What is Percutaneous Endoscopy or Choledoscopy gallstone procedure?
Percutaneous endoscopic procedure is a technique that can be used to treat patient that have gallstones, known as cholelithiasis, but cannot undergo surgery for gallbladder removal due to other medical issues. Often times these patients end up with a gallbladder drain, a cholecystostomy tube, that cannot be removed because of the risk of recurrent pain and symptoms.
There may also be stones in the bile ducts, known as choledocholithiasis.
This procedure is performed by specially trained interventional radiologists, a doctor who uses X-rays and other advanced imaging to see inside the body and treat conditions without surgery. The interventional radiologist using direct visualization with a camera and X-ray guidance from a fluoroscopy machine that allows for control of the instruments used to remove the stones.
Am I A Candidate for Percutaneous Gallstone Removal?
Endoscopic gallstone removal is for patients who are not able to have traditional gallbladder removal surgery or who have bile duct stones that cannot be removed in the standard fashion.
If you have had a gallbladder drain placed for gallstones but cannot get your gallbladder surgically removed, then you are potentially a candidate for this procedure.
This is a safe and effective procedure when performed by an experienced interventionalist with an understanding of techniques to reduce complications.
Gallstones can cause pain that is usually on the right side or middle of your upper belly, may be constant or worse after a heavy meal, may sometimes feel more like fullness than pain, may be felt in your back and in the tip of your right shoulder blade. Other symptoms may include nausea, vomiting, fever, and chills. The symptoms of gallbladder problems may look like other health problems. Always see your healthcare provider to be sure.
What is the Success Rate of Percutaneous Gallstone Removal?
Endoscopic and fluoroscopic-guided gallstone removal is highly successful, with complete stone removal from the gallbladder or bile ducts occurring in 80% of cases. This has a significant impact on patients and their family who are left to care for the drainage catheter, which would be otherwise for the rest of the patient’s life. After the procedure, the catheter can be removed allowing the patient to have a better quality of life.
How is the Endoscopic Gallstone Removal Performed?
Percutaneous endoscopy is performed through the existing gallbladder drain tract that you already have. If your gallbladder drain was placed through a portion of the liver however, a new drain will have to be placed and the old one removed.
After 6-8 weeks of healing to allow a tract to form around the gallbladder drain, the endoscopy can then be performed. After increasing the size of the drainage catheter over a short period (weeks) of time, the stones can then be removed with percutaneous endoscopy.
On the day of the procedure, the drain is exchanged for a larger temporary access into the gallbladder that will fit the endoscopic camera. Iodinated contrast material maybe injected into the bile ducts to locate gallstones that maybe causing blockage. Small stones are removed using a basket that fits through the camera. Other stones can be washed out by irrigating the gallbladder with saline or water. Larger stones can be fragmented under endoscopic guidance with a precisely directed holmium laser.
On average, it takes two scope episodes to clear patients of their stones. After the stones are removed, the tube will stay in place for a couple of weeks to ensure the gallbladder/bile system is still intact and then removed.
How to Prepare for Gallstone Removal Procedure
Prior to the Procedure
You may not eat or drink eight to 12 hours prior to the procedure.
If you are on blood-thinning medication, ask your provider if you need to stop it prior to the procedure.
During the Procedure
You will be asked to change into a gown before the procedure.
Labs maybe obtained.
You will be given a sedative by the anesthesiologist, who will be present to monitor your vital signs during the examination.
After the Procedure
You will remain in a recovery room until most of the effect of the sedative has worn off.
Because of sedation used during the procedure, you’ll need to make plans to have someone take you home.
What are the Risks?
Discomfort at the insertion site
Bile duct or gallbladder injuries like perforation