Percutaneous Treatment of Extrahepatic Bile Duct Stones Assisted by Balloon Sphincteroplasty and Occlusion Balloon

Abstract

ObjectiveTo describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing.Materials and MethodsFifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated.ResultsEight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patient, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis.ConclusionPercutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful.

Percutaneous Treatment of Common Bile Duct Stones: Results and Complications in 110 Consecutive Patients

“…Percutaneous transhepatic removal of CBD stones is a minimally invasive alternative for surgical treatment. This approach is not commonly used for patients in whom ERCP treatment is not possible and only a few studies have reported the results of this procedure [17,18,19,20,21,22,23]. …”

Innovative percutaneous antegrade clearance of intrahepatic and extrahepatic biliary stones with the use of a hysterosalpingography catheter

“…Percutaneous antegrade expulsion of bile stones into the duodenum over a dilated papilla was initially described by Meranze et al [10], Muchart et al [11], and Gil et al [12] and then reported by others [2,13,14] in large series of patients. This technique is considered to be safe and effective: maintenance of the anatomic integrity and function of the sphincter is desirable, resulting in a great advantage compared with other treatment techniques, such as endoscopic papillotomy or surgery.…”

Analysis of Wire-Guided Hemostasis Introducer for Percutaneous Therapy of Bile Duct Stones

“…Frequently, prior mechanical lithotripsy is required and removal of BDS remains incomplete. Both methods revealed certain risks like pancreatitis, bleeding, or intrahepatic injury whilst concrement extraction [10, 11]. …”

“…Both techniques have been shown to be a less invasive alternative for extraction of BDS compared to surgery. Nevertheless, pancreatitis, hemorrhage, or injury of liver tissue were reported [11]. Furthermore, necessity of maintaining access to PTCD for several weeks is accompanied with marked reduction of patients comfort, quality of life, and increases costs.…”

“…For extraction of large BDS implementation of a percutaneous fistula by means of repeated dilation for 14–21 days is mandatory [10]. Prior to duodenal launch, percutaneous papillary balloon dilation has to be performed [11-13]. Both techniques have been shown to be a less invasive alternative for extraction of BDS compared to surgery.…”