Clinical Outcomes of Percutaneous Biliary Endoscopy: A 7-Year Single-Institution Experience

Purpose: To evaluate safety and effectiveness of percutaneous biliary endoscopy (PBE) performed on patients ineligible for surgery or endoscopic retrograde cholangiopancreatography. Materials and Methods: Retrospective review was conducted for all patients who underwent PBE at a single academic institution between June 2013 and February 2020; 39 patients underwent 58 choledochoscopy sessions, and 21 patients underwent 48 cholecystoscopy sessions. Choledochoscopy indications included stone removal (23 of 39 patients) or biliary stenosis evaluation (19 of 39 patients). Cholecystoscopy indications included calculous cholecystitis (18 of 21 patients) and symptomatic cholelithiasis (3 of 21 patients). Technical success, procedural and fluoroscopy times, and tube-free survival were assessed. Results: For all PBEs performed for stone clearance, using disposable endoscopes led to shorter mean +/- SD procedural (128.7 minutes +/- 56.2 vs 240.2 minutes +/- 184.6; P < .01) and fluoroscopy times (10.7 minutes +/- 7.9 vs 16.5 minutes +/- 12.0; P = .01) than using reusable endoscopes. Increasing institutional experience was associated with reduced procedural time (beta = -56.73; P < .001). Choledochoscopy technical success was 94.8% with 1 adverse event of bile duct perforation with bile leak requiring drainage. For patients with choledocholithiasis, biliary drains were removed in 14 (60.9%) patients, with a mean tube-free survival of 22.1 months +/- 23.8. For cholecystoscopy, technical success was 93.8% with no adverse events. Cholecystostomy tubes were removed in 15 (71.4%) patients, with a mean tube-free survival of 7.5 months +/- 8.8. Conclusions: This study supports PBE as a safe and feasible option for nonsurgical patients or those with altered anatomy precluding endoscopic retrograde cholangiopancreatography. Moreover, PBE may result in tube-free survival.