Percutaneous transhepatic biliary stone removal in patients with prior bile duct stents: Report of 2 cases

Gallstones with bile duct stones in patients with prior stent placement challenge traditional endoscopic or surgical management, particularly in high-risk individuals. Percutaneous transhepatic biliary stone removal (PTBD) offers a minimally invasive alternative, but its role in this population is underexplored. This case series assesses PTBD's efficacy and feasibility. Two female patients (56 and 60 years) with bile duct obstruction from stones and prior stents (metallic and plastic) underwent PTBD with laser fragmentation and stent management under fluoroscopic guidance. Outcomes were tracked over 7 days, with informed consent obtained. In the 56-year-old (metallic stent, 2 months), PTBD with stent removal cleared stones; elevated bilirubin postprocedure but normalized by day 7. In the 60-year-old (plastic stent, 3 years), PTBD with sphincter dilation succeeded, with mild bilirubin increase resolving by day 7. No major complications occurred; unobstructed bile flow was restored in both. PTBD effectively manages bile duct stones in stent patients, reducing risks compared to traditional methods. Its adaptability to stent-related issues is promising, though technical challenges warrant careful planning. Further studies are needed to confirm long-term efficacy and broader applicability.