We wanted to report on the efficacy and safety of the percutaneous biliary stone removal technique using hydraulic pressure after balloon sphincteroplasty through the PTBD tract for patients with bile duct stones.

The subjects of this study were 85 patients (46 men and 39 women) with bile duct stones who came to hospital over a period of the previous 4 years. All subjects had undergone attempts for with the biliary tree through PTBD. First, an 8-9 F sheath was inserted into the biliary tree through the PTBD route by using a balloon catheter prior to sphincteroplasty, and 50cc of hydraulic pressure with contrast-mixed saline solution was then injected via the sheath. Follow-up cholangiogram was performed 1-3 days later to evaluate the results of stone removal. For residual stones, we attempted second, third, and fourth trials to completely remove the stones. The size and number of stones were analyzed. The results were analyzed, together with the complications, after classifying the cases as "success", "partial removal" or "failure" according to the number of remaining stones.

Out of 85 patients, 71 (83%) cases had successful results, and 43 (51%) cases resulted in success with the first attempt. The second, third and fourth trials were conducted on 16, 10 and 2 cases, respectively. Out of 14 failure cases, 10 patients had too many intrahepatic duct stones. The complications were abdominal pain (n=21), fever (n=9), and pancreatitis (n=2), and portal vein thrombosis, biloma and sepsis were also found in 1 case each.

We report that this percutaneus biliary stone removal technique using hydraulic pressure after balloon sphincteroplasty through the PTBD is safe and effective, and particularly, it achieves good results as the primary therapy for treating only choledocholiths.