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
Bile duct stones are the most frequent cause of benign bile duct disease. The choice of management of common bile duct (CBD) stones includes surgical exploration, endoscopic intervention and percutaneous transhepatic intervention. Subsequent cholecystectomy is the first choice to prevent the recurrence of stones for patients with concomitant CBD stones and gallstones. This retrospective study aimed to evaluate the clinical efficacy and safety of ursodeoxycholic acid combined with percutaneous transhepatic balloon dilation for management of gallstones after elimination of CBD Stones.
Percutaneous transhepatic intervention served as an effective option for management of CBD stones in the past decades. The preferable choice of management for patients with concomitant CBD stones and gallstones is controversial.
The retrospective study evaluated the effectiveness and safety of a novel technique for management of gallstones after expulsion of CBD stones in terms of technical success and postoperative complications.
Fifteen consecutive patients diagnosed with concomitant CBD stones and gallstones were evaluated. All patients underwent application of ursodeoxycholic acid combined with percutaneous transhepatic balloon dilation for management of gallstones after elimination of CBD stones. Clinical assessment, physical examination, laboratory tests and imaging were assessed in all patients. All statistics analyses were performed using SPSS 24.0. P-values < 0.05 were defined as statistically difference for all data.
The novel technique was successful in 86.7% of patients with concomitant CBD stones and gallstones with few postoperative complications treated successfully via nonsurgical management. It seems to be an alternative to open or laparoscopic surgery and endoscopic intervention.
The present study showed that ursodeoxycholic acid combined with percutaneous transhepatic balloon dilation was secure and feasible for management of gallstones after elimination of CBD stones, especially for patients with good gallbladder contraction function, diameter of gallstone 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.
In case of therapeutic failure, good gallbladder contraction function or dilation of the cystic duct was not observed. However, the diameters of stones in failed cases were much greater than those of successful cases. This novel technique provides a feasible option for patients with concomitant gallstones and CBD stones. Prospective studies are needed for further confirmation.