{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T18:23:15Z","timestamp":1787595795066,"version":"build-2736575974"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the safety and efficacy of percutaneous transhepatic endoscopic holmium laser lithotripsy (PTEHL) for bile duct stones in elderly patients aged \u226580 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective study included 50 patients (mean age 86.4\u2009\u00b1\u20094.5 years) who underwent PTEHL from January 2023 to December 2024. Inclusion criteria were age\u2009\u2265\u200980 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2009\u00b1\u20098.0 days and was significantly longer in patients with cholangitis (p\u2009=\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PTEHL may represent a feasible minimally invasive treatment option for elderly patients with biliary stone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0356488","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T17:27:30Z","timestamp":1787592450000},"page":"e0356488","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Percutaneous transhepatic cholangioscopy-guided holmium laser lithotripsy for bile duct stones in elderly patients"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7032-5730","authenticated-orcid":true,"given":"Nhan Hien","family":"Phan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dang Khanh","family":"Do","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong Canh","family":"Pham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thai Binh","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"issue":"3","key":"pone.0356488.ref001","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1111\/jgs.15682","article-title":"High-risk comorbidity combinations in older patients undergoing emergency general surgery","volume":"67","author":"VP Ho","year":"2019","journal-title":"J Am Geriatr Soc"},{"issue":"1","key":"pone.0356488.ref002","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s12916-017-0986-2","article-title":"Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis","volume":"16","author":"J Watt","year":"2018","journal-title":"BMC Med"},{"issue":"1","key":"pone.0356488.ref003","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.cger.2020.08.005","article-title":"Managing gallstone disease in the elderly","volume":"37","author":"A Chhoda","year":"2021","journal-title":"Clin Geriatr Med"},{"key":"pone.0356488.ref004","doi-asserted-by":"crossref","first-page":"989061","DOI":"10.3389\/fsurg.2022.989061","article-title":"Risk factors for complications in elderly patients aged 85 years and over undergoing endoscopic biliary stone removal","volume":"9","author":"DY Zhang","year":"2022","journal-title":"Front Surg"},{"issue":"14","key":"pone.0356488.ref005","doi-asserted-by":"crossref","first-page":"2988","DOI":"10.12998\/wjcc.v8.i14.2988","article-title":"Endoscopic retrograde cholangiopancreatography in elderly patients: Difficult cannulation and adverse events","volume":"8","author":"F Tabak","year":"2020","journal-title":"World J Clin Cases"},{"issue":"3","key":"pone.0356488.ref006","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1093\/gastro\/goy046","article-title":"Management of complicated gallstones in the elderly: comparing surgical and non-surgical treatment options","volume":"7","author":"Y Nassar","year":"2019","journal-title":"Gastroenterol Rep (Oxf)"},{"issue":"7","key":"pone.0356488.ref007","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1007\/s00268-023-06995-6","article-title":"Comparison of efficacy and safety of laparoscopic holmium laser lithotripsy and laparoscopic bile duct exploration for bile duct stones: a systematic review and meta-analysis","volume":"47","author":"B Liu","year":"2023","journal-title":"World J Surg"},{"issue":"1","key":"pone.0356488.ref008","doi-asserted-by":"crossref","first-page":"8","DOI":"10.4097\/kja.19391","article-title":"Anesthetic management of geriatric patients","volume":"73","author":"B-G Lim","year":"2020","journal-title":"Korean J Anesthesiol"},{"issue":"4","key":"pone.0356488.ref009","doi-asserted-by":"crossref","first-page":"102568","DOI":"10.1016\/j.clinre.2025.102568","article-title":"Impact of frailty on outcomes and biliary drainage strategies in acute cholangitis: a retrospective cohort analysis","volume":"49","author":"A Jaan","year":"2025","journal-title":"Clin Res Hepatol Gastroenterol"},{"key":"pone.0356488.ref010","volume-title":"Holmium intraductal laser lithotripsy of biliary stones in liver