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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Percutaneous transhepatic extraction and balloon dilation for simultaneous gallbladder stones and common bile duct stones: A novel technique
Bin Liu, De-Shun Wu, Pi-Kun Cao, Yong-Zheng Wang, Wu-Jie Wang, Wei Wang, Hai-Yang Chang, Dong Li, Xiao Li, Yancu Hertzanu, Yu-Liang Li
Bin Liu, Yong-Zheng Wang, Wu-Jie Wang, Wei Wang, Hai-Yang Chang, Yancu Hertzanu, Yu-Liang Li, Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
Bin Liu, Yong-Zheng Wang, Wu-Jie Wang, Wei Wang, Hai-Yang Chang, Yu-Liang Li, Interventional Oncology Institute of Shandong University, Jinan 250033, Shandong Province, China
De-Shun Wu, Department of General Surgery, Jiyang County People’s Hospital, Jinan 251400, Shandong Province, China
Pi-Kun Cao, Dong Li, Xiao Li, School of Medicine, Shandong University, Jinan 250014, Shandong Province, China
Yancu Hertzanu, Department of Radiology, Ben-Gurion University, Negev 88874, Israel
Author contributions: Liu B designed and performed the research, analyzed and interpreted data, wrote the paper, and obtained funding; Wu DS designed the research, analyzed, and interpreted data; Cao PK collected, analyzed, and interpreted data; Wang YZ, Wang WJ, Wang W, and Chang HY technically supported the research; Li D and Li X collected data; Hertzanu Y critically revised the manuscript for important intellectual content; Li YL designed the research, supervised the report, and obtained funding.
Supported by the National Natural Science Foundation of China, No. 61671276; and the Natural Science Foundation of Shandong Province, No. 2014ZRE27479 and No. ZR2018PH032.
Institutional review board statement: This study was approved by the ethics committee of the Second Hospital of Shandong University [KYLL-2018(LW)007].
Informed consent statement: All participants provided written informed consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yu-Liang Li, MD, Chief Doctor, Professor, Department of Interventional Medicine, The Second Hospital of Shandong University, 247 Beiyuan Road, Jinan 250033, Shandong Province, China. lyl.pro@sdu.edu.cn
Telephone: +86-531-85875462 Fax: +86-531-85875462
Received: May 30, 2018
Peer-review started: May 30, 2018
First decision: July 6, 2018
Revised: July 9, 2018
Accepted: July 22, 2018
Article in press: July 22, 2018
Published online: September 7, 2018
AIM
To evaluate the clinical efficacy and safety of an innovative percutaneous transhepatic extraction and balloon dilation (PTEBD) technique for clearance of gallbladder stones in patients with concomitant stones in the common bile duct (CBD).
METHODS
The data from 17 consecutive patients who underwent PTEBD for clearance of gallbladder stones were retrospectively analyzed. After removal of the CBD stones by percutaneous transhepatic balloon dilation (PTBD), the gallbladder stones were extracted to the CBD and pushed into the duodenum with a balloon after dilation of the sphincter of Oddi. Large stones were fragmented using a metallic basket. The patients were monitored for immediate adverse events including hemorrhage, perforation, pancreatitis, and cholangitis. During the two-year follow-up, they were monitored for stone recurrence, reflux cholangitis, and other long-term adverse events.
RESULTS
Gallbladder stones were successfully removed in 16 (94.1%) patients. PTEBD was repeated in one patient. The mean hospitalization duration was 15.9 ± 2.2 d. Biliary duct infection and hemorrhage occurred in one (5.9%) patient. No severe adverse events, including pancreatitis or perforation of the gastrointestinal or biliary tract occurred. Neither gallbladder stone recurrence nor refluxing cholangitis had occurred two years after the procedure.
CONCLUSION
Sequential PTBD and PTEBD are safe and effective for patients with simultaneous gallbladder and CBD stones. These techniques provide a new therapeutic approach for certain subgroups of patients in whom endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy or surgery is not appropriate.
Core tip: Simultaneous gallbladder and common bile duct stones present a challenge in certain subgroups of patients with pulmonary or cardiac comorbidities who cannot tolerate the risk of general anesthesia with tracheal intubation, endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy, or surgery. For these patients, sequential percutaneous transhepatic balloon dilation and percutaneous transhepatic extraction and balloon dilation, providing a path with compliance and only requiring intravenous anesthesia, could be a safe and effective procedure.
