A 32-year-old man presented with recurrent right upper abdominal pain for >1 year, exacerbated by fatty food intake. Ultrasonography indicated gallbladder stones (22 mm × 8 mm) complicated with cholecystitis. He was admitted for the treatment of gallbladder stones. After admission, due to impacted stones in the gallbladder neck, the gallbladder contraction test yielded no measurable results, while laboratory examination indicators showed no obvious abnormalities. Given the patient's strong desire for gallbladder preservation, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) was performed on 19 September 2025. Endoscopic lithotripsy was conducted 1 month later ( Video 1 ). The endoscope was advanced along the stent, revealing impacted stones in the gallbladder neck ( Fig. 1 ). Repeated attempts using a snare, lithotripsy basket, and stone extraction basket were unsuccessful in removing the stones. Therefore, endoscopic electrohydraulic lithotripsy (EHL) under direct vision was adopted to fragment the stones, followed by successful extraction. On postoperative day 4, endoscopic re-examination confirmed a clear gallbladder lumen without residual stones, and the AXIOS stent was removed ( Fig. 2 ). Gastroscopic re-examination 1 week after the operation indicated that the fistula orifice had basically healed. Two months after surgery, the gallbladder contraction test showed good function ( Fig. 3 ).
Fig. 1.
The combination of endoscopic ultrasound-guided gallbladder drainage and electrohydraulic lithotripsy. a Impacted gallbladder neck stones. b Electrohydraulic lithotripsy. c Clean gallbladder lumen after stone extraction.
Fig. 2.
Post AXIOS stent extraction and fistula healing status. a Post stent removal. b Nearly closed fistula with local ulceration 1 week postoperatively.
Fig. 3.
The gallbladder contraction test performed 2 months after surgery showed good gallbladder contractile functions.
Endoscopic ultrasound-guided gallbladder drainage and electrohydraulic lithotripsy for the treatment of gallbladder neck stones.
Video 1
Gallbladder stones are common with rising incidence, 1 which can lead to complications such as acute cholecystitis, acute pancreatitis, gallstone ileus, and gallbladder cancer. 2 Current treatment modalities usually include EUS-guided interventional stone extraction and surgical intervention. 3 At present, EHL is widely used in the treatment of biliary tract stones under surgical choledochoscopy, characterized by high lithotripsy efficiency and minimal tissue damage 4 . Previously, impacted gallbladder neck stones generally required surgical cholecystectomy. This case report describes the first innovative application of EUS-GBD combined with electrohydraulic lithotripsy for the treatment of impacted gallbladder neck stones, ultimately achieving complete stone clearance while preserving gallbladder functions.
Endoscopy_UCTN_Code_TTT_1AS_2AH
Acknowledgement
We would like to express our sincere gratitude to all individuals and institutions who contributed to the completion of this study. First and foremost, we extend our deepest appreciation to the patient for his trust and willingness to participate in this innovative treatment and follow-up process, which made this case report possible. We are highly grateful to the medical and nursing staff of the Department of Gastroenterology at The 960th Hospital of PLA Joint Logistic Support Force for their professional assistance in patient care, endoscopic procedures, and postoperative follow-up. Special thanks go to our colleagues in the radiology department for providing high-quality imaging support, which was crucial for the accurate diagnosis and intraoperative guidance.
Footnotes
Conflict of Interest The authors declare that they have no conflict of interest.
Contributorsʼ Statement Yifan Wang: Conceptualization, Writing – original draft. Qianqian Dong: Conceptualization, Writing – original draft. Lingmin Li: Project administration, Resources, Supervision. Xiaofeng Liu: Conceptualization, Writing – review & editing. Wenbo Li: Conceptualization, Methodology. Qun Li: Conceptualization, Writing – review & editing.
References
- 1.Song Y, Ma Y, Xie F et al. Age, gender, geographic and clinical differences for gallstones in China: a nationwide study. Ann Transl Med. 2022;10:735. doi: 10.21037/atm-21-6186. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Baca-Arzaga A, Navarro-Chávez A, Galindo-Jiménez A et al. Gallstone lithotripsy with SpyGlass system through a cholecystoduodenal fistula in a patient with type IIIa Mirizzi syndrome. Rev Gastroenterol Mex (Engl Ed) 2021;86:99–101. doi: 10.1016/j.rgmx.2020.01.003. [DOI] [PubMed] [Google Scholar]
- 3.Chan S, Teoh A, Yip H et al. Feasibility of per-oral cholecystoscopy and advanced gallbladder interventions after EUS-guided gallbladder stenting (with video) Gastrointest Endosc. 2017;85:1225–1232. doi: 10.1016/j.gie.2016.10.014. [DOI] [PubMed] [Google Scholar]
- 4.Manes G, Paspatis G, Aabakken L et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2019;51:472–491. doi: 10.1055/a-0862-0346. [DOI] [PubMed] [Google Scholar]