Hybrid transgastric NOTES for gallbladder-preserving cholecystolithotomy: a feasible and minimally invasive approach to gallstone management.

BACKGROUND Cholecystectomy has traditionally been the mainstay of treatment for symptomatic gallstones; however, the complications of cholecystectomy have led to the adoption of minimally invasive gallbladder-preserving approaches in some patients. A simple but highly effective technique is currently lacking. This study aimed to evaluate the feasibility and safety of a novel endoscopic transgastric gallbladder-preserving cholecystolithotomy (GPC) for this condition.

METHODS This was a single-arm prospective clinical study involving 23 patients with symptomatic gallstones enrolled between July 2018 and August 2020. All patients underwent a novel endoscopic transgastric GPC, in which we performed the cholecystogastrostomy via transgastric natural orifice translumenal endoscopic surgery (NOTES) using a gallbladder stent as the passage before advanced endoscopic cholecystolithotomy. Technical success, therapeutic efficacy, and procedure-related complications were evaluated.

RESULTS The technical success rate of transgastric NOTES-guided cholecystogastric stent placement was 95.7% (22/23). One case which failed due to an intraoperative finding of pericholecystic adhesions was subsequently converted to cholecystectomy. Among the 22 patients who achieved technical success, 19 underwent a simple cholecystolithotomy using a basket or balloon. In the remaining three patients, two required lithotripsy for large gallstones and the other for an incarcerated calculus using an ultraslim endoscope on retrial. All 22 patients achieved wound healing within 4 days postoperatively. Common procedure-related complications were hemorrhage and infection, all of which were mild and temporal. The overall stone recurrence rate was 9.1% at the 3-year follow-up.

CONCLUSION The novel endoscopic transgastric GPC could be a safe and effective alternative endoscopic approach for GPC.