Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2018; 24(33): 3799-3805
Published online Sep 7, 2018. doi: 10.3748/wjg.v24.i33.3799
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:
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.
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
Research background

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.

Research motivation

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.

Research objectives

We aimed to evaluate the clinical efficacy of an innovative percutaneous transhepatic extraction and balloon dilation (PTEBD) following percutaneous transhepatic balloon dilation (PTBD).

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

In the future, larger studies and generalizability of the results to more widespread populations will be investigated.