Electrohydraulic Lithotripsy(EHL) of Large Common Bile Duct Stone and Endocoil Insertion with Percutaneous Transhepatic Choledochoscopy

Cho, Hyung Chul; Oh, Ki Chang; Cho, Jang Hyun; Chu, Jin Ho; Kim, Weon Seuk; Kim, Myung Won; Kang, Myung Weon; Yeo, Hyang Soon; Park, Hong Bae

Abstract

BACKGROUND/AIMS: Electrohydraulic lithotrypsy(EHL) under cholangioscopic control has been performed for difficult bile duct stones. The percutaneous transhepatic approach is technically easy and useful in diagnosis and treatment of bile duct obstruction and stones. Biliary stenting with self expanding metal stent is gaining increasingly wider acceptance as a palliative treatment of bile duct obstruction.
METHODS
Between Sep. 1994 and Sep. 1996, EHL under choledochoscopy by percutaneous transhepatic approach was performed in 30 cases(Male: 13, Female: 17). After PTBD with 7F pig tail catheter, the percutaneous transhepatic passage was dilated over guide wire with dilaters of increasing size up to 16Fr in 3-Sdays. In one week, after fistula had been estabilished, choledochoscopy was performed.
RESULTS
(1) Mean age was 61.3 years. Mean stone number was 2.5. And mean stone size was 1.6 X 2.3 cm. (2) Com.plete removal of the stone was achieved in all patients(100%). (3) There were no serious complications. (4) In six cases, Endocoils were implanted with successful decompression of obstructions and simultaneous removal of biliary stones located at both side of stricutre.
CONCLUSIONS
Percutaneous transhepatic choledochoscopy is easy and safe and assists in the diagnosis and treatment of biliary stricture and the management of difficult CBD stone.