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Transcholecystic management of extrahepatic duct stones in poor candidates for endoscopic or transhepatic approaches

  • Interventional
  • Published:
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Abstract

Objectives

To investigate transcholecystic management of extrahepatic duct (EHD) stones using balloon ampulloplasty in patients who are poor candidates for endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) and assess its efficacy and safety.

Methods

Forty-one patients who were unable to undergo ERCP or had failed ERCP with non-dilated intrahepatic ducts (IHD) between February 2019 and October 2020 were retrospectively enrolled. After clinical improvement with percutaneous cholecystostomy (PC), EHD stones were managed through cystic duct passage, guidewire unwinding, sheath insertion, and EHD stone removal using balloon ampulloplasty. If the transcholecystic route failed, a transhepatic approach was used according to the pre-existing cholangiogram obtained via PC. We evaluated the technical success rate and complications of each step.

Results

The technical success rate for the transcholecystic-only approach was 80.5%. The remaining cases were successfully managed with transhepatic conversion. Multiple stone removal sessions were required in 22% of the cases. One patient with combined IHD stones was initially converted to a transhepatic approach without any transcholecystic removal trial. The technical success rates for each step were as follows: cystic duct passage (38/40, 95%), guidewire unwinding (36/38, 94.7%), sheath insertion (36/36, 100%), and stone removal using balloon ampulloplasty (33/36, 91.7%). The overall clinical success was 97.6% (40/41) without major procedure-related complications. Thereafter, cholecystectomy was successfully performed in patients with concomitant gallstones (n = 20). No postprocedural complications occurred during the follow-up (1–70 days).

Conclusions

Percutaneous EHD stone removal through transcholecystic and transhepatic routes after PC is effective and safe in poor candidates for PTBD or ERCP.

Key Points

• This study shows the safety and efficacy of extrahepatic duct (EHD) stones in patients who are poor candidates for initial percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography.

• The overall technical success for the transcholecystic-only approach was 80.5% (33/41). Including transhepatic conversions, it was 100% (41/41). Stone removal was successful in one session in 78% (32/41) of the patients and in multiple sessions in 28.1% (9/41) of the patients.

• Balloon ampulloplasty with stone expulsion using an occlusion balloon catheter is also a safe and effective method for removing EHD stones.

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Abbreviations

EHD:

Extrahepatic duct

ERCP:

Endoscopic retrograde cholangiopancreatography

IHD:

Intrahepatic duct

PC:

Percutaneous cholecystostomy

PTBD:

Percutaneous transhepatic biliary drainage

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Author notes

  1. SuhYoung Kim and Sangjoon Lee contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, South Korea

    Suh Young Kim & Youngjong Cho

  2. Department of Radiology, Pohang St. Mary’s Hospital, Gyeongsangbuk-do, Pohang-si, South Korea

    Sangjoon Lee

  3. Department of Radiology, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, South Korea

    Sung-Joon Park

  4. Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, South Korea

    Hyoung Nam Lee

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  1. Suh Young Kim
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  2. Sangjoon Lee
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  4. Sung-Joon Park
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Corresponding author

Correspondence to Youngjong Cho.

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The scientific guarantor of this publication is Youngjong Cho.

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

This retrospective study was approved by the institutional review board of our institution, which waived the need for written informed consent from patients (approval no. GNAH 2020-12-001).

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• performed at one institution

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Suh Young Kim and Sangjoon Lee are co-first authors of this work.

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Kim, S.Y., Lee, S., Cho, Y. et al. Transcholecystic management of extrahepatic duct stones in poor candidates for endoscopic or transhepatic approaches. Eur Radiol 32, 1709–1717 (2022). https://doi.org/10.1007/s00330-021-08259-0

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  • DOI: https://doi.org/10.1007/s00330-021-08259-0

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