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Choi, Han, Jin, Lee, and Yu: Effectiveness of Percutaneous Biliary Stone Removal as Primary Treatment in Cases with Difficulties in the Use of an Endoscopy
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Journal of the Korean Society of Radiology 2014; 70(3): 225-231.

Published online: 12 March 2014

DOI: https://doi.org/10.3348/jksr.2014.70.3.225

Effectiveness of Percutaneous Biliary Stone Removal as Primary Treatment in Cases with Difficulties in the Use of an Endoscopy

Sin Ae Choi, MD1, Young Min Han, MD1, 2, 3, Gong Yong Jin, MD1, 2, Seung Ok Lee, MD2, 4, Hee Chul Yu, MD2, 5

1Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea.

2Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.

3Institute of Cardiovascular Research, Chonbuk National University Medical School and Hospital, Jeonju, Korea.

4Department of Internal Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.

5Department of Surgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea.

Corresponding author: Young Min Han, MD. Department of Radiology, Research Institute of Clinical Medicine, Institute of Cardiovascular Research, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 561-712, Korea. Tel. 82-63-250-1176, Fax. 82-63-272-0481, ymhan@jbnu.ac.kr

Received 28 October 2013       Accepted 20 December 2013

Copyright © 2014 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effectiveness of percutaneous biliary stone removal as a primary treatment in cases with difficulties to use an endoscopy.

Materials and Methods

From March 2004 to May 2011, 17 patients who underwent primary percutaneous biliary stone removal (Group 1) and 34 case-matched patients who underwent primary endoscopic biliary stone removal were selected (Group 2). The inclusion criteria were as follows: patients who had 1) ≥ 15 mm bile duct stones, 2) intrahepatic bile duct stones, 3) bile duct stones with a history of previous gastrointestinal bypass surgery. In the present study were analyzed the success rates, the length of postprocedural hospital stay, the change of Amylase/Lipase values and complications post procedure. Statistical analysis was performed using paired t-test and unpaired t-test.

Results

The success rate was higher in Group 1 (94.1%) than in Group 2 (85.3%). Length of post procedural hospital stay and the post procedural amylase level were significantly increased in Group 2 (p = 0.036 and p = 0.017, respectively).

Conclusion

In cases of bile duct stones with difficulties in the use of an endoscopy a percutaneous biliary stone removal can be efficient as a primary treatment.

Keywords: Percutaneous Biliary Stone Removal, Endoscopic Retrograde Cholangio, Pancreatography, ≥ 15 mm Bile Duct Stones, Intrahepatic Bile Duct Stones, History of Gastrointestinal Bypass Surgery

Figures and Tables

Fig. 1
A 87-year-old woman with distal common bile duct stones.
A. Cholangiogram shows a large impacted stones (55, 18 mm in each diameter) in the distal common bile duct.
B, C. On endoscopic examination, one stone was broken using by mechanical lithotripsy. But lithotripsy for large proximal stone was failed.
D. The ampullary sphincter was dilated using a 10 mm-sized balloon catheter.
E. The stone was captured and fragmented using 7 Fr stone basket. The fragmented stones were completely extracted.
F. Follow-up cholangiogram shows no demonstrable residual stone in the distal common bile duct.
jksr-70-225-g001
Fig. 2
A 77-year-old woman with distal common bile duct stone. She underwent total gastrectomy with esophago-jejunostomy due to gastric cancer.
A. Cholangiogram shows an impacted stones in the distal common bile duct (white arrow).
B. On endoscopic examination, the ampullary orifice could not be found due to previous operation.
C. The ampullary sphincter was dilated using a 10 mm-sized balloon catheter (stone diameter: 13 mm, black arrow).
D. The stone was captured and pulled using 7 Fr stone basket. The fragmented stone was completely extracted.
E. Follow-up cholangiogram shows no demonstrable residual stone in the distal common bile duct.
jksr-70-225-g002
Table 1
Patient and Disease Characteristics
jksr-70-225-i001

Note.-Hx of GI bypass surgery = history of gastrointestinal bypass surgery, IHBD = intrahepatic bile duct

Table 2
Amylase and Lipase Level at Pre- and Post-Procedure
jksr-70-225-i002

Note.-*Latest level before first biliary stone removal procedure.

†Highest level after last biliary stone removal procedure.

Group 1 = Group who underwent primary percutaneous biliary stone removal, Group 2 = Group who underwent primary endoscopic retrograde cholangiopancreatography

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