Treatment of gallbladder stones without scalpel

A 91 y.o. Male with recurrent right upper quadrant colicky pain, with one stone on abdominal ultrasound who refused surgical intervention presented to my attention asking for gallbladder treatment alternative to surgery.

Elective endoscopic gallbladder treatment (EEGBT) was offered to him who accepted.

After exclusion of common bile duct stones at EUS, transgastric placement of a 15x10mm Axios sent was done (Figure 1) at UPMC-Salvator Mundi International Hospital.

One week later, intracholecystic inspection disclosed numerous large gallstones. Holmium laser lithotripsy was initiated and performed for about 2 hours (Figure 3). Lithotripsy treatment was repeated few days later until complete stone clearance was obtained. At the end, stent was removed (Figure 4) and fistulous tract closed with endoscopic clips (Figure 5).

No complications occurred in any of the different procedural steps.

This case clearly illustrate the possibility to endoscopically treat gallstone disease, even in complex cases with multiple large stones.