Percutaneous transhepatic papillary balloon dilation as a therapeutic option for choledocholithiasis

For choledocholithiasis, endoscopic therapy, including endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD), is now standard. However, the procedure of endoscopic therapy is very complicated and sometimes incomplete for reasons of anatomical anomalies. Therefore, we started performing percutaneous transhepatic papillary balloon dilations (PTPBD) instead of endoscopic therapy for choledocholithiasis 1 year ago for some selected patients. We report our technical methods of PTPBD.

First, percutaneous transhepatic cholangiodrainage (PTCD) was performed under ultrasound guidance. Via the drainage route, the balloon catheter was inserted until the common bile duct was reached. Then, cholangiography was performed and the stones were identified. The balloon was maintained in the inflated state with 4 ml air at the papilla of Vater for 3 min. Next, the stones were pushed out rapidly into the duodenum with the same balloon catheter. If the stone diameter was larger than 8 mm, then basket lithotripsy was performed before balloon dilation.

Five patients underwent PTPBDs. The bile duct stones were successfully pushed out into the duodenum in all patients. The first three patients required two sessions for complete stone clearance due to technical problems; however, the last two patients needed only one session. There were no deaths and no complications.

We recommend that PTPBD might be a feasible and alternative therapeutic option for choledocholithiasis.