Issue link: https://viewer.e-digitaledition.com/i/1418924
to Address Gallstones BY K ATY MENA-BERKLEY PENN STATE HEALTH MILTON S. HERSHEY MEDICAL CENTER OFFERS PATIENTS WHO ARE NOT CANDIDATES FOR GALLBL ADDER REMOVAL THE OPPORTUNIT Y TO LIVE LIFE DRAIN-FREE THROUGH PERCUTANEOUS ENDOSCOPIC BILIARY LITHECTOMY (PEBL). F O R M A N Y PAT I E N T S liv i ng w it h cholelithiasis, life with a drain is a matter of course. Clinicians at Penn State Health Milton S. Hershey Medical Center are on a mission to change that narrative. Through a procedure called percutaneous endoscopic biliary lithectomy (PEBL), doctors can remove gallstones that are either in the gallbladder or have migrated downstream to the biliary tree without having to perform a surgery. "Many people we care for who have a lready had a dra in put in have been thoroughly reviewed and told they are not candidates for standard procedures to take out their stones," says Eric Pauli, MD, chief of the Division of Minimally Invasive and Bariatric Surgery at the Milton S. Hershey Medical Center and the David L. Nahrwold professor of surgery at Penn State College of Medicine. "For example, if you have severe underlying pulmonary disease, you might not be a candidate for genera l anesthesia and ga llbladder remova l. We can perform PEBL w it h minima l to no sedation, take out the gallstones and then remove the drains, curing the patient's disease without removing any organs." REPURPOSING A PROCEDURE To perform PEBL, a physician utilizes a previously placed drain that goes into a patient's gallbladder or bile ducts. The physician then threads a small camera t h rou g h t he d ra i n t ra c t t o prov ide visualization while performing one of the following procedures: + Basket and remove the gallstones + Flush the gallstones downstream + Break the gallstones into small pieces and remove them " Va r iou s people h ave been doi n g a version of PEBL for years, so we did not invent this concept," Dr. Pauli says. "What we did was start more widespread implementation. Using PEBL for gallstone remova l grew organica lly out of other operations we were doing." Specifica lly, years ago a radiologist with Hershey Medica l Center bega n removing stones from the bile duct by taking a scope down a tract, inspiring Dr. Pauli a nd Joshua S. Winder, MD, genera l surgeon at Hershey Medica l Center, to employ PEBL for the purpose of removing gallstones from surgically complicated patients. "Oftentimes, interventional radiologists ma na ge t hese t y pes of procedu res, and they do them a bit differently than surgeons do, starting with an imaging background," Dr. Winder says. "Dr. Pauli and I see things through a surgical lens. But as experienced endoscopists, we are able to use endoscopic techniques to navigate the gastrointestinal tract, get around tight corners, open things up and remove stones and debris. For patients who are poor candidates for surgery, this is an effective option to remove stones and improve quality of life." n To learn more, call 717-531-8887 or visit pennstatehealth.org/mis. " We have the ability to dramatically change the long-term treatment options for patients who have been told they have to live with a drain in place. Yes, the trade-off is a few trips to the medical center, but if two trips to get a drain out allows you to avoid pain and visits to the hospital every couple of weeks to have the drain changed, the trade-off is well worth it." — ERIC PAULI, MD, CHIEF OF THE DIVISION OF MINIMALLY INVASIVE AND BARIATRIC SURGERY AT HERSHEY MEDICAL CENTER AND THE DAVID L. NAHRWOLD PROFESSOR OF SURGERY AT PENN STATE COLLEGE OF MEDICINE A Sophisticated Solution Endoscopic view of a gallstone being removed with a basket M D N E W S . C O M /// M D N E W S M I D - P E N N ■ 2 0 21 0 7