Percutaneous Treatment of Extrahepatic Bile Duct Stones Assisted by Balloon Sphincteroplasty and Occlusion Balloon

Percutaneous Treatment of Extrahepatic Bile Duct Stones Assisted by Balloon Sphincteroplasty and Occlusion BalloonObjective: To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing. Materials and Methods:Fifteen patients with extrahepatic bile duct stones were included in this study.Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia.At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD).A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon.Success rate, reason for failure, and complications associated with the procedure were evaluated.Results: Eight patients had one stone, five patients had two stones, and two patients had more than five stones.The procedure was successful in 13 patients (13/15).In 12 of the patients, all stones were removed in the first trial.In one patient, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial.Technical failure occurred in two patients.Both of these patients had severely dilated CBD and multiple stones with various sizes.Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis.Conclusion: Percutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful.ile duct stones may be related to various clinical manifestations such as biliary colic, obstructive jaundice, cholangitis, and biliary sepsis.Medication is needed to relieve clinical symptoms and improve patients' clinical condition, although stone removal is necessary to completely remedy the condition.Various methods including surgical and non-surgical techniques have been used to remove bile duct stones.Among them, endoscopic sphincterotomy has been recognized as the primary modality to remove extrahepatic duct stones based on its effectiveness and overall comfort of the patients.Its usefulness has been confirmed in numerous studies (1, 2), and it is being adopted as the main modality in most centers.Development of devices and techniques used in endoscopic sphincterotomy has improved the success rate of stone removal.However, the use endoscopic sphincterotomy may be difficult or impossible in some clinical situations, including previous