Bing-Rong Liu1, Li-Xia Zhao1, Saif Ullah1

1The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Background/Aims: This study evaluated the feasibility, safety, and efficacy of pure natural orifice transluminal endoscopic surgery (NOTES) trans-rectal gallbladder preserving cholecystolithotomy to treat patients with symptomatic gallstones using a flexible endoscope.

Methods: 65 patients with symptomatic cholelithiasis were enrolled and record was retrospectively analyzed. This was a single center, single gastroenterologist study of consecutive patients who underwent pure NOTES trans-rectal gallbladder preserving cholecystolithotomy.

Results: The procedure technical success rate was 100%. 48 (74%) patients full recovered without symptoms or abnormal signs (fever, peritonitis) or recurrence to date. Bile peritonitis occurred in five (7.7%) patients and all were managed by abdominal lavage which involved flushing peritoneal cavity with saline, and a common bile duct plastic stent was placed in 2 patients by ERCP. The mean post-operative hospital stay was 5.1 days. During 6 to 48 months follow-up, symptomatic gallstone recurred in 5 (7.6%) patients.

Conclusion: Pure NOTES trans-rectal gallbladder preserving cholecystolithotomy appears to be feasible, safe, and effective in treating gallstones. It provides an alternative approach to the management of symptomatic gallstones. Further prospective multi-centered randomized-controlled studies are needed.

Keywords: Gallstones, NOTES, Trans-rectal NOTES, Gallbladder preservation, Cholecystolithotomy