title: Percutaneous treatment of bile duct stones in patients treated unsuccessfully with endoscopic retrograde procedures.
abstract: BACKGROUND
  The preferred treatment for stones in the bile duct is endoscopic sphincterotomy followed by stone extraction. When this fails, percutaneous treatment is an alternative to surgery. The purpose of this study was to evaluate the success and complication rate of percutaneous treatment.
  
  
  METHODS
  Between April 1990 and April 1997, a total of 31 consecutive patients (20 men, 11 women, mean age 70.1 years) underwent percutaneous treatment of bile duct stones (average of 2.2 per patient, range 1 to 10). The percutaneous treatment was considered successful if all stones could be removed. Time and number of sessions needed for imaging, percutaneous treatment, and complications were scored.
  
  
  RESULTS
  Twenty-seven patients (87%) were free of stones after 2 to 15 sessions (mean 5.6). The median time for treatment was 16 days (3 to 299). Complications occurred in 3 of the 31 patients: one myocardial infarction during extracorporeal shockwave lithotripsy, one pancreatitis, and one bacteremia. None of these complications were life threatening. Four patients (13%) underwent surgery after failed percutaneous treatment.
  
  
  CONCLUSIONS
  Percutaneous treatment of bile duct stones is an alternative with a high success rate when endoscopic stone removal fails. Surgery can be avoided in nearly 90% of cases.
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. jurgenvandervelden@wxs.nl
authors.forename: J J
authors.initials: JJ
authors.lastname: van der Velden
authors.forename: M Y
authors.initials: MY
authors.lastname: Berger
authors.forename: H J
authors.initials: HJ
authors.lastname: Bonjer
authors.forename: K
authors.initials: K
authors.lastname: Brakel
authors.forename: J S
authors.initials: JS
authors.lastname: Laméris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic / Q000379:methods; D017211:Treatment Failure; D016896:Treatment Outcome