Percutaneous Treatment of Biliary Stones:Sphincteroplasty and Occlusion Balloon for the Clearance of Bile Duct Calculi

Abstract

Percutaneous anterograde evacuation of bile duct stones with dilatation of the papilla using an angioplasty catheter and assisted with an occlusion balloon to expel the calculi is a cost-effective, nontraumatic, and safe procedure that retains the anatomic and functional integrity of the sphincter. It is a viable alternative procedure in the treatment of bile duct lithiasis.

The role of endoscopy in the management of choledocholithiasis

“…However, percutaneous techniques have also been used for extrahepatic biliary stones via a T-tube sinus tract or percutaneous transhepatic tract. [183][184][185][186] High rates of successful duct clearance (90%-100%) using a variety of techniques have consistently been reported with percutaneous approaches. [183][184][185][186][187][188][189][190][191] However, severe bleeding events have been reported in as many as 14% of patients with percutaneous transhepatic approaches, with mortality as high as 8%.…”

“…[183][184][185][186] High rates of successful duct clearance (90%-100%) using a variety of techniques have consistently been reported with percutaneous approaches. [183][184][185][186][187][188][189][190][191] However, severe bleeding events have been reported in as many as 14% of patients with percutaneous transhepatic approaches, with mortality as high as 8%. 184,188 Given the logistical complexity (percutaneous tracts take time to mature), incidence of severe complications, and available alternatives, percutaneous techniques for managing extrahepatic bile duct stones are not recommended as a first-line strategy.…”

“…[183][184][185][186][187][188][189][190][191] However, severe bleeding events have been reported in as many as 14% of patients with percutaneous transhepatic approaches, with mortality as high as 8%. 184,188 Given the logistical complexity (percutaneous tracts take time to mature), incidence of severe complications, and available alternatives, percutaneous techniques for managing extrahepatic bile duct stones are not recommended as a first-line strategy. However, removal of small stones via a mature T-tube sinus tract represents a potential exception because excellent results have been achieved in experienced hands.…”

Percutaneous Treatment of Common Bile Duct Stones: Results and Complications in 110 Consecutive Patients

“…Percutaneous transhepatic removal of CBD stones is a minimally invasive alternative for surgical treatment. This approach is not commonly used for patients in whom ERCP treatment is not possible and only a few studies have reported the results of this procedure [17,18,19,20,21,22,23]. …”

Operative Cholangiography in Two-Port Needlescopic Cholecystectomy

“…One patient in our series was treated by balloon dilatation of the sphincter of Oddi through the transcystic route. [12][13][14] The balloon catheter is inserted through the supraumbilical port site. Incision on the cystic duct should not be more than one-third of its circumference to avoid avulsion of the cystic duct during retraction.…”