BackTable Vascular & Interventional Ep. 560 Biliary Endoscopy Techniques for Gallstones with Dr. John Smirniotopoulos
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Jul 25, 2025 Dr. John Smirniotopoulos, an interventional radiologist at MedStar Health, discusses groundbreaking biliary endoscopy techniques for gallstone management. He shares insights from his early experiences with cholangioscopy and highlights the importance of selecting the right equipment. The conversation delves into effective patient management, the collaboration between radiologists and surgeons, and innovative strategies to overcome technical challenges. Dr. Smirniotopoulos also emphasizes the significance of billing and coding knowledge in clinical practice.
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Successful Early Gallbladder Case
- John Smirniotopoulos shared a case of a 90-year-old patient with acute cholecystitis who healed well after stone removal using upsized sheaths and irrigation techniques.
- The patient was able to remove her tube and resume normal activities, highlighting the procedure's impact on quality of life.
Optimize Gallbladder Access
- Prefer transhepatic access to stabilize the system and reduce leakage risk when placing large sheaths in the gallbladder.
- Aim for fundus access for better linear pathway toward the cystic duct and easier navigation.
Cystic Duct Assessment Tips
- Always inject contrast through the existing tube to assess cystic duct patency and identify obstructions before intervention.
- When stones or strictures block the cystic duct, advancing wires and scopes can facilitate trans-cystic stone removal and drainage.