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Combined radiological-endoscopic management of difficult bile duct stones: 18-year single center experience.
- Source :
-
Therapeutic advances in gastroenterology [Therap Adv Gastroenterol] 2015 Nov; Vol. 8 (6), pp. 340-51. - Publication Year :
- 2015
-
Abstract
- Objectives: Clinical evidence regarding radiological-endoscopic management of intrahepatic bile duct stones is currently lacking. Our aim is to report our 18-year experience in combined radiological-endoscopic management of intrahepatic difficult bile duct stones.<br />Methods: From June 1994 to June 2012, 299 symptomatic patients with difficult bile duct stones were admitted to our institution. Percutaneous transhepatic cholangiography (PTC)/biliary drainage/s was performed, dilating the PTC track to 10 or 16 French within 3-7 days. Afterward we carried out percutaneous transhepatic cholangioscopy (PTCS) with electrohydraulic lithotripsy (EHL) and/or interventional radiology techniques. Follow up was made with clinical/laboratory tests and ultrasound (US). We retrospectively analyzed our radiological-endoscopic approach and reported our technical and clinical outcomes.<br />Results: Complete stone clearance was achieved in 298 patients after a maximum of 4 consecutive sessions. Most patients (64.6%) were treated with PTCS/EHL alone, while the remaining with radiological techniques alone (26%) or a combination of both techniques (13.3%). Recurrence of stones occurred in 45 cases (15%, Tsunoda class III and class IV) within 2 years and were successfully retreated. Major adverse events were: 5 (1.6%) cases of massive bleeding that required embolisation, 2 (0.66%) perforations of the common bile duct and 31 cases (10.3%) of acute cholangitis managed with medical therapy or intervention.<br />Conclusion: After 18 years of experience we demonstrated that our combined radiological-endoscopic approach to 'difficult bile duct stones' may result in both immediate and long-term clearance of stones with a low rate of adverse events.
Details
- Language :
- English
- ISSN :
- 1756-283X
- Volume :
- 8
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Therapeutic advances in gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 26557890
- Full Text :
- https://doi.org/10.1177/1756283X15587483