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
Gallstones constitute a significant health issue, and 15% of these cases have concomitant common bile duct (CBD) stones. Open exploration of CBD, endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) followed by open or laparoscopic cholecystectomy may solve the problem.
However, a certain subgroup of patients with pulmonary or cardiac comorbidities cannot tolerate the risk of general anesthesia with tracheal intubation, ERCP/EST, or surgery.
We aimed to evaluate the clinical efficacy of an innovative percutaneous transhepatic extraction and balloon dilation (PTEBD) following percutaneous transhepatic balloon dilation (PTBD).
From December 2013 to June 2014, 17 consecutive patients with 35 simultaneous gallbladder and CBD stones underwent PTEBD after percutaneous CBD stone removal in our hospital. Laboratory values, including WBC count, aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), albumin (ALB) and serum amylase were obtained using routine laboratory tests. Gallbladder and CBD stone diameters ranged from 0.6-2.2 cm. Ten (28.6%) stones were < 10 mm, twenty-one stones ranged from 10-20 mm, and four were > 20 mm. Six patients were admitted with acute cholecystitis, nine with acute cholangitis, and two with pancreatitis. All statistical analyses were performed using IBM SPSS Statistics 24.0. Categorical variables were presented as number and percentage. Continuous data were presented as mean ± standard deviation. We used paired t-tests for the same indexes before and after the procedure in the same patient. P < 0.05 was considered statistically significant.
Thirty-five gallbladder stones were successfully removed by PTEBD in 16 of the 17 patients. PTEBD was repeated in one patient. The mean hospitalization duration was 15.9 ± 2.2 d. The concentrations of AST, TBIL, DBIL and WBC count declined markedly after PTBD and PTEBD. The differences in these indexes before PTBD, one week after PTBD, and one week after PTEBD were all significant. In contrast, ALB concentration significantly increased after PTBD and PTEBD. No severe adverse events, including pancreatitis or perforation of the gastrointestinal or biliary duct occurred during the perioperative period. Neither recurrence of gallbladder or CBD stones nor refluxing cholangitis had occurred two years after the procedure.
As our data indicate, sequential PTBD and PTEBD is a safe, feasible, and effective treatment option for simultaneous gallbladder and CBD stones. It is an innovative alternative procedure for a subgroup of patients who cannot tolerate the risk of general anesthesia.
In the future, larger studies and generalizability of the results to more widespread populations will be investigated.