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Yoon SB, Jeon TY, Moon SH, Shin DW, Park JW, Kim SE, Kim MJ. Effectiveness and complication rates of percutaneous transhepatic fluoroscopy-guided management of common bile duct stones: a single-arm meta-analysis. Eur Radiol 2023; 33:7398-7407. [PMID: 37326663 DOI: 10.1007/s00330-023-09846-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To perform a systematic review and meta-analysis to determine the success and complication rate of percutaneous transhepatic fluoroscopy-guided management (PTFM) for the removal of common bile duct stones (CBDS). METHODS A comprehensive literature search of multiple databases was conducted to identify original articles published between January 2010 and June 2022, reporting the success rate of PTFM for the removal of CBDS. A random-effect model was used to summarize the pooled rates of success and complications with 95% confidence intervals (CIs). RESULTS Eighteen studies involving 2554 patients met the inclusion criteria and were included in the meta-analysis. Failed or infeasible endoscopic management was the most common indication of PTFM. The meta-analytic summary estimates of PTFM for the removal of CBDS were as follows: rate of overall stone clearance 97.1% (95% CI, 95.7-98.5%); stone clearance at first attempt 80.5% (95% CI, 72.3-88.6%); overall complications 13.8% (95% CI, 9.7-18.0%); major complications 2.8% (95% CI, 1.4-4.2%); and minor complications 9.3% (95% CI, 5.7-12.8%). Egger's tests showed the presence of publication bias with respect to the overall complications (p = 0.049). Transcholecystic management of CBDS had an 88.5% pooled rate for overall stone clearance (95% CI, 81.2-95.7%), with a 23.0% rate for complications (95% CI, 5.7-40.4%). CONCLUSION The systematic review and meta-analysis answer the questions of the overall stone clearance, clearance at first attempt, and complication rate of PTFM by summarizing the available literature. Percutaneous management could be considered in cases with failed or infeasible endoscopic management of CBDS. CLINICAL RELEVANCE STATEMENT This meta-analysis highlights the excellent stone clearance rate achieved through percutaneous transhepatic fluoroscopy-guided removal of common bile duct stones, potentially influencing clinical decision-making when endoscopic treatment is not feasible. KEY POINTS • Percutaneous transhepatic fluoroscopy-guided management of common bile duct stones had a pooled rate of 97.1% for overall stone clearance and 80.5% for clearance at the first attempt. • Percutaneous transhepatic management of common bile duct stones had an overall complication rate of 13.8%, including a major complication rate of 2.8%. • Percutaneous transcholecystic management of common bile duct stones had an overall stone clearance rate of 88.5% and a complication rate of 23.0%.
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Affiliation(s)
- Seung Bae Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Tae Yeon Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Hoon Moon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-Ro 170 Beon-Gil, Dongan-Gu, Anyang, Gyeonggi-Do, 14068, South Korea.
| | - Dong Woo Shin
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-Ro 170 Beon-Gil, Dongan-Gu, Anyang, Gyeonggi-Do, 14068, South Korea
| | - Ji Won Park
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-Ro 170 Beon-Gil, Dongan-Gu, Anyang, Gyeonggi-Do, 14068, South Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-Ro 170 Beon-Gil, Dongan-Gu, Anyang, Gyeonggi-Do, 14068, South Korea
| | - Min-Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
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MacCormick A, Jenkins P, Zhong J, Makris GC, Gafoor N, Chan D. Nationwide Outcomes following Percutaneous Cholecystostomy for Acute Calculous Cholecystitis and the Impact of Coronavirus Disease 2019: Results of the Multicentre Audit of Cholecystostomy and Further Interventions (MACAFI study). J Vasc Interv Radiol 2023; 34:269-276. [PMID: 36265818 DOI: 10.1016/j.jvir.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 09/09/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To assess the mortality, readmission rates, and practice variation of percutaneous cholecystostomy (PC) in patients with acute calculous cholecystitis in the United Kingdom (UK). MATERIALS AND METHODS A total of 1,186 consecutive patients (636 men [53.6%]; median age, 75 years; range, 24-102 years) who underwent PC for acute calculous cholecystitis between January 1, 2019, and December 31, 2020, were included from 36 UK hospitals. The exclusion criteria were diagnostic aspirations, absence of acute calculous cholecystitis, and age less than 16 years. The coronavirus disease 2019 (COVID-19) lockdown was declared on March 26, 2020, in the UK, which served to distinguish among groups. RESULTS Most patients (66.3%) underwent PC as definitive treatment, whereas 31.3% underwent PC as a bridge to surgery. The overall 30-day readmission rate was 42.2% (500/1,186), and the 30-day mortality was 9.1% (108/1,186). Centers performing fewer than 30 PCs per year had higher 90-day mortality than those performing more than 60 (19.3% vs 11.0%, respectively; P = .006). A greater proportion of patients presented with complicated acute calculous cholecystitis during the COVID-19 pandemic compared to prior (49.9% vs 40.9%, respectively; P = .007), resulting in more PCs (61.3 vs 37.9 per month, respectively; P < .001). More PCs were performed in tertiary hospitals than in district general hospitals (9 vs 3 per 100 beds, respectively; P < .001), with a greater proportion performed as a bridge to surgery (50.5% vs 22.8%, respectively; P < .001). CONCLUSIONS The practice of PC is highly variable throughout the UK. The readmission rates are high, and there is significant correlation between mortality and PC case volume.
