Clinical Outcomes of Percutaneous Biliary Endoscopy: A 7-Year Single-Institution Experience |
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| Affiliation: | 1. Division of Interventional Radiology, Department of Radiology, Cleveland Clinic, Cleveland, Ohio;2. Division of Interventional Radiology, Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland;3. Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts;1. Interventional Radiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana;2. Vascular and Interventional Specialists, Charlotte Radiology, Charlotte, North Carolina;3. Interventional Radiology, Northwestern Medicine, Palos Health, Palos Heights, Illinois;4. Los Angeles Imaging and Interventional Consultants, PIH Health, Whittier, California;5. Gastroenterology and Hepatology, Atrium Health, Charlotte, North Carolina;6. Division of Hepatobiliary and Pancreas Surgery, Atrium Health, Charlotte, North Carolina;1. Department of Radiology, Kaiser Permanente Oakland Medical Center, Oakland, California;2. Department of Radiology, Kaiser Permanente Richmond Medical Center, Richmond, California;3. Department of Psychology, George Mason University, Fairfax, Virginia;1. Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin;2. Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin;3. Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania;4. Division of Vascular and Interventional Radiology, Department of Radiology, University of California San Diego, La Jolla, California;1. Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts;2. Medical School, Sigmund Freud University, Vienna, Austria;3. Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts;4. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts |
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| Abstract: | PurposeTo evaluate safety and effectiveness of percutaneous biliary endoscopy (PBE) performed on patients ineligible for surgery or endoscopic retrograde cholangiopancreatography.Materials and MethodsRetrospective review was conducted for all patients who underwent PBE at a single academic institution between June 2013 and February 2020; 39 patients underwent 58 choledochoscopy sessions, and 21 patients underwent 48 cholecystoscopy sessions. Choledochoscopy indications included stone removal (23 of 39 patients) or biliary stenosis evaluation (19 of 39 patients). Cholecystoscopy indications included calculous cholecystitis (18 of 21 patients) and symptomatic cholelithiasis (3 of 21 patients). Technical success, procedural and fluoroscopy times, and tube-free survival were assessed.ResultsFor all PBEs performed for stone clearance, using disposable endoscopes led to shorter mean ± SD procedural (128.7 minutes ± 56.2 vs 240.2 minutes ± 184.6; P < .01) and fluoroscopy times (10.7 minutes ± 7.9 vs 16.5 minutes ± 12.0; P = .01) than using reusable endoscopes. Increasing institutional experience was associated with reduced procedural time (β = −56.73; P < .001). Choledochoscopy technical success was 94.8% with 1 adverse event of bile duct perforation with bile leak requiring drainage. For patients with choledocholithiasis, biliary drains were removed in 14 (60.9%) patients, with a mean tube-free survival of 22.1 months ± 23.8. For cholecystoscopy, technical success was 93.8% with no adverse events. Cholecystostomy tubes were removed in 15 (71.4%) patients, with a mean tube-free survival of 7.5 months ± 8.8.ConclusionsThis study supports PBE as a safe and feasible option for nonsurgical patients or those with altered anatomy precluding endoscopic retrograde cholangiopancreatography. Moreover, PBE may result in tube-free survival. |
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