Skip to main content

Advertisement

SpringerLink
Log in

Predictors of technical success of percutaneous transhepatic common bile duct stone removal: is it only a matter of stone size?

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The common practice is to remove symptomatic common bile duct (CBD) stones in patients. This study aimed to investigate the factors affecting the percutaneous transhepatic removal of CBD stones.

Methods

We retrospectively analyzed the data of 100 patients (66 men and 34 women; age: 25–105 years, mean 79.1 years) with symptomatic CBD stones who underwent percutaneous transhepatic stone removal (PTSR) from January 2010 through October 2019. After balloon dilation of the ampulla of Vater or bilioenteric anastomosis, the stones were pushed out of the CBD into the small bowel with a balloon catheter. If failed, basket lithotripsy was performed. Technical success was defined as complete clearance of the bile ducts on a cholangiogram.

Results

The technical success rate was 83%, and achieved 90.2% in patients with altered gastroduodenal/pancreatobiliary anatomy. Multivariable analysis revealed that CBD diameter (odds ratio [OR]: 506.460, p = 0.015), failed ERCP (OR: 16.509, p = 0.004), Tokyo guidelines TG18/TG13 severity (grade III; OR: 60.467, p = 0.006), and left-sided transhepatic approach (OR: 21.621, p = 0.012) were risk factors for technical failure. The appropriate cutoff CBD size was 15.5 mm (area under the curve: 0.91). CBD stone size, radiopacity of stones, and CBD angle between retroduodenal and pancreatic portion did not influence technical success.

Conclusions

PTSR is effective for CBD stone removal in older adults and individuals with altered gastrointestinal tract anatomy. The aforementioned risk factors for technical failure should be considered in preoperative evaluation before PTSR to improve the success rate.

Key Points

• PTSR is effective in symptomatic CBD stone management among older adults and individuals with altered anatomy. Investigating clinical /anatomic factors can guide radiologists toward a more comprehensive preoperative evaluation to maximize the success rate.

• Our data indicate that dilated CBD (diameter ≥ 15.5 mm) and left-sided PTBDs reduce the technical success rate by 506-fold and 22-fold, respectively.

• Clinical factors such as previous failed ERCP for stone removal and higher severity of acute cholangitis lessen the technical success rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

aCBD:

CBD angulation between retroduodenal and pancreatic portion

ALKP:

Alkaline phosphatase

AUC:

Area under the curve

CBD:

Common bile duct

CI:

Confidence interval

CRP:

C-reactive protein

CT:

Computed tomography

ERCP:

Endoscopic retrograde cholangiopancreatography

ESCP:

Endosonography-guided cholangiopancreatography

ESWL:

Extracorporeal shock-wave lithotripsy

fERCP:

Previous ERCP failure for stone removal

HU:

Hounsfield unit

IHD:

Intrahepatic bile duct

MRCP:

Magnetic resonance cholangiopancreatography

OR:

Odds ratio

PAD:

Periampullary diverticulum

PTBD:

Percutaneous transhepatic biliary drainage

PTSR:

Percutaneous transhepatic biliary stone removal

T.bil:

Total bilirubin

TG18/TG 13:

Tokyo guideline 2018/2013 for acute cholangitis severity

References

  1. Shah KN, Clary BM (2017) Chapter 36A - stones in the bile duct: clinical features and open surgical approaches and techniques. In: Jarnagin WR (ed) Blumgart’s Surgery of the Liver, Biliary Tract and Pancreas, 2-Volume Set, 6th edn. Elsevier, Philadelphia, pp 585-603.e3

    Google Scholar 

  2. Manes G, Paspatis G, Aabakken L et al (2019) Endoscopic management of common bile duct stones. Eur Soc Gastrointest Endosc (ESGE) Guide Endosc 51(5):472–491

    Google Scholar 

  3. Li G, Pang Q, Zhai H et al (2021) SpyGlass-guided laser lithotripsy versus laparoscopic common bile duct exploration for large common bile duct stones: a non-inferiority trial. Surg Endosc 35(7):3723–3731

