title: Usefulness of percutaneous transhepatic cholangioscopic lithotomy for removal of difficult common bile duct stones.
abstract: OBJECTIVE
  Approximately 5% to 10% of common bile duct (CBD) stones are difficult to remove by conventional endoscopic methods. Percutaneous transhepatic cholangioscopic lithotomy (PTCSL) can be an alternative method for this condition, but is not well established yet. The aim of this study was to evaluate the clinical efficacy and safety of PTCSL for removal of difficult CBD stones.
  
  
  METHODS
  This study is a retrospective review of 34 consecutive patients who underwent unsuccessful removal of CBD stones using conventional endoscopic methods between December 2008 and July 2010 and were subsequently treated using PTCSL.
  
  
  RESULTS
  Among 443 patients with CBD stones, 34 patients (7.8%) failed to achieve stone removal using conventional endoscopic methods. Of these 34 patients, 33 were treated using PTCSL. In all 33 cases (100%), complete stone removal was achieved using PTCSL. Most complications (15/17, 88.2%) were mild and transient. Major complications occurred in two patients (6.1%) who experienced hemobilia, and percutaneous transhepatic biliary drainage tract disruption, respectively; which were fully recovered without mortality.
  
  
  CONCLUSIONS
  Despite prolonged hospital stay and temporary decline of quality of life, PTCSL is an effective and safe method in the management of difficult CBD stones, especially in patients with difficulty in approaching the affected bile duct.
authors: Department of Internal Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors: Jae Hyung
authors: JH
authors: Lee
authors: Hyung Wook
authors: HW
authors: Kim
authors: Dae Hwan
authors: DH
authors: Kang
authors: Cheol Woong
authors: CW
authors: Choi
authors: Su Bum
authors: SB
authors: Park
authors: Suk Hun
authors: SH
authors: Kim
authors: Ung Bae
authors: UB
authors: Jeon
keywords: Common bile duct stones; Percutaneous transhepatic cholangioscopic lithotomy