Percutaneous Transhepatic Lithotripsy Research Articles

Treatment efficacy and early complications of Percutaneous Transhepatic Holmium Laser Lithotripsy for biliary stones under Digital Subtraction Angiography guidance

Background: Intrahepatic stones and common bile duct stones are common diseases in Vietnam. Surgical treatments have a high rate of remaining intrahepatic bile duct stones and are ineffective with intrahepatic stones and cases with biliary strictures, while endoscopic retrograde cholangiopancreatography stone removal (ERCP) is usually indicated for small common bile duct stones and has disadvantages such as having to performe sphincterectomie of Oddi, 5% causing acute pancreatitis. Nowadays, minimally invasive treatment techniques are more and more developed. Percutaneous transhepatic lithotripsy under fluoroscopy guidance (TSQD) is an improved method using Holmium laser with small sized trocart (16F) help avoid open surgery and increase the rate of stone clearance, especially with stones located in the intrahepatic duct branches. For that reason, we conducted research to evaluate the treatment effectiveness and early complications of this method. Materials and method: This study was conducted on a group of 38 patients with main biliary tract stones, diagnosed and treated using PTHLL under fluoroscopy guidance at Hanoi Medical University Hospital from July 2018 to December 2019. Results: The PTHLL procedures was performed on patients with main extrahepatic biliary stones (28.9%) and those with intrahepatic stones, either isolated or combined (71.1%). One-step lithotripsy was applied in 26.3% of cases without cholangitis, simple stones. In another hand, Two-steps procedure were indicated in 73.7% of cases with cholangitis, multiple stones, and poor patient health. Stand-alone laser lithotripsy (23.7%) was suitable for simpler cases, while combination with baskets and balloons (76.3%) was used for complex situations. The overall complete stone clearance rate was 84.2%. Complications included septicemie (7.8%) and biloma (2.6%). No major complications like bleeding or deaths were encountered in this study. Conclusion: PTHLL under fluoroscopy guidance is a minimally invasive method that achieves a high rate of complete stone clearance in both intra- and extrahepatic biliary stones, with a low early complication rate. Key words: intervention, biliary stone, percutaneous transhepatic holmium laser lithotripsy.

Spyglass percutaneous transhepatic lithotripsy of symptomatic recurrent lithiasis of the intrahepatic bile duct with distal stenosis.

In patients with symptomatic intrahepatic biliary lithiasis, the treatment is usually discussed by a multidisciplinary team. Although hepatectomy is considered as definitive treatment, when lobar atrophy is absent, endoscopic procedures are frequently proposed as first-line treatment due the low invasiveness and for sparing liver parenchyma. Percutaneous route is used in case of peroral approach failure. We present a case of recurrent symptomatic intrahepatic biliary lithiasis of the right posterior hepatic duct, sustained by downstream biliary stenosis. Peroral cholangioscopy failed to visualize the stone for the accompanying stenosis. Thus, the patient was successfully treated with percutaneous transhepatic lithotripsy performed with Spyglass direct visualization system II (Boston Scientific Inc., Natick, Massachusetts, USA). During the procedure, the biopsy of the biliary stenosis revealed fibrosis, which was treated by cholangioplasty with cutting balloon. After 15 months, the patient is asymptomatic, with moderate residual stenosis in absence of calculi at follow-up magnetic resonance cholangiography.

Percutaneous Transhepatic Electrohydraulic Lithotripsy for the Treatment of Difficult Bile Stones.

Objectives: To evaluate the efficacy and safety of percutaneous transhepatic lithotripsy (PTL) using an electro-hydraulic (EH) system for difficult bile stones. Methods: We retrospectively evaluated two patients with recurrent cholangitis, jaundice and fever for the presence of difficult bile stones, inaccessible by an endoscopic approach, treated with PTL. Both procedures were conducted using the same protocol, with two different accesses. The treatments were performed using a 10 Fr flexible choledoscopy SpyGlass DSTM for visualization and an EH system for lithotripsy. Results: Technical success, clinical success and complications were evaluated. The two procedures were successfully concluded in both patients without any residual stones in the biliary tree. For both patients, a short follow-up period of six months was available, during which they remained asymptomatic. Neither major nor minor complications were registered. Conclusion: PTL was determined to be an effective and safe technique. This procedure allows a direct visualization of the stone, reducing fluoroscopy time and permitting a less invasive and less traumatic method for the percutaneous management of difficult bile stones. Advances in knowledge: The direct visualization, the high quality of the digital view, the adequate length of the device and the less traumatic approach of EH systems represent advantages compared with other available technologies.

Percutaneous transhepatic lithotripsy using a choledochoscope: long-term follow-up in 14 patients.

The purpose of our study was to estimate the long-term prognosis of patients with bile duct stones who undergo electrohydraulic lithotripsy guided by choledochoscopy. Since 1987, at our institution, 14 patients with bile duct stones have been treated using percutaneous electrohydraulic lithotripsy guided by choledochoscopy. The procedure was performed 5-7 days after biliary drainage using a 5-mm choledochoscope placed through an 18- to 20-French sheath. All patients underwent follow-up CT, sonography, or both every 6-12 months after treatment. No complications occurred in the 14 patients who underwent treatment. During a mean follow-up period of 4.8 years (range, 2-9 years), two (14%) of the 14 patients developed recurrent common bile duct stones, and another two (14%) developed recurrent small intrahepatic stones; all patients remained asymptomatic. Percutaneous electrohydraulic lithotripsy can be safely performed using a 5-mm choledochoscope. Recurrent calculi may be seen in 28% of patients.