Korean J Radiol.  2005 Dec;6(4):235-240. 10.3348/kjr.2005.6.4.235.

Percutaneous Treatment of Extrahepatic Bile Duct Stones Assisted by Balloon Sphincteroplasty and Occlusion Balloon

• Park YS
• Kim JH
• Choi YW
• Lee TH
• Hwang CM
• Cho YJ
• Kim KW

• KMID: 1777281
• DOI: http://doi.org/10.3348/kjr.2005.6.4.235

Abstract

OBJECTIVE
To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing. MATERIALS AND METHODS: Fifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated. RESULTS: Eight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patient, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis. CONCLUSION: Percutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful.

Keyword

Extrahepatic bile duct, calculi; Extrahepatic bile duct, stone extraction

MeSH Terms

Treatment Outcome
Middle Aged
Male
Humans
Gallstones/*therapy
Female
Feasibility Studies
Cholangiography
*Bile Ducts, Extrahepatic
Balloon Occlusion/methods
Balloon Dilatation/*methods
Aged, 80 and over
Aged

Figure

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  Fig. 1 Fourty-three year-old female patient with a common bile duct stone and related right upper quadrant pain. This patient refused endoscopy, due to a terrible experience during a previous endoscopy (A) percutaneous transhepatic biliary drainage is performed, showing a stone in the common bile duct. B. The stone is pushed more distally using a 5 F catheter, and 0.035 inch stiff wire is passed to the duodenum. C. Using a 10 mm dilatation balloon, the ampullary sphincter is dilated. D. 11.5 mm occlusion balloon (white arrow) is inserted into the common bile duct, just proximal to the stone (black arrow). E. Using the occlusion balloon, the stone is pushed into the duodenum. F. The stone is completely pushed into the duodenum. G. The stone is shown in the duodenum (arrow).

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  Fig. 2 Fifty-six year-old male complaining of fever and right upper quadrant pain. A. Multiple filling defects are seen in Common bile duct, indicating multiple stones. Common bile duct is severely dilated, measuring 16-17 mm in diameter. B-D. Stone evacuation with occlusion balloon failed. The occlusion balloon passed over the stone, unable to push the stones effectively. E. Even a larger sized balloon (13 mm), that is used for endoscopic common bile duct stone removal, fails in pushing the stones. F. Multiple stones still remain in common bile duct.

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