Published online Sep 7, 2018. doi: 10.3748/wjg.v24.i33.3799
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
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).
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.
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.
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.