HYBRID PERCUTANEOUS-ENDOSCOPIC REMOVAL (HPER) OF CHOLELITHIASIS

Acute cholecystitis (AC) affects over 20 million Americans annually, leading to an annual cost exceeding US$6 billion. Optimal treatment is early cholecystectomy (CCY). However, patients deemed high surgical risk undergo percutaneous cholecystostomy tube placement (PCT) as a bridge to surgery or more commonly as a definitive therapy. We hereby describe our experience with a new procedure named "Hybrid Percutaneous Endoscopic Removal (HPER) of cholelithiasis" that is meant for patients with chronic indwelling PCT. This procedure is an effective alternative to EUS guided gallbladder drainage in high risk patients. It does not require special expertise or technology and is simply performed by placement of a fully covered metal stent conduit through the existing mature percutaneous tract allowing endoscopic removal of gallstones through this conduit. This procedure can prevent recurrence of gallstone-related complications as well as chronic PCT-related cost and adverse events. In our video, we present a case series and long term follow up of patients who underwent HPER as an alternative definitive therapy for calculous AC.