Percutaneous Transhepatic Biliary Stones Removal — An Effective and Safe Alternative (original) (raw)

2020, Hong Kong Journal of Radiology

Introduction: Percutaneous transhepatic biliary stone removal is a well-established treatment for biliary stone disease, as an alternative to the standard endoscopic or surgical approaches. We present our experience in biliary stone removal via the percutaneous transhepatic route, focusing on the techniques, clinical success rate, and complications. Methods: Data on all percutaneous transhepatic biliary stone removals performed at our institution between January 2014 and May 2017 were extracted from patient records. Clinical outcomes, procedure success rate, and complication rate were analysed. Results: In total, 33 procedures were performed in 27 consecutive patients (24 men, 3 women, median age 78.0 years; range, 55-92 years). Reasons for percutaneous transhepatic biliary stone removal included contra-indication to or failure of endoscopic removal (prior gastrectomy or duodenal surgery, n = 19; failed endoscopic retrograde cholangiopancreatography cannulation, n = 3; duodenal stenosis, n = 3; and hepaticojejunostomy stricture, n = 1), and one patient had intrahepatic ductal stones not amenable to endoscopic removal. The overall clinical success rate was 90.9%, with an initial procedure success of complete ductal clearance achieved in 24 cases (72.7%) after the first attempt. Stone removal was unsuccessful in two cases, and incomplete stone removal was present in one case, which were all related to unfavourable biliary anatomy. There were no significant complications (0%) or mortality (0%). The mild complication rate was 15.2% (mild haemobilia, n = 5). Conclusion: Percutaneous transhepatic biliary stone removal is an effective and safe procedure. It is a reliable alternative for patients when endoscopic or surgical approaches are not feasible or unsuccessful.