    PubMed  Google Scholar 

  4. Costi R, Gnocchi A, Di Mario F, Sarli L (2014) Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol 20(37):13382–401

    PubMed  PubMed Central  Google Scholar 

  5. Morrell D, Pauli E, Juza R (2019) Endoscopy in surgically altered anatomy. Annals Laparosc Endoscopic Surg 4(41)

  6. Ali MF, Modayil R, Gurram KC, Brathwaite CEM, Friedel D, Stavropoulos SN (2018) Spiral enteroscopy-assisted ERCP in bariatric-length Roux-en-Y anatomy: a large single-center series and review of the literature (with video). Gastrointest Endosc 87(5):1241–1247

    PubMed  Google Scholar 

  7. Committee AT, Chauhan SS, Manfredi MA et al (2015) Enterosc Gastrointest Endosc 82(6):975–990

    Google Scholar 

  8. Jirapinyo P, Lee LS (2016) Endoscopic ultrasound-guided pancreatobiliary endoscopy in surgically altered anatomy. Clin Endosc 49(6):515–529

    PubMed  PubMed Central  Google Scholar 

  9. Martin A, Kistler CA, Wrobel P, Yang JF, Siddiqui AA (2016) Endoscopic ultrasound-guided pancreaticobiliary intervention in patients with surgically altered anatomy and inaccessible papillae: a review of current literature Endosc. Ultrasound 5(3):149–156

    Google Scholar 

  10. Koggel LM, Wahab PJ, Robijn RJ et al (2021) Efficacy and safety of 100 laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography procedures in patients with Roux-en-Y gastric bypass. Obes Surg 31(3):987–993

    PubMed  Google Scholar 

  11. Saleem A, Levy MJ, Petersen BT, Que FG, Baron TH (2012) Laparoscopic assisted ERCP in Roux-en-Y gastric bypass (RYGB) surgery patients. J Gastrointest Surg 16(1):203–8

    PubMed  Google Scholar 

  12. Lopes TL, Clements RH, Wilcox CM (2009) Laparoscopy-assisted ERCP: experience of a high-volume bariatric surgery center (with video). Gastrointest Endosc 70(6):1254–9

    PubMed  Google Scholar 

  13. Lezoche E, Paganini AM (2000) Technical considerations and laparoscopic bile duct exploration: transcystic and choledochotomy. Semin Laparosc Surg 7(4):262–278

    CAS  PubMed  Google Scholar 

  14. Shojaiefard A, Esmaeilzadeh M, Ghafouri A, Mehrabi A (2009) Various techniques for the surgical treatment of common bile duct stones: a meta review. Gastroenterol Res Pract 2009:840208

    PubMed  PubMed Central  Google Scholar 

  15. Sharma A, Dahiya P, Khullar R, Soni V, Baijal M, Chowbey PK (2012) Management of common bile duct stones in the laparoscopic era. Indian J Surg 74(3):264–269

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Hongjun H, Yong J, Baoqiang W (2015) Laparoscopic common bile duct exploration: choledochotomy versus transcystic approach? Surg Laparosc Endosc Percutan Tech 25(3):218–222

    PubMed  Google Scholar 

  17. Perez MR, Oleaga JA, Freiman DB, McLean GL, Ring EJ (1979) Removal of a distal common bile duct stone through percutaneous transhepatic catheterization. Arch Surg 114(1):107–109

    CAS  PubMed  Google Scholar 

  18. Clouse ME (1983) Dormia basket modification for percutaneous transhepatic common bile duct stone removal. AJR Am J Roentgenol 140(2):395–397

    CAS  PubMed  Google Scholar 

  19. Clouse ME, Falchuk KR (1983) Percutaneous transhepatic removal of common duct stones: report of ten patients. Gastroenterology 85(4):815–819

    CAS  PubMed  Google Scholar 

  20. Centola CA, Jander HP, Stauffer A, Russinovich NA (1981) Balloon dilatation of the papilla of Vater to allow biliary stone passage. AJR Am J Roentgenol 136(3):613–614