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Affiliation(s)
| | - Paul Jenkins
- Peninsula Radiology Academy, Plymouth, United Kingdom; University Hospitals Plymouth NHS Trust, Plymouth, Department of Interventional Radiology, London, United Kingdom; UK National Interventional Radiology Trainee Research (UNITE) Collaborative.
| | - Jim Zhong
- UK National Interventional Radiology Trainee Research (UNITE) Collaborative; St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Harehills, Leeds, and Department of Interventional Radiology
| | - Gregory C Makris
- UK National Interventional Radiology Trainee Research (UNITE) Collaborative; Department of Interventional Radiology, St Thomas' Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom; St Thomas' Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Nelofer Gafoor
- University Hospitals Plymouth NHS Trust, Plymouth, Department of Interventional Radiology, London, United Kingdom
| | - David Chan
- University Hospitals Plymouth NHS Trust, Department of Upper GI Surgery
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- UK National Interventional Radiology Trainee Research (UNITE) Collaborative
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MacCormick A, Jenkins P, Gafoor N, Chan D. Percutaneous transcystic removal of gallbladder and common bile duct stones: a narrative review. Acta Radiol 2022; 63:571-576. [PMID: 33845612 DOI: 10.1177/02841851211006915] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The incidence of gallstone-related complications is rising, thus leading to increases in waiting list times for elective laparoscopic cholecystectomy (LC). Percutaneous cholecystostomy (PC) provides immediate biliary drainage and may be used as an emergency option in a critically unwell patient as a bridge to surgery, or as the management option of a patient who is not fit for surgery. However, a significant number of these patients may be readmitted after PC with recurrent acute cholecystitis or pancreatitis, leading to significant morbidity and mortality. The aim of the present review was to analyze the available literature surrounding the use of the transcystic approach, including the extraction and balloon expulsion method, in the management of patients with gallbladder stones and/or common bile duct (CBD) stones. The full text of 18 articles were reviewed, of which four were included in this review. Results showed an overall success rate of CBD stone extraction in 118 of 139 patients (84.9%), gallbladder stone extraction in 97 of 114 (85.0%), and CBD stone expulsion in 27 of 29 (93.1%). Percutaneous CBD and gallbladder stone extraction may be a safe management option for elderly or co-morbid patients who are not appropriate for surgical intervention. However, the evidence base surrounding this is very limited; therefore, further research is required in order to evaluate this in more detail.
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Affiliation(s)
- Andrew MacCormick
- Department of Interventional Radiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Paul Jenkins
- Department of Interventional Radiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Nelofer Gafoor
- Department of Interventional Radiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David Chan
- Department of Upper GI Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Transcholecystic management of extrahepatic duct stones in poor candidates for endoscopic or transhepatic approaches. Eur Radiol 2021; 32:1709-1717. [PMID: 34505194 DOI: 10.1007/s00330-021-08259-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/25/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To investigate transcholecystic management of extrahepatic duct (EHD) stones using balloon ampulloplasty in patients who are poor candidates for endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) and assess its efficacy and safety. METHODS Forty-one patients who were unable to undergo ERCP or had failed ERCP with non-dilated intrahepatic ducts (IHD) between February 2019 and October 2020 were retrospectively enrolled. After clinical improvement with percutaneous cholecystostomy (PC), EHD stones were managed through cystic duct passage, guidewire unwinding, sheath insertion, and EHD stone removal using balloon ampulloplasty. If the transcholecystic route failed, a transhepatic approach was used according to the pre-existing cholangiogram obtained via PC. We evaluated the technical success rate and complications of each step. RESULTS The technical success rate for the transcholecystic-only approach was 80.5%. The remaining cases were successfully managed with transhepatic conversion. Multiple stone removal sessions were required in 22% of the cases. One patient with combined IHD stones was initially converted to a transhepatic approach without any transcholecystic removal trial. The technical success rates for each step were as follows: cystic duct passage (38/40, 95%), guidewire unwinding (36/38, 94.7%), sheath insertion (36/36, 100%), and stone removal using balloon ampulloplasty (33/36, 91.7%). The overall clinical success was 97.6% (40/41) without major procedure-related complications. Thereafter, cholecystectomy was successfully performed in patients with concomitant gallstones (n = 20). No postprocedural complications occurred during the follow-up (1-70 days). CONCLUSIONS Percutaneous EHD stone removal through transcholecystic and transhepatic routes after PC is effective and safe in poor candidates for PTBD or ERCP. KEY POINTS • This study shows the safety and efficacy of extrahepatic duct (EHD) stones in patients who are poor candidates for initial percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography. • The overall technical success for the transcholecystic-only approach was 80.5% (33/41). Including transhepatic conversions, it was 100% (41/41). Stone removal was successful in one session in 78% (32/41) of the patients and in multiple sessions in 28.1% (9/41) of the patients. • Balloon ampulloplasty with stone expulsion using an occlusion balloon catheter is also a safe and effective method for removing EHD stones.
