Clin Endosc.  2022 Mar;55(2):297-301. 10.5946/ce.2020.301.

Successful Removal of a Difficult Common Bile Duct Stone by Percutaneous Transcholecystic Cholangioscopy

• Lee H
• Lee SH
• Huh G
• Kim Y
• Hur S
• Hur M
• Lee M
• Ahn B

• KMID: 2527576
• DOI: http://doi.org/10.5946/ce.2020.301

Abstract

Common bile duct (CBD) stones are prevalent in 11% to 21% of patients with gallstones and can cause various clinical manifestations, from biliary colic to biliary sepsis. The treatment of choice is endoscopic retrograde cholangiopancreatography, but approximately 5% to 10% of CBD stones are difficult to remove using these conventional endoscopic methods. Although percutaneous transhepatic cholangioscopy and lithotripsy can be used as an alternative, it can be technically demanding and risky if the intrahepatic duct is not dilated. We report a case of a large CBD stone that was successfully removed using percutaneous transcholecystic cholangioscopy.

Keyword

Cholangioscopy; Cholecystostomy; Choledocholithiasis

Figure

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  Fig. 1. Abdominal computed tomography images. Axial (A, B) and coronal (C) images showing a radiopaque stone measuring 2 cm in the distal part of the common bile duct with upstream dilatation. The intrahepatic duct is not markedly dilated.

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  Fig. 2. Images of percutaneous cholecystostomy. (A) Abdominal ultrasonography showing a distended gallbladder without gallstones or pericholecystic fluid collection. (B) Fluoroscopic image showing successful placement of a percutaneous cholecystostomy tube.

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  Fig. 3. Fluoroscopic images of partial removal of a common bile duct (CBD) stone using a percutaneous transcholecysttic approach and tract dilatation. (A) Injection of contrast material showing nondilated intrahepatic ducts. (B, C) Successful negotiation of a guidewire into the CBD. Cholangiogram showing a CBD stone (arrow). (D) Placement of an 8.5 Fr biliary drainage tube (Cook Medical, Bloomington, IN, USA). (E-G) Partial stone removal with a basket and a 10 mm × 4 cm Mustang balloon (Boston Scientific, Marlborough, MA, USA). (H) Tract dilatation with a 12 Fr catheter (Cook Medical). (I) Tract dilatation with an 18 Fr percutaneous transhepatic cholangioscopy catheter (Sumitomo Bakelite Co., Ltd., Tokyo, Japan).

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  Fig. 4. Images of percutaneous transcholecystic cholangioscopy. (A-C) Electrohydraulic lithotripsy was performed to break down the stone into debris, and flushing was performed with saline to clear the common bile duct. (D-F) Follow-up cholangiogram and abdominal computed tomography scans show no residual stone in the common bile duct.

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