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Hybrid Percutaneous-Endoscopic Removal (HPER) of Cholelithiasis

机译：胆石病的杂种经皮 - 内窥镜去除（HPER）

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摘要

Acute cholecystitis (AC) affects over 20 million Americans annually, leading to annual costs exceeding USD 6 billion. Optimal treatment is early cholecystectomy. However, patients deemed high surgical risk undergo percutaneous cholecystostomy tube (PCT) placement 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 placing a fully covered metal stent conduit through the existing mature percutaneous tract allowing the endoscopic removal of gallstones through this conduit. This procedure can prevent the recurrence of gallstone-related complications as well as chronic PCT-related costs 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.
机译：急性胆囊炎（AC）每年影响2000多万美国人，导致每年的费用超过60亿美元。最佳治疗方法是早期胆囊切除术。然而，被认为具有高手术风险的患者，需要将经皮胆囊造瘘管（PCT）置入术中，作为通往手术的桥梁，或更常见的是作为最终治疗。我们在此介绍一种名为“混合式经皮内窥镜胆囊结石摘除术（HPER）”的新手术的经验，该手术适用于慢性留置PCT患者。该手术是EUS引导下高危患者胆囊引流的有效替代方法。它不需要特殊的专业知识或技术，只需在现有成熟的经皮导管中放置一个完全覆盖的金属支架导管，即可通过该导管内窥镜取出胆石。这种手术可以防止胆结石相关并发症的复发，以及慢性PCT相关费用和不良事件的发生。在我们的视频中，我们介绍了一系列病例和长期随访，这些患者接受HPER作为结石性AC的替代最终治疗。

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