J Korean Med Sci.  2015 Mar;30(3):278-282. 10.3346/jkms.2015.30.3.278.

Percutaneous Papillary Large Balloon Dilation during Percutaneous Cholangioscopic Lithotripsy for the Treatment of Large Bile-Duct Stones: A Feasibility Study

• Han JY
• Jeong S
• Lee DH

• KMID: 2133305
• DOI: http://doi.org/10.3346/jkms.2015.30.3.278

Abstract

When access to a major duodenal papilla or endoscopic retrograde cholangiopancreatography has failed, percutaneous transhepatic cholangioscopic lithotripsy (PTCS-L) may be useful for removing common bile duct (CBD) stones. However, the feasibility and usefulness of percutaneous transhepatic papillary large-balloon dilation (PPLBD) during PTCS-L for the removal of large CBD stones has not been established. We aimed to determine the safety and efficacy of PPLBD for the treatment of large CBD stones. Eleven patients with large CBD stones in whom the access to the major papilla or bile duct had failed were enrolled prospectively. Papillary dilation was performed using a large (12-20 mm) dilation balloon catheter via the percutaneous transhepatic route. Post-procedure adverse events and efficacy of the stone retrieval were measured. The initial success rate of PPLBD was 100%. No patient required a basket to remove a stone after PPLBD. Electrohydraulic lithotripsy was required in 2 (18.2%) patients. The median time to complete stone removal after PPLBD was 17.8 min and no adverse events occurred after PPLBD. Asymptomatic hyperamylasemia was not encountered in any patients. This study indicates that PPLBD is safe and effective for removal of large CBD stones.

Keyword

Choledocholithiasis; Dilatation; Balloon; Ampulla of Vater

MeSH Terms

Ampulla of Vater/surgery
Bile Ducts/*surgery
Cholangiopancreatography, Endoscopic Retrograde
Choledocholithiasis/*surgery
Feasibility Studies
Gallstones/surgery
Humans
Hyperamylasemia
Lithotripsy/adverse effects/*methods
Prospective Studies
Sphincterotomy, Endoscopic/*methods
Treatment Outcome
Urinary Bladder Calculi/*surgery

Figure

• 

  Fig. 1 Cholangiograms of CBD stone removal by percutaneous transhepatic papillary large-balloon dilation. (A) A large stone is visualized in the dilated common bile duct (arrow). (B) The papilla was percutaneously dilated by inflating a large-bored balloon catheter. (C) Image obtained after dilation showing spontaneously discharged stone through the dilated papilla.

Reference

1. Chen MF, Jan YY. Percutaneous transhepatic removal of common bile duct and intrahepatic duct stones with a fiberoptic choledochoscope. Gastrointest Endosc. 1986; 32:347–349.

2. Jeng KS, Chiang HJ, Shih SC. Limitations of percutaneous transhepatic cholangioscopy in the removal of complicated biliary calculi. World J Surg. 1989; 13:603–610.

3. Navarrete CG, Castillo CT, Castillo PY. Choledocholithiasis: percutaneous treatment. World J Surg. 1998; 22:1151–1154.

4. Jeong EJ, Kang DH, Kim DU, Choi CW, Eum JS, Jung WJ, Kim PJ, Kim YW, Jung KS, Bae YM, et al. Percutaneous transhepatic choledochoscopic lithotomy as a rescue therapy for removal of bile duct stones in Billroth II gastrectomy patients who are difficult to perform ERCP. Eur J Gastroenterol Hepatol. 2009; 21:1358–1362.

5. Moon JH, Cho YD, Ryu CB, Kim JO, Cho JY, Kim YS, Lee JS, Lee MS, Shim CS. The role of percutaneous transhepatic papillary balloon dilation in percutaneous choledochoscopic lithotomy. Gastrointest Endosc. 2001; 54:232–236.

6. Ersoz G, Tekesin O, Ozutemiz AO, Gunsar F. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointest Endosc. 2003; 57:156–159.

7. Bang S, Kim MH, Park JY, Park SW, Song SY, Chung JB. Endoscopic papillary balloon dilation with large balloon after limited sphincterotomy for retrieval of choledocholithiasis. Yonsei Med J. 2006; 47:805–810.

8. Espinel J, Pinedo E, Olcoz JL. Large hydrostatic balloon for choledocolithiasis. Rev Esp Enferm Dig. 2007; 99:33–38.

9. Heo JH, Kang DH, Jung HJ, Kwon DS, An JK, Kim BS, Suh KD, Lee SY, Lee JH, Kim GH, et al. Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones. Gastrointest Endosc. 2007; 66:720–726. quiz 768, 771.

10. Maydeo A, Bhandari S. Balloon sphincteroplasty for removing difficult bile duct stones. Endoscopy. 2007; 39:958–961.

11. Minami A, Hirose S, Nomoto T, Hayakawa S. Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy. World J Gastroenterol. 2007; 13:2179–2182.

12. Attasaranya S, Cheon YK, Vittal H, Howell DA, Wakelin DE, Cunningham JT, Ajmere N, Ste Marie RW Jr, Bhattacharya K, Gupta K, et al. Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series. Gastrointest Endosc. 2008; 67:1046–1052.

13. Jeong S, Ki SH, Lee DH, Lee JI, Lee JW, Kwon KS, Kim HG, Shin YW, Kim YS. Endoscopic large-balloon sphincteroplasty without preceding sphincterotomy for the removal of large bile duct stones: a preliminary study. Gastrointest Endosc. 2009; 70:915–922.

14. Chan HH, Lai KH, Lin CK, Tsai WL, Wang EM, Hsu PI, Chen WC, Yu HC, Wang HM, Tsay FW, et al. Endoscopic papillary large balloon dilation alone without sphincterotomy for the treatment of large common bile duct stones. BMC Gastroenterol. 2011; 11:69.

15. Mazzariello R. Removal of residual biliary tract calculi without reoperation. Surgery. 1970; 67:566–573.

16. Gil S, de la Iglesia P, Verdú JF, de España F, Arenas J, Irurzun J. Effectiveness and safety of balloon dilation of the papilla and the use of an occlusion balloon for clearance of bile duct calculi. AJR Am J Roentgenol. 2000; 174:1455–1460.

17. Szulman C, Giménez M, Sierre S. Antegrade papillary balloon dilation for extrahepatic bile duct stone clearance: lessons learned from treating 300 patients. J Vasc Interv Radiol. 2011; 22:346–353.

18. Park SJ, Kim JH, Hwang JC, Kim HG, Lee DH, Jeong S, Cha SW, Cho YD, Kim HJ, Kim JH, et al. Factors predictive of adverse events following endoscopic papillary large balloon dilation: results from a multicenter series. Dig Dis Sci. 2013; 58:1100–1109.

19. Kim JH, Yang MJ, Hwang JC, Yoo BM. Endoscopic papillary large balloon dilation for the removal of bile duct stones. World J Gastroenterol. 2013; 19:8580–8594.