    CAS  PubMed  Google Scholar 

  21. Ozcan N, Kahriman G, Mavili E (2012) Percutaneous transhepatic removal of bile duct stones: results of 261 patients. Cardiovasc Intervent Radiol 35(3):621–7

    PubMed  Google Scholar 

  22. Liu B, Ma J, Li S, et al (2021) Percutaneous transhepatic papillary balloon dilation versus endoscopic retrograde cholangiopancreatography for common bile duct stones: a multicenter prospective study. Radiology 300(2):470–478

  23. Muglia R, Lanza E, Poretti D et al (2020) Percutaneous transhepatic endoscopic lithotripsy of biliary stones with holmium laser for the treatment of recurrent cholangitis. Abdom Radiol (NY) 45(8):2561–2568

    PubMed  Google Scholar 

  24. Tripathi N, Mardini H, Koirala N, Raissi D, Emhmed Ali SM, Frandah WM (2020) Assessing the utility, findings, and outcomes of percutaneous transhepatic cholangioscopy with spyglass(TM) direct visualization system: a case series. Transl Gastroenterol Hepatol 5:12

    PubMed  PubMed Central  Google Scholar 

  25. Zhuo H, Chen Z, Lin R, et al (2020) Percutaneous transhepatic choledochoscopic lithotomy (PTCSL) is effective for the treatment of intrahepatic and extrahepatic choledocholithiasis. Surg Laparosc Endosc Percutan Tech 31(3):326–330

  26. Wang P, Tao H, Liu C et al (2021) One-step percutaneous transhepatic cholangioscopic lithotripsy in patients with choledocholithiasis. Clin Res Hepatol Gastroenterol 45(2):101477

    PubMed  Google Scholar 

  27. Jung GS, Kim YJ, Yun JH et al (2019) Percutaneous transcholecystic removal of common bile duct stones: case series in 114 patients. Radiology 290(1):238–243

  28. Deal AK, Murthy S, Wason S, Vingan H, Fabrizio M (2016) Percutaneous transhepatic holmium laser lithotripsy of a large common bile duct stone. Radiol Case Rep 11(4):361–364

    PubMed  PubMed Central  Google Scholar 

  29. Herr A, Collins D, White M et al (2019) Percutaneous biliary endoscopy for stones. Tech Vasc Interv Radiol 22(3):127–134

    PubMed  Google Scholar 

  30. Lamanna A, Maingard J, Bates D, Ranatunga D, Goodwin M (2019) Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: a technical report. J Med Imaging Radiat Oncol 63(6):758–764

    PubMed  Google Scholar 

  31. Tao H, Wang P, Sun B, Li K, Zhu C (2020) One-step multichannel percutaneous transhepatic cholangioscopic lithotripsy applied in bilateral hepatolithiasis. World J Surg 44(5):1586–1594

    PubMed  Google Scholar 

  32. Gerges C, Vazquez AG, Tringali A, et al (2021) Percutaneous transhepatic cholangioscopy using a single-operator cholangioscope (pSOC), a retrospective, observational, multicenter study. Surg Endosc 35(12):6724–6730

  33. Lauri A, Horton RC, Davidson BR, Burroughs AK, Dooley JS (1993) Endoscopic extraction of bile duct stones: management related to stone size. Gut 34(12):1718–1721

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Kiriyama S, Kozaka K, Takada T et al (2018) Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 25(1):17–30

    PubMed  Google Scholar 

  35. Skandalakis JE, Gray SW, Rowe JS (1983) Anatomical complications in general surgery 1st ed., McGraw-Hill. Book company. New York paris 130

  36. Patel IJ, Rahim S, Davidson JC et al (2019) Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions-Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 30(8):1168-1184 e1

    PubMed  Google Scholar 

  37. Cotton PB, Eisen GM, Aabakken L et al (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71(3):446–454

    PubMed  Google Scholar 

  38. Banks PA, Bollen TL, Dervenis C et al (2013) Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut 62(1):102–11

    PubMed  Google Scholar 

  39. Kim CW, Chang JH, Lim YS, Kim TH, Lee IS, Han SW (2013) Common bile duct stones on multidetector computed tomography: attenuation patterns and detectability. World J Gastroenterol 19(11):1788–1796