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Wang W, Wang W, Liu B, Li Y. Fluoroscopy-guided percutaneous lithotripsy using FREDDY laser for giant gallstones: Preliminary experience. Lasers Surg Med 2021; 54:392-398. [PMID: 34463963 DOI: 10.1002/lsm.23477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Percutaneous treatment of symptomatic cholelithiasis with large gallstones remains a challenge. We aimed to evaluate the efficacy and safety of a new method for the removal of giant gallstones with percutaneous lithotripsy using a frequency-doubled double-pulse neodymium: YAG (FREDDY) laser. MATERIALS AND METHODS This study included 16 patients (7 males, 9 females; mean age, 63.4 ± 14.9 years) with giant gallstones who experienced the recurrence of cholecystitis and were not eligible for operation. The percutaneous transcystic approach was established using an 8-French sheath. A 6-French steerable sheath were inserted through the sheath. FREDDY laser lithotripsy was performed to break the stones into fragments. The stone fragments were extracted through the 6-French sheath or pushed into the duodenum using a balloon catheter. Cholecystography was performed before removing the catheter. Follow-up ultrasound or computed tomography examination were performed. RESULTS Gallstone clearance was accomplished in 16 (100%) patients at the initial assessment. Eleven patients underwent one session, and five patients underwent two sessions. Residual stones were found in 3 (18.8%) patients during the follow-up period. Peritonitis was found in two (12.5%) patients and hemocholecyst was detected in one (6.3%) patient. No procedure-related deaths occurred. CONCLUSION Percutaneous lithotripsy using a FREDDY laser may be an effective and safe alternative choice for treating giant gallstones, especially for patients who are not eligible for cholecystectomy.
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Affiliation(s)
- Wujie Wang
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Wei Wang
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
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Liu B, Cao PK, Wang YZ, Wang WJ, Tian SL, Hertzanu Y, Li YL. Modified percutaneous transhepatic papillary balloon dilation for patients with refractory hepatolithiasis. World J Gastroenterol 2020; 26:3929-3937. [PMID: 32774067 PMCID: PMC7385557 DOI: 10.3748/wjg.v26.i27.3929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/24/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Some patients with hepatolithiasis cannot tolerate surgery due to severe cardiac or pulmonary comorbidities, or cannot be endoscopically treated because of altered gastrointestinal anatomies.
AIM To propose a modified percutaneous transhepatic papillary balloon dilation procedure, and evaluate the clinical efficacy and safety of this modality.
METHODS Data from 21 consecutive patients who underwent modified percutaneous transhepatic papillary balloon dilation with hepatolithiasis were retrospectively analyzed. Using auxiliary devices, intrahepatic bile duct stones were pushed into the common bile duct and expelled into the duodenum with an inflated balloon catheter. The outcomes recorded included success rate, procedure time, hospital stay, causes of failure, and procedure-related complications. Patients with possible long-term complications were followed up for 2 years.
RESULTS Intrahepatic bile duct stones were successfully removed in 20 (95.23%) patients. Mean procedure time was 65.8 ± 5.3 min. Mean hospital stay was 10.7 ± 1.5 d. No pancreatitis, gastrointestinal, or biliary duct perforation was observed. All patients were followed up for 2 years, and there was no evidence of reflux cholangitis or calculi recurrence.
CONCLUSION Modified percutaneous transhepatic papillary balloon dilation was feasible and safe with a small number of patients with hepatolithiasis, and may be a treatment option in patients with severe comorbidities or in patients in whom endoscopic procedure was not successful.
