Supplementary Material for: Hybrid Percutaneous-Endoscopic Removal (HPER) of Cholelithiasis

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.急性胆囊炎（Acute cholecystitis, AC）每年影响超2000万美国人，年度相关医疗支出超过60亿美元。其最优治疗方案为早期胆囊切除术。然而，手术高风险患者需行经皮胆囊造瘘管（Percutaneous cholecystostomy tube, PCT）置入术，该操作可作为手术过渡方案，更常见的是作为确定性治疗手段。本文介绍我们针对长期留置PCT的患者开展的新型术式——“混合经皮内镜胆结石取出术（Hybrid Percutaneous Endoscopic Removal, HPER）”的应用经验。该术式是高危患者内镜超声引导下胆囊引流术的有效替代方案，无需特殊专业技能或设备，仅需通过已成熟的经皮通道置入全覆膜金属支架通路，即可经此通路完成胆囊结石的内镜下取出。该术式可预防胆结石相关并发症复发，同时减少长期留置PCT带来的医疗成本与不良事件。本视频展示了接受HPER作为结石性急性胆囊炎确定性替代治疗方案的患者病例系列及其长期随访结果。