    PubMed  PubMed Central  Google Scholar 

  40. Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y (1974) Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc 20(4):148–151

    CAS  PubMed  Google Scholar 

  41. Hallerback B, Enochsson L (2020) A prospective nationwide study on the impact of the level of sedation on cannulation success and complications of endoscopic retrograde cholangiopancreatography. Ann Gastroenterol 33(3):299–304

    PubMed  PubMed Central  Google Scholar 

  42. Simsek O, Simsek A, Ergun S, Velidedeoglu M, Saribeyoglu K, Pekmezci S (2017) Managing endoscopic retrograde cholangiopancreatography-related complications in patients referred to the surgical emergency unit. Ulus Travma Acil Cerrahi Derg 23(5):395–399

    PubMed  Google Scholar 

  43. Neoptolemos JP, Carr-Locke DL, Fraser I, Fossard DP (1984) The management of common bile duct calculi by endoscopic sphincterotomy in patients with gallbladders in situ. Br J Surg 71(1):69–71

    CAS  PubMed  Google Scholar 

  44. Dumonceau JM, Kapral C, Aabakken L et al (2020) ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 52(2):127–149

  45. Plewka M, Rysz J, Kujawski K (2017) Complications of endoscopic retrograde cholangiopancreatography. Pol Merkur Lekarski 43(258):272–275

    PubMed  Google Scholar 

  46. Karaahmet F, Kekilli M (2018) The presence of periampullary diverticulum increased the complications of endoscopic retrograde cholangiopancreatography. Eur J Gastroenterol Hepatol 30(9):1009–1012

    PubMed  Google Scholar 

  47. Grimes KL, Maciel VH, Mata W, Arevalo G, Singh K, Arregui ME (2015) Complications of laparoscopic transgastric ERCP in patients with Roux-en-Y gastric bypass. Surg Endosc 29(7):1753–1759

    PubMed  Google Scholar 

  48. Hu Y, Kou DQ, Guo SB (2020) The influence of periampullary diverticula on ERCP for treatment of common bile duct stones. Sci Rep 10(1):11477

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Kim HJ, Choi HS, Park JH et al (2007) Factors influencing the technical difficulty of endoscopic clearance of bile duct stones. Gastrointest Endosc 66(6):1154–1160

    PubMed  Google Scholar 

Download references

Acknowledgements

Kan Ling contributed to the figure illustration (Fig. 4).

Funding

This study has received funding by Wong Vung-Hau Radiology Foundation (WVH). The WVH Foundation had no role in the design, analysis or interpretation of the results in this study, or the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China

    Hsun-Chieh Chiu, Chien-An Liu, Kan Ling, Yin-Chen Tsai, Hsuen-En Huang & Rheun-Chuan Lee

  2. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China

    Hsun-Chieh Chiu, Chien-An Liu, Hsiuo-Shan Tseng, Kan Ling, Yin-Chen Tsai, Hsuen-En Huang, Pei-Shan Wu & Rheun-Chuan Lee

  3. Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China

    Chien-An Liu

  4. Department of Medical Imaging, Cheng Hsin General Hospital, Taipei, 201, Section 2, Shi-Pai Road, Taipei, 112, Taiwan, Republic of China

    Hsiuo-Shan Tseng

  5. Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China

    Pei-Shan Wu

  6. Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China

    Pei-Shan Wu

Authors
  1. Hsun-Chieh Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chien-An Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hsiuo-Shan Tseng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kan Ling
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yin-Chen Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hsuen-En Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pei-Shan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rheun-Chuan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chien-An Liu.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Chien-An Liu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• prognostic study/observational

• performed at one institution

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 425 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chiu, HC., Liu, CA., Tseng, HS. et al. Predictors of technical success of percutaneous transhepatic common bile duct stone removal: is it only a matter of stone size?. Eur Radiol 33, 6872–6882 (2023). https://doi.org/10.1007/s00330-023-09631-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-023-09631-y

Keywords

Search

Navigation