grafts. Transplantation Proceedings","author":"U Maggi","year":"2016"},{"issue":"8","key":"pone.0356488.ref011","doi-asserted-by":"crossref","first-page":"2561","DOI":"10.1007\/s00261-020-02554-y","article-title":"Percutaneous transhepatic endoscopic lithotripsy of biliary stones with holmium laser for the treatment of recurrent cholangitis","volume":"45","author":"R Muglia","year":"2020","journal-title":"Abdom Radiol (NY)"},{"issue":"4","key":"pone.0356488.ref012","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.jvir.2022.12.027","article-title":"Clinical outcomes of percutaneous biliary endoscopy: a 7-year single-institution experience","volume":"34","author":"JJ Guan","year":"2023","journal-title":"J Vasc Interv Radiol"},{"issue":"9","key":"pone.0356488.ref013","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1016\/j.jvir.2025.04.013","article-title":"Safety and effectiveness of percutaneous electrohydraulic and laser lithotripsy in the management of biliary stones: the multicenter national percutaneous cholangioscopy registry","volume":"36","author":"A Jost","year":"2025","journal-title":"J Vasc Interv Radiol"},{"issue":"1","key":"pone.0356488.ref014","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1002\/jhbp.515","article-title":"Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos)","volume":"25","author":"M Yokoe","year":"2018","journal-title":"J Hepatobiliary Pancreat Sci"},{"issue":"8","key":"pone.0356488.ref015","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1007\/s00270-017-1703-4","article-title":"Cirse quality assurance document and standards for classification of complications: the Cirse Classification System","volume":"40","author":"DK Filippiadis","year":"2017","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"12","key":"pone.0356488.ref016","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.3390\/medicina59122171","article-title":"The comparison of clinical outcomes in elderly (\u226575 years) and non-elderly (<75 years) patients with acute cholangitis due to choledocholithiasis","volume":"59","author":"T-Y Lee","year":"2023","journal-title":"Medicina (Kaunas)"},{"issue":"20","key":"pone.0356488.ref017","doi-asserted-by":"crossref","first-page":"6112","DOI":"10.3390\/jcm13206112","article-title":"Comparison of ERCP outcomes and complication risk between elderly and younger patients: a large single-center study","volume":"13","author":"Y Cagir","year":"2024","journal-title":"J Clin Med"},{"issue":"3","key":"pone.0356488.ref018","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1007\/s00464-019-06914-8","article-title":"Safety and efficacy of emergency laparoscopic common bile duct exploration in elderly patients with complicated acute cholangitis","volume":"34","author":"B Jia","year":"2020","journal-title":"Surg Endosc"},{"issue":"4","key":"pone.0356488.ref019","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1089\/lap.2024.0382","article-title":"Laparoscopic common bile duct exploration for choledocholithiasis in the elderly: a systematic review and meta-analysis","volume":"35","author":"LM Delgado","year":"2025","journal-title":"J Laparoendosc Adv Surg Tech A"},{"issue":"2","key":"pone.0356488.ref020","doi-asserted-by":"crossref","first-page":"210","DOI":"10.3348\/kjr.2011.12.2.210","article-title":"Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath in high-risk surgical patients with acute cholecystitis","volume":"12","author":"YH Kim","year":"2011","journal-title":"Korean J Radiol"},{"issue":"1","key":"pone.0356488.ref021","doi-asserted-by":"crossref","DOI":"10.1016\/j.cgh.2021.10.013","article-title":"Endoscopic treatment of large bile duct stones: a systematic review and network meta-analysis","volume":"21","author":"A Facciorusso","year":"2023","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"12","key":"pone.0356488.ref022","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.diii.2019.05.007","article-title":"Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis","volume":"100","author":"A Lamanna","year":"2019","journal-title":"Diagn Interv Imaging"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356488","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T17:27:34Z","timestamp":1787592454000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356488"}},"subtitle":[],"editor":[{"given":"Miloud","family":"Chakit","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":22,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0356488","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]}}}