SENSITIVITY OF PERCUTANEOUS ENDOSCOPY COMPARED WITH ULTRASONOGRAPHY IN THE DETECTION OF RESIDUE OR MUCOSAL LESIONS AFTER TOPICAL GALLBLADDER STONE DISSOLUTION

Background: Early gallstone recurrence in some patients after ''succes sful'' percutaneous topical dissolution may be due to residual debris. An endoscope small enough to be introduced without dilating the exist ing percutaneous track was used for gallbladder examination after ston e dissolution. Methods: The sensitivity of gallbladder endoscopy was c ompared with ultrasonography and double-contrast cholecystography for the detection of residual debris or mucosal lesions in 18 patients who underwent percutaneous topical dissolution. All examinations were per formed before catheter removal and after the gallbladder was deemed st one-free by the traditionally employed technique of single-contrast ch olecystography. Results: Residual debris was detected in only one pati ent by ultrasonography and in none of the 18 patients by double-contra st cholecystography, yet endoscopy showed stone fragments ranging from 1 to 3 mm in 13 of the 18 patients. In all these patients, catheter r epositioning and additional solvent perfusion resulted in elimination of the debris as assessed endoscopically. Two patients had endoscopica lly detected erosions. Double-contrast fluoroscopy found only one of t hese, whereas ultrasonography detected neither. Conclusions: Percutane ous gallbladder endoscopy is a more sensitive imaging modality for the detection of residual stone debris or mucosal lesions after gallstone dissolution.