Lorenzo García-García1, Carlos Lanciego. 1. Unidad de Radiología Intervencionista, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Avenida Barber s/n, Toledo 45004, Spain.
Abstract
OBJECTIVE: Our study describes the percutaneous expulsion of bile duct calculi into the duodenum by dilating the papilla with a balloon catheter. SUBJECTS AND METHODS. Patients (n = 212; 101 men and 111 women; mean age, 73 years; range, 31-95 years) had their calculi (single, 131; multiple, 81) percutaneously expelled into the duodenum in 73 patients via an indwelling T tube, and in 139 via transhepatic or transcystic duct route. Stone expulsion was facilitated with an occlusion balloon after balloon sphincteroplasty and with prior mechanical fragmentation in only 37 patients. After the expulsion of the calculi into the duodenum, drainage of the main bile duct to the exterior was maintained for 2-8 days. RESULTS: Technical success was initially 90.4%, increasing to 93% at the second attempt. There were 13 failures due to the large size of the calculi in nine patients, excessive tortuosity of the T tube (Kher tube) in one, and breaches of the established protocol in two. Residual lithiasis was resolved in 98.6% of cases, decreasing to 92% in the group of native, or nonresidual, lithiasis. There were 10 major complications (hemobilia) with three cases of poor clinical outcome: hepatic necrosis, multiorgan failure, or death. CONCLUSION: Percutaneous anterograde evacuation of bile duct stones with dilatation of the papilla using an angioplasty catheter and assisted with an occlusion balloon to expel the calculi is a cost-effective, nontraumatic, and safe procedure that retains the anatomic and functional integrity of the sphincter. It is a viable alternative procedure in the treatment of bile duct lithiasis.
OBJECTIVE: Our study describes the percutaneous expulsion of bile duct calculi into the duodenum by dilating the papilla with a balloon catheter. SUBJECTS AND METHODS. Patients (n = 212; 101 men and 111 women; mean age, 73 years; range, 31-95 years) had their calculi (single, 131; multiple, 81) percutaneously expelled into the duodenum in 73 patients via an indwelling T tube, and in 139 via transhepatic or transcystic duct route. Stone expulsion was facilitated with an occlusion balloon after balloon sphincteroplasty and with prior mechanical fragmentation in only 37 patients. After the expulsion of the calculi into the duodenum, drainage of the main bile duct to the exterior was maintained for 2-8 days. RESULTS: Technical success was initially 90.4%, increasing to 93% at the second attempt. There were 13 failures due to the large size of the calculi in nine patients, excessive tortuosity of the T tube (Kher tube) in one, and breaches of the established protocol in two. Residual lithiasis was resolved in 98.6% of cases, decreasing to 92% in the group of native, or nonresidual, lithiasis. There were 10 major complications (hemobilia) with three cases of poor clinical outcome: hepatic necrosis, multiorgan failure, or death. CONCLUSION: Percutaneous anterograde evacuation of bile duct stones with dilatation of the papilla using an angioplasty catheter and assisted with an occlusion balloon to expel the calculi is a cost-effective, nontraumatic, and safe procedure that retains the anatomic and functional integrity of the sphincter. It is a viable alternative procedure in the treatment of bile duct lithiasis.
Authors: Yong Sung Park; Ji Hyung Kim; Young Woo Choi; Tae Hee Lee; Cheol Mog Hwang; Young Jun Cho; Keum Won Kim Journal: Korean J Radiol Date: 2005 Oct-Dec Impact factor: 3.500
Authors: Yang Won Kim; Sang Min Lee; Ho Cheol Choi; Jung Ho Won; Jae Boem Na; Jae Min Cho; Dae Seob Choi; Mi Jung Park; Hwa Seon Shin; Ji Eun Kim; Sung Eun Park; Jong Joon Shim Journal: Medicine (Baltimore) Date: 2021-04-09 Impact factor: 1.817