Percutaneous transhepatic lithotripsy using a choledochoscope: long-term follow-up in 14 patients.

Abstract

with bile duct stoneswho undergoelectrohydraulic lithotripsy guided by choledochoscopy. SUBJECTS AND METHODS. Since 1987, atourinstitution, 14patients with bileductstones have been treated using percutaneouselectrohydraulic lithotripsy guided by choledo choscopy. The procedurewasperformed5â€"7 daysafter biliary drainageusinga 5-mm chole dochoscope placedthroughan 18-to 20-Frenchsheath. All patientsunderwentfollow-up CT, sonography, or both every 6â€"12months after treatment. RESULTS. No complications occurred in the 14patients whounderwent treatment. During a mean follow-up period of 4.8 years (range, 2â€"9 years), two (14%) of the 14 patients de veloped recurrent common bile duct stones,and another two (14%) developed recurrent small intrahepaticstones; all patientsremainedasymptomatic. CONCLUSION. Percutaneous electrohydraulic lithotripsy can besafely performed using a 5-mm choledochoscope. Recurrent calculi may be seen in 28% of patients. Subjects and MethodsFrom August 1987to July 1995, 17patients un derwent percutaneous removal of bileductstones atour institution;biliary lithotripsyusingcholedo choscopicguidancewasperformedin 14of them. All 14 eitherrefusedsurgeryor were a high risk for surgery. We did not perform endoscopic re movalfor thefollowing reasons: In threepatients, the stones were too large to grasp; in seven pa tients, endoscopic removal had previously failed; and in four patients, intrahepatic stones were diffi All procedures wereperformed byourinterven tional radiology service. IV midazolam hydrochlo ride or pentazocine was used as necessary, and broad-spectrumantibioticswere routinelygiven.All patientswere administered continuous oxygensaW rationandunderwent periodicbloodpressure moni toting. The technique of percutaneoustranshepatic biliary drainage hasbeendescribed in detail[81.In our series, the bile duct branches were punctured un dersonographic guidance, guidewires werethenin serted, thetract wasdilated, andadrainage tubewas placed.In nine patients,the drainagetube was placedontheleft sideofthe duct,andin theremain ing fivepatients,the drainagetube was placedon the right side.We generally placed a 10-Frenchdrainage catheter (Castaneda Nephrostomy; BostonScien

Therapeutic Biliary Endoscopy

“…Two papers published by authors in East Asia studied the percutaneous application of electrohydraulic lithotripsy under cholangioscopic con trol. Hayashi and colleagues [12] evaluated the long-term outcome of 14 patients who had undergone transhepatic li thotripsy. After a mean follow-up period of 4.8 years, 28% of the patients had asymptomatic recurrence of biliary stones.…”