Clinical success was defined as stone-free status on 3-month follow-up imaging without recurrence of biliary colic symptoms.
Results
Fifty-one patients (mean age 46.7yr, range 25.9–76.1yr; 14 male and 37 female) with biliary colic secondary to cholelithiasis, 44 patients had transhepatic, 6 patients had transperitoneal, and 1 patient had both transhepatic and transperitoneal de novo cholecystostomy accesses at the time of GO-SCOPE. A minimally invasive rigid (MIP-L) nephroscope was utilized in 47 patients, while a disposable cholangioscope was used in 3 patients and a flexible cystoscope in 1 patient to visualize the stones. Dual-energy lithotripsy was performed on 34 patients, electrohydraulic lithotripsy on 2 patients, and laser lithotripsy on 4 patients. Basket retrieval and irrigation were utilized solely in 11 patients. Mean procedure time was 54.0 min (SD 27.6 min), and mean fluoroscopy time was 10.1 min (SD 8.9 min). There was a 100% technical success rate in stone removal with no major adverse events. A cholecystostomy tube was left in place to allow decompression of the gallbladder and tract formation. 100% were symptom-free and pain-free during follow-up at the time of tube removal. Mean hospital stay post-procedure was 23 hours. Mean gallstone extraction to biliary tube removal time was 21.8 days (SD 9.5 days). One of the 51 patients (2.0%) demonstrated residual 4-mm cholelithiasis on 3-month follow-up US or cross-sectional imaging. No patients had cholecystitis or cholangitis.
Conclusion
Gallstone Organ-Sparing Cholangioscopy and Percutaneous Extraction (GO-SCOPE) is a safe and effective outpatient procedure for gallstone removal in healthy patients who seek to preserve their gallbladder.