title: Alternative percutaneous approach for endoscopic inaccessible common bile duct stones.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy followed by stone extraction is a well-established and standard procedure for common bile duct (CBD) stones. An altered anatomy may be related to inaccessible papilla. Percutaneous transhepatic approach, surgery or alternative endoscopy is considered for inaccessible papilla. Percutaneous transhepatic wire-guided retrieval balloon may not be stiff enough for pushing CBD stones in some situations, such as multiple stones or impacted stones. A percutaneous transhepatic cholangiodrainage (PTCD) assisted retrieval balloon technique for increasing the power for pushing CBD stones was designed in this study.
  
  
  METHODS
  A PTCD tube was placed in a situation of inaccessible CBD initially. Percutaneous transhepatic approach with wire-guided balloon dilatation of the papilla assisted with a dilatation balloon. After balloon dilatation of papilla, we performed PTCD assisted retrieval balloon under wired-guided for pushing CBD stones into intestine.
  
  
  RESULTS
  We report on two patients with inaccessible papilla treated with papillary dilation followed by PTCD tube assisted pushing common bile duct stones.
  
  
  CONCLUSIONS
  We recommend that papillary dilatation followed by PTCD tube assisted retrieval balloon push in patients with endoscopic inaccessible common bile duct stones, particularly in multiple stones or impacted stone.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Yen-Chun
authors.initials: YC
authors.lastname: Peng
authors.forename: Wai-Keung
authors.initials: WK
authors.lastname: Chow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008297:Male