Percutaneous Papillary Balloon Dilation Research Articles

Antegrade Papillary Balloon Dilation for Extrahepatic Bile Duct Stone Clearance: Lessons Learned from Treating 300 Patients

Purpose To report the authors' experience with percutaneous papillary balloon dilation for extrahepatic bile duct stone clearance to the duodenum in 300 patients. Materials and Methods During a 16-year period, 300 patients with extrahepatic bile duct stones who underwent papillary balloon dilation were retrospectively evaluated. Two hundred eighty-six patients with retained extrahepatic bile duct stones were treated through a postoperative drain placed during cholecystectomy; 245 patients were treated through a T-tube route and 41 through a transcystic approach. In the remaining 14 patients, the procedure was performed through a newly created percutaneous transhepatic route. Success rates, technical features, reasons for failure, and complications were evaluated. Results Biliary duct stone removal after papillary dilation was successful in 288 patients (96%). In 244 patients, the procedure was successfully completed on the first attempt. Forty-three patients needed two sessions, and in one patient it took three sessions. Stone diameters ranged from 4 mm to 18 mm (mean, 8 mm). Two hundred fourteen patients had four or fewer stones (mean, 2.3), and 86 patients had more than four (mean, 8.8; range, 5–25). Two patients required surgical intervention after loss of transcystic drainage, with subsequent development of peritonitis. During the follow-up period (mean, 26.6 months), no clinical or laboratory abnormalities were observed. Conclusions Percutaneous antegrade papillary balloon dilation and stone clearance is a safe and effective tool in removing common bile duct stones. Some technical issues should be considered to achieve complete stone removal while minimizing the incidence of complications.

Technique of laparoscopic cholecystectomy combined with percutaneous papillary balloon dilatation under general anesthesia for cholecystocholedocholithiasis

Since the introduction of laparoscopic cholecystectomy (LC), the treatment of cholecystocholedocholithiasis has become a controversial issue among surgeons and endoscopists all over the world. We evaluated the effectiveness of LC combined with percutaneous papillary balloon dilatation (PPBD) under general anesthesia in the treatment of cholecystocholedocholithiasis in 22 patients. All stones in the bile duct were successfully evacuated into the duodenum in all patients. The PPBD was feasible in all patients under general anesthesia. The mean postoperative stay was 9 days. The overall length hospital stay and the duration of PTBD were 19 ± 7 days and 16 ± 8 days, respectively. There were no deaths nor major complications, although a transient hyperamylasemia was found in 10 patients (45%). Cholecystocholedocholithiasis was able to be treated by means of LC combined with PPBD under general anesthesia without laparotomy, sphincterotomy or choledochotomy. This technique can be a choice for the treatment that enables a patient to avoid any discomfort arisen as a result of papillary dilatation.

Simultaneous Laparoscopic Cholecystectomy and Percutaneous Papillary Balloon Dilatation for Cholecystocholedocholithiasis

Aim: We evaluated the effectiveness of simultaneous laparoscopic cholecystectomy (LC) and percutaneous papillary balloon dilatation (PPBD) under general anesthesia in the treatment of cholecystocholedocholithiasis in elderly patients in poor general condition. Patients and Methods: We treated 17 patients (group 1) with LC and PPBD as separate procedures and 21 patients (group 2) with simultaneous LC and PPBD under general anesthesia. We compared the success rates, complications, durations of percutaneous transhepatic biliary drainage (PTBD) and hospital stays of the 2 groups. Results: The stones were successfully pushed out into the duodenum in all patients in both groups. All patients in group 1 complained of transient pain caused by balloon dilatation of the papilla. In group 2, PPBD was performed comfortably in all patients because of the general anesthesia. The mean postoperative stay of patients in both groups was 9 days. The overall duration of the hospital stay and the duration of PTBD were 28 ± 5 and 25 ± 9 days, respectively, in group 1, and 18 ± 7 and 15 ± 8 days in group 2 (significant difference: p < 0.01 and p < 0.01, respectively). There were no deaths or major complications, although transient hyperamylasemia occurred in both groups. Conclusions: Cholecystocholedocholithiasis can be treated by simultaneous LC and PPBD under general anesthesia without laparotomy, sphincterotomy, choledochotomy or the discomfort arising from papillary dilatation.

Percutaneous Papillary Balloon Dilatation as a Therapeutic Option for Cholecystocholedocholithiasis in the Era of Laparoscopic Cholecystectomy

Percutaneous Papillary Balloon Dilatation as a Therapeutic Option for Cholecystocholedocholithiasis in the Era of Laparoscopic Cholecystectomy

PERCUTANEOUS PAPILLARY BALLON DILATION AND LAPAROSCOPIC

Twelve cases of bile duct and gallbladder stones were subjected to a study of clinically evaluating the usefulness for percutaneous papillary balloon dilation (PPBD) with laparoscopic cholecystectomy (LC). In conducting the PPBD, a gastointestinal ballon for dilation was inserted throught the percutaneous transhepatic bile duct (PTBD) route to dilate the papilla; and after the papilla was dilated, bile duct stones were pushed out to the duodenum by using a ballon catheter for angiography. LC was used in due form. The maximum horizontal diameter of the bile duct stones ranged from 7mm to 15mm (11 ± 3mm), and there were one to 25 stones. Ten patients had the stones in the common hepatic duct-common bile duct, and two patients in the left hepatic duct-common bile duct. Removal of stones were possible in all cases, but two patients who had stones with horizontal diameter of over 13mm necessitated lithotripsy with electric hydrostatic percussion waves (a success rate: 100%). It took 146 ± 26 minutes for LC operation. Hospital stay after LC was 9 ± 3 days. Indwelling time of PTBD was 23 ± 6 days and total mean hospital stay was 26 ± 3 days. We think that PPBD can be used for cases of multiple bile duct stones, those of huge stones, and those in which the stones are escaped during operation. Further, the associated use of PPBD with LC may contribute to an increase in candidates who are omitted from laparotomy.