Published online Oct 21, 2018. doi: 10.3748/wjg.v24.i39.4489
Peer-review started: July 25, 2018
First decision: August 27, 2018
Revised: August 29, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: October 21, 2018
To evaluate the effectiveness and safety of combined ursodeoxycholic acid and percutaneous transhepatic balloon dilation for management of gallstones after expulsion of common bile duct (CBD) stones.
From April 2014 to May 2016, 15 consecutive patients (6 men and 9 women) aged 45-86 (mean, 69.07 ± 9.91) years suffering from CBD stones associated with gallstones were evaluated. Good gallbladder contraction function was confirmed by type B ultrasonography. Dilation of the CBD and cystic duct was detected. Percutaneous transhepatic balloon dilation of the papilla was performed, ursodeoxycholic acid was administered, and all patients had a high-fat diet. All subjects underwent repeated cholangiography, and percutaneous transhepatic removal was carried out in patients with secondary CBD stones originating from the gallbladder.
All patients underwent percutaneous transhepatic balloon dilation with a primary success rate of 100%. The combined therapy was successful in 86.7% of patients with concomitant CBD stones and gallstones. No remaining stones were detected in the gallbladder. Transient adverse events include abdominal pain (n = 1), abdominal distension (n = 1), and fever (n = 1). Complications were treated successfully via nonsurgical management without long-term complications. No procedure-related mortality occurred.
For patients with concomitant CBD stones and gallstones, after percutaneous transhepatic removal of primary CBD stones, oral ursodeoxycholic acid and a high-fat diet followed by percutaneous transhepatic removal of secondary CBD stones appear to be a feasible and effective option for management of gallstones.
Core tip: Percutaneous transhepatic removal combined with oral ursodeoxycholic acid and a high-fat diet appears to be a feasible and safe alternative to surgery or endoscopic procedure for elimination of gallstones, especially for patients with good gallbladder contraction function, diameter of gallstones no greater than 12 mm, and dilation of the cystic duct. It also provides an alternative when operative management is not available for patients in poor condition.