Percutaneous treatment of extrahepatic bile duct stones assisted by balloon sphincteroplasty and occlusion balloon.
OBJECTIVE
To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing.


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.


CONCLUSIONS
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.
Park
Yong Sung
YS
Department of Diagnostic Radiology,Konyang University Hospital, Daejeon, Korea. mdazzi70@yahoo.co.kr
Kim
Ji Hyung
JH
Choi
Young Woo
YW
Lee
Tae Hee
TH
Hwang
Cheol Mog
CM
Cho
Young Jun
YJ
Kim
Keum Won
KW
D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000379:methods; D017734:Bile Ducts, Extrahepatic; D002404:Catheterization / Q000379:methods*; D002758:Cholangiography; D005240:Feasibility Studies; D005260:Female; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome