Percutaneous transhepatic cholangioscopy-guided holmium laser lithotripsy for bile duct stones in elderly patients

PURPOSE: To evaluate the safety and efficacy of percutaneous transhepatic endoscopic holmium laser lithotripsy (PTEHL) for bile duct stones in elderly patients aged ≥80 years. MATERIALS AND METHODS: This retrospective study included 50 patients (mean age 86.4 ± 4.5 years) who underwent PTEHL from January 2023 to December 2024. Inclusion criteria were age ≥ 80 years, presence of intra- and/or extrahepatic bile duct stones, and indication for PTEHL. Outcomes assessed included stone clearance, adverse events, and hospitalization duration. Adverse events were categorized according to the CIRSE classification. RESULTS: PTEHL was performed once in 48 patients, while 2 patients required two sessions. Final outcomes showed that all patients achieved complete (72%) or near-complete stone clearance (28%), with no requirement for any additional subsequent treatment. Thirteen patients (26%) experienced adverse events, mostly minor; only one moderate adverse event (biliopleural fistula) was recorded. No procedure-related mortality occurred. Multivariate analysis revealed that the presence of cholangitis and combined intra- and extrahepatic stones were significantly associated with incomplete clearance. Mean hospital stay was 14.8 ± 8.0 days and was significantly longer in patients with cholangitis (p = 0.001). CONCLUSION: PTEHL may represent a feasible minimally invasive treatment option for elderly patients with biliary stone.