Clin Endosc.  2013 Jan;46(1):65-70. 10.5946/ce.2013.46.1.65.

Usefulness of Percutaneous Transhepatic Cholangioscopic Lithotomy for Removal of Difficult Common Bile Duct Stones

• Lee JH
• Kim HW
• Kang DH
• Choi CW
• Park SB
• Kim SH
• Jeon UB

• KMID: 1792642
• DOI: http://doi.org/10.5946/ce.2013.46.1.65

Abstract

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.

Keyword

Percutaneous transhepatic cholangioscopic lithotomy; Common bile duct stones

MeSH Terms

Bile Ducts
Common Bile Duct
Drainage
Hemobilia
Humans
Length of Stay
Quality of Life
Retrospective Studies

Figure

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  Fig. 1 Flow diagram describes the treatment of 443 patients with common bile duct (CBD) stones. ERCP, endoscopic retrograde cholangiopancreatography; PTCSL, percutaneous transhepatic cholangioscopic lithotomy.

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  Fig. 2 (A) Endoscopic retrograde cholangiopancreatography showing a giant common bile duct (CBD) stone with markedly dilated CBD. (B) Cholangioscopy showing a fragmented stone by electrohydraulic lithotripsy. (C) Cholangiogram showing clear removal state of a previously giant CBD stone.

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