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Affiliation(s)
- Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
- Interventional Oncology Institute of Shandong University, Jinan 250033, Shandong Province, China
| | - Pi-Kun Cao
- Department of Cancer Center, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Yong-Zheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
- Interventional Oncology Institute of Shandong University, Jinan 250033, Shandong Province, China
| | - Wu-Jie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
- Interventional Oncology Institute of Shandong University, Jinan 250033, Shandong Province, China
| | - Shi-Lin Tian
- School of Medicine, Shandong University, Jinan 250014, Shandong Province, China
| | - Yancu Hertzanu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
- Interventional Oncology Institute of Shandong University, Jinan 250033, Shandong Province, China
| | - Yu-Liang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
- Interventional Oncology Institute of Shandong University, Jinan 250033, Shandong Province, China
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vanSonnenberg E, Panchanathan R. Percutaneous Transcholecystic Management of Choledocholithiasis: A Next Horizon for Interventional Radiologists? Radiology 2019; 290:244-245. [DOI: 10.1148/radiol.2018181942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Eric vanSonnenberg
- From the Department of Radiology, University of Arizona College of Medicine Phoenix, 550 Van Buren Ave, Building HSEB, Office C536, Phoenix, AZ 85004 (E.v., R.P.); and Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095 (E.v.)
| | - Roshan Panchanathan
- From the Department of Radiology, University of Arizona College of Medicine Phoenix, 550 Van Buren Ave, Building HSEB, Office C536, Phoenix, AZ 85004 (E.v., R.P.); and Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095 (E.v.)
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Jung GS, Kim YJ, Yun JH, Park JG, Yun BC, Han BH, Lee SU, Kim YH. Percutaneous Transcholecystic Removal of Common Bile Duct Stones: Case Series in 114 Patients. Radiology 2018; 290:238-243. [PMID: 30226454 DOI: 10.1148/radiol.2018173043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose To evaluate the safety and effectiveness of percutaneous transcholecystic removal of common bile duct (CBD) stones in 114 patients. Materials and Methods This retrospective study was approved by the institutional review board. From September 2011 through February 2017, 114 consecutive patients (68 men, 46 women; mean age, 73 years) underwent percutaneous transcholecystic removal of CBD stones. All patients had acute cholangitis or cholecystitis. Stones were extracted through a 12-F sheath by using a Wittich nitinol stone basket uder fluoroscopic guidance. Technical success rates, complications, and long-term follow-up were evaluated. Results Technical success was achieved in 96 of 114 (84.2%) patients. In 18 patients, stone removal was unsuccessful due to failure of cystic duct cannulation (n = 11), proximal migration of the CBD stone (n = 3), multiple CBD stones (n = 3), and low insertion of the cystic duct (n = 1). No major procedure-related complications were seen. During the mean follow-up of 644 days (range, 11-2206 days), CBD stones recurred in 12 patients after a mean of 884 days (range, 439-1799 days) after the procedure. Conclusion Percutaneous transcholecystic removal of common bile duct stones seems to be a safe and effective method. © RSNA, 2018 Online supplemental material is available for this article . See also the editorial by vanSonnenberg and Panchanathan in this issue.
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Affiliation(s)
- Gyoo-Sik Jung
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Yong Joo Kim
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Jong Hyuk Yun
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Jung Gu Park
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Byung Chul Yun
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Byung Hoon Han
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Sang Uk Lee
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
| | - Young Hwan Kim
- From the Departments of Radiology (G.S.J., J.H.Y., J.G.P.) and Internal Medicine (B.C.Y., B.H.H., S.U.L.), Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea; and Department of Radiology, Andong General Hospital, Gyeongsangbuk-do, South Korea (Y.J.K., Y.H.K.)
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Liu B, Wu DS, Cao PK, Wang YZ, Wang WJ, Wang W, Chang HY, Li D, Li X, Hertzanu Y, Li YL. Percutaneous transhepatic extraction and balloon dilation for simultaneous gallbladder stones and common bile duct stones: A novel technique. World J Gastroenterol 2018; 24:3799-3805. [PMID: 30197485 PMCID: PMC6127656 DOI: 10.3748/wjg.v24.i33.3799] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/09/2018] [Accepted: 07/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM 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).
METHODS 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.
RESULTS 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.
CONCLUSION 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.
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Affiliation(s)
- Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
- 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
- School of Medicine, Shandong University, Jinan 250014, Shandong Province, China
| | - Yong-Zheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
- Interventional Oncology Institute of Shandong University, Jinan 250033, Shandong Province, China
| | - Wu-Jie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
- Interventional Oncology Institute of Shandong University, Jinan 250033, Shandong Province, China
| | - Wei Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
- Interventional Oncology Institute of Shandong University, Jinan 250033, Shandong Province, China
| | - Hai-Yang Chang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
- Interventional Oncology Institute of Shandong University, Jinan 250033, Shandong Province, China
| | - Dong Li
- School of Medicine, Shandong University, Jinan 250014, Shandong Province, China
| | - Xiao Li
- School of Medicine, Shandong University, Jinan 250014, Shandong Province, China
| | - Yancu Hertzanu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
- Department of Radiology, Ben-Gurion University, Negev 88874, Israel
| | - Yu-Liang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
- Interventional Oncology Institute of Shandong University, Jinan 250033, Shandong Province, China
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