New Procedure Removes Gallstones Without Surgery.

Gallstones are hard deposits of cholesterol, pigmentation, calcium, or bile that can form in the gallbladder, a small organ in the upper abdomen that stores and releases bile as part of the digestive system. Stones can cause life-disrupting symptoms such as abdominal pain, nausea and vomiting, and fever or chills.  

For most gallstones causing symptoms or infection, treatment options are straightforward:

• No treatment if there are no symptoms
• Medications to help dissolve stones
• Percutaneous cholecystostomy tube (PCT), which requires regular dressing changes and limits personal activities such as bathing and exercise.
• Surgery to remove the gallbladder (cholecystectomy)

However, not everyone can have or necessarily wants surgery. In these cases, or for patients living with a “gallbladder drain” or percutaneous cholecystostomy tube (PCT) that was placed for previous infection, a new procedure is available at MedStar Washington Hospital Center. 

With this procedure called percutaneous cholangioscopy, we can treat the stones without surgically removing the gallbladder. This advanced treatment is offered by John Smirniotopoulos, MD, and the MedStar Interventional Radiology team at Washington Hospital Center. 

Using the existing gallbladder drain, a camera called a “cholangioscope” is inserted into the gallbladder without creating a new incision. Using the camera, Dr. Smirniotopoulos can remove the gallstones and leave the gallbladder in place using a variety of innovative tools.

For very large gallstones (larger than 1.5 centimeters), patients can get cutting-edge dual modality lithotripsy—a highly effective, nonsurgical treatment that leaves no fragments behind with percutaneous cholangioscopy. Offering this advanced treatment at MedStar Washington Hospital Center grew from a collaboration between the Stone Disease Program led by urologist Daniel Marchalik, M.D., and John Smirniotopoulos, M.D., and the Interventional Radiology team. 

By combining our specialized training and surgical skills, we can offer patients with complex health problems an effective treatment for large and recurrent gallstones.

What to expect with percutaneous cholangioscopy and dual mode lithotripsy.

If your doctor determines you are a candidate for this procedure, you will receive anesthesia and pain medication. Dr. Smirniotopoulos will locate the gallstones using fluoroscopy, a continuous X-ray technique that displays your anatomy on a computer monitor in real time, as well as percutaneous cholangioscopy, using a camera (called SpyGlass Discover) through the existing PCT to directly identify the gallstones. Stones that are less than 1.5cm will be removed using a combination of devices including baskets and lasers.

For stones larger than 1.5cm, Dr. Marchalik will insert a thin probe called a dual action lithotripsy system into the gallbladder through the cholangioscope. The lithotripsy machine transmits shock pulses and ultrasonic waves through the probe, which causes pressure that breaks up the stones into particles that are suctioned out at the same time. 

Any residual small fragments are passed through the intestines along the normal route. The treatment takes less than two hours, and most patients spend the night in the hospital after the procedure.

A combination of shock pulse and ultrasonic lithotripsy isn’t a new technology—it’s a new application of a proven treatment used to treat kidney stones. This method directs high energy shock waves at stones to break them into small pieces that are removed at the same time.

In our research, which was published in the Journal of Interventional and Vascular Radiology, we found that this approach completely removes the gallstones, reducing the risk of recurrent stones. All our patients have reported being pain-free and symptom-free after the procedure. 

Working together to benefit patients.

We are continuing to investigate the benefits of dual modality lithotripsy for gallstones and track our patients’ outcomes. With a wide range of world-class specialists in our center, we are always working to find new uses for, and improvements upon, existing technology.

This collaboration between the Interventional Radiology and the Urology Kidney Stone teams is just one example of how we combine our knowledge to develop innovative solutions that benefit our patients.