Gastrointestinal Interventions

Session: Educational Exhibit Presentations - Station 4: Gastrointestinal Interventions

Percutaneous Cholangioscopy-Assisted Electrohydraulic Versus Laser Lithotripsy for Gallbladder and Biliary Tract Stones: Comparison of Technique, Safety, and Efficacy

Monday, March 6, 2023

5:10 PM – 5:15 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

MS

Michael Samuel, MD (he/him/his)

Fellow
University of Cincinnati

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

MD

Mouhamed Diop, MD

Resident
University of Cincinnati
Jacob Byers

Medical Student - M2
University of Cincinnati College of Medicine
Ali Kord, MD, MPH

Assistant Professor of Radiology
University of Cincinnati Medical Center
BN

Bashar Nahab, MD

Assistant Professor of Radiology
University of Cincinnati

Disclosure(s):

Michael Samuel, MD: No financial relationships to disclose

Mouhamed Diop, MD: No financial relationships to disclose

Jacob Byers: No financial relationships to disclose

Ali Kord, MD, MPH: No financial relationships to disclose

Learning Objectives:

An image-rich case-based review and comparison between two modalities of percutaneous lithotripsy for gallbladder and biliary tract stones.

To review the techniques and device settings for each lithotripsy modality.

To discuss the efficacy and safety of each modality.

Background: Percutaneous transhepatic interventions including stone retrieval and lithotripsy are emerging effective treatment options for gallbladder (GB) and intrahepatic biliary stones, particularly if conventional endoscopic and/or surgical approaches fail or due to non-surgical candidacy. Two percutaneous cholangioscopy-assisted lithotripsy (PCAL) techniques are available: electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL). There is a paucity of standardized data on the safety and efficacy of emerging percutaneous techniques to treat biliary stones. This exhibit provides a comparison between two modalities (EHL versus LL), to help guide interventional radiologists (IRs) to choose the most suitable option for their patients.

Clinical Findings/Procedure Details: PCAL techniques including EHL and LL are becoming widely used by IRs. Each modality provides certain advantages and disadvantages. EHL uses a charge generator transmitting a charge across the electrodes at the tip of a bipolar probe, generating a spark that expands the surrounding fluid resulting in an oscillating shockwave that fragments the stones. EHL causes displacement of the stone fragments during fragmentation. The Laser system utilize Holmium laser technology and laser fiber which produces a thermal effect due to its strong absorption by water, which results in stone vaporization, it converts the stones into very tiny fragments or dust, allowing it to pass freely into the bowel via the biliary system, without significantly displacing the stone fragments during fragmentation, providing more control. The dusting technique prolongs the procedure time. EHL can be advantageous in intrahepatic ducts interventions, LL can be favorable in GB interventions in addition to intrahepatic ducts stones. Complications of both EHL and LL include hemobilia, ductal perforation, and bile leak. GB perforation and bile duct injury are more likely to occur with LL due to the thermal effect.

Conclusion and/or Teaching Points: Both EHL and LL are effective modalities for GB and intrahepatic stones. EHL is advantageous for intrahepatic stones. LL is a favorable option for GB stones in addition to intrahepatic stones. Given the unique characteristics of each modality, in-depth knowledge of both techniques is important to guide IRs to select the most appropriate modality for their patients.