Related Experiment Video
Updated: May 30, 2026
Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
Published on: May 2, 2025
Alternative percutaneous approach for endoscopic inaccessible common bile duct stones
Yen-Chun Peng1, Wai-Keung Chow
1Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Background/Aims:
Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy followed by stone extraction is a well-established and standard procedure for common bile duct (CBD) stones. An altered anatomy may be related to inaccessible papilla. Percutaneous transhepatic approach, surgery or alternative endoscopy is considered for inaccessible papilla. Percutaneous transhepatic wire-guided retrieval balloon may not be stiff enough for pushing CBD stones in some situations, such as multiple stones or impacted stones. A percutaneous transhepatic cholangiodrainage (PTCD) assisted retrieval balloon technique for increasing the power for pushing CBD stones was designed in this study.
Methodology:
A PTCD tube was placed in a situation of inaccessible CBD initially. Percutaneous transhepatic approach with wire-guided balloon dilatation of the papilla assisted with a dilatation balloon. After balloon dilatation of papilla, we performed PTCD assisted retrieval balloon under wired-guided for pushing CBD stones into intestine.
Results:
We report on two patients with inaccessible papilla treated with papillary dilation followed by PTCD tube assisted pushing common bile duct stones.
Conclusion:
We recommend that papillary dilatation followed by PTCD tube assisted retrieval balloon push in patients with endoscopic inaccessible common bile duct stones, particularly in multiple stones or impacted stone.
