Clinical Endoscopy

Original Article

Usefulness of Percutaneous Transhepatic Cholangioscopic Lithotomy for Removal of Difficult Common Bile Duct Stones: Jae Hyung Lee, Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Su Bum Park, Suk Hun Kim, Ung Bae Jeon; Clin Endosc 2013;46(1):65-70. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.65

Background/Aims

Approximately 5% to 10% of common bile duct (CBD) stones are difficult to remove by conventional endoscopic methods. Percutaneous transhepatic cholangioscopic lithotomy (PTCSL) can be an alternative method for this condition, but is not well established yet. The aim of this study was to evaluate the clinical efficacy and safety of PTCSL for removal of difficult CBD stones.

Methods

This study is a retrospective review of 34 consecutive patients who underwent unsuccessful removal of CBD stones using conventional endoscopic methods between December 2008 and July 2010 and were subsequently treated using PTCSL.

Results

Among 443 patients with CBD stones, 34 patients (7.8%) failed to achieve stone removal using conventional endoscopic methods. Of these 34 patients, 33 were treated using PTCSL. In all 33 cases (100%), complete stone removal was achieved using PTCSL. Most complications (15/17, 88.2%) were mild and transient. Major complications occurred in two patients (6.1%) who experienced hemobilia, and percutaneous transhepatic biliary drainage tract disruption, respectively; which were fully recovered without mortality.

Conclusions

Despite prolonged hospital stay and temporary decline of quality of life, PTCSL is an effective and safe method in the management of difficult CBD stones, especially in patients with difficulty in approaching the affected bile duct.

Citations

Citations to this article as recorded by

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Bilateral Biliary Approach in Patients with Hepatolithiasis: Dong Uk Kim, M.D., Geun Am Song, M.D., Kwang Ha Kim, M.D., Suk Kim, M.D.*, Hyung Wook Kim, M.D. and Dae Hwan Kang, M.D.; Korean J Gastrointest Endosc 2010;41(5):273-279. Published online November 30, 2010

Abstract PDF: Background
/Aims: Percutaneous procedures for treating patients with hepatolithiasis associated with intrahepatic biliary stricture (IHBS) have been shown to have a relatively lower rate of successful stone removal than without IHBS. The reason is tight stenosis or acute angulation of intrahepatic bile ducts (IHDs). We suggest that a bilateral approach to IHDs would improve the success rate of stone removal in patients with complicated IHBS.
Methods
Conventional cholangioscopic electrohydrolithotripsy (EHL) was performed in 82 patients without IHBS. Percutaneous transhepatic stricture dilation and cholangioscopic EHL through unilateral access was performed to treat 41 patients with hepatolithiasis with IHBS. In 21 patients with complicated stricture and multiple stones, removal of hepatolithiasis was achieved by a bilateral approach. The rate of complete stone clearance and complication was reviewed retrospectively.
Results
Complete stone clearance was achieved in 92.7% (76/82) of patients using a unilateral approach without IHBS, in 61.0% (25/41) of cases using a unilateral approach with IHBS, and in 85.7% (18/21) of cases using a bilateral approach with IHBS (p＜0.05). The number of sessions of PTCS was 2.7±0.3, 3.9±0.3, and 2.7±0.5 respectively. The overall complication rate was 14.6% (21/144), and didn't differ between groups.
Conclusions
A bilateral approach to IHDs may be a useful alternative treatment in unresectable patients with multiple hepatolithiasis associated with complicated IHBS. (Korean J Gastrointest Endosc 2010;41:273-279)

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