Bile duct stones: percutaneous transhepatic removal

Area of Science:

• Gastroenterology
• Interventional Radiology
• Hepatobiliary Surgery

Background:

• Obstructive jaundice, biliary colic, and cholangitis often result from biliary stones.
• Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is a common treatment but not always feasible.
• Alternative methods are needed for patients with complex anatomy or prior surgeries.

Purpose of the Study:

• To evaluate the efficacy and safety of percutaneous transhepatic intervention for transduodenal biliary stone removal.
• To assess the procedure's utility in patients where ERCP is contraindicated or has failed.

Main Methods:

• Percutaneous transhepatic placement of a modified Dormia basket into the common bile duct, with the tip positioned in the duodenum.
• Stones were either passed into the duodenum for natural elimination or fragmented in situ.
• Monooctanoin was used adjunctively to dissolve residual fragments and sludge.

Main Results:

• The procedure was performed 38 times in 34 patients.
• No procedure-related deaths occurred.
• The complication rate was 21%, comparable to surgical interventions in similar patient groups.

Conclusions:

• Percutaneous transhepatic intervention is a viable and safe option for biliary stone removal.
• This technique is particularly beneficial for patients who cannot undergo or have refused ERCP, including those with prior choledochojejunostomy.