Usefulness of Percutaneous Transhepatic Cholangioscopic Lithotomy for Removal of Difficult Common Bile Duct Stones
2
조회
0
다운로드
5
인용
0
참고문헌
키워드
초록
Background/Aims: Approximately 5% to 10% of common bile duct (CBD) stones are difficult to remove by conventional endoscopic methods. Percutaneous transhepatic cholangioscopic lithotomy (PTCSL) can be an alternative method for this condition, but is not well established yet. The aim of this study was to evaluate the clinical efficacy and safety of PTCSL for removal of difficult CBD stones. Methods: This study is a retrospective review of 34 consecutive patients who underwent unsuccessful removal of CBD stones using conventional endoscopic methods between December 2008 and July 2010 and were subsequently treated using PTCSL. Results: Among 443 patients with CBD stones, 34 patients (7.8%) failed to achieve stone removal using conventional endoscopic methods. Of these 34 patients, 33 were treated using PTCSL. In all 33 cases (100%), complete stone removal was achieved using PTCSL. Most complications (15/17, 88.2%) were mild and transient. Major complications occurred in two patients (6.1%) who experienced hemobilia,and percutaneous transhepatic biliary drainage tract disruption, respectively; which were fully recovered without mortality. Conclusions: Despite prolonged hospital stay and temporary decline of quality of life, PTCSL is an effective and safe method in the management of difficult CBD stones, especially in patients with difficulty in approaching the affected bile duct.
Abstract
Background/Aims: Approximately 5% to 10% of common bile duct (CBD) stones are difficult to remove by conventional endoscopic methods. Percutaneous transhepatic cholangioscopic lithotomy (PTCSL) can be an alternative method for this condition, but is not well established yet. The aim of this study was to evaluate the clinical efficacy and safety of PTCSL for removal of difficult CBD stones. Methods: This study is a retrospective review of 34 consecutive patients who underwent unsuccessful removal of CBD stones using conventional endoscopic methods between December 2008 and July 2010 and were subsequently treated using PTCSL. Results: Among 443 patients with CBD stones, 34 patients (7.8%) failed to achieve stone removal using conventional endoscopic methods. Of these 34 patients, 33 were treated using PTCSL. In all 33 cases (100%), complete stone removal was achieved using PTCSL. Most complications (15/17, 88.2%) were mild and transient. Major complications occurred in two patients (6.1%) who experienced hemobilia,and percutaneous transhepatic biliary drainage tract disruption, respectively; which were fully recovered without mortality. Conclusions: Despite prolonged hospital stay and temporary decline of quality of life, PTCSL is an effective and safe method in the management of difficult CBD stones, especially in patients with difficulty in approaching the affected bile duct.
참고문헌 (29)
- Adamek HE, "Management of retained bile duct stones: a prospective open trial comparing extracorporeal and intracorporeal lithotripsy", Gastrointest Endosc, 44, pp.40~47 (1996)
- Binmoeller KF, "Endoscopic management of bile duct stones", J Clin Gastroenterol, 32, pp.106~118 (2001)
- Ellis RD, "Clearance of refractory bile duct stones with extracorporeal shockwave lithotripsy", Gut, 47, pp.728~731 (2000)
- Neuhaus H., "Endoscopic and percutaneous treatment of difficult bile duct stones", Endoscopy, 35, pp.S31~S34 (2003)
- Arya N, "Electrohydraulic lithotripsy in 111 patients: a safe and effective therapy for difficult bile duct stones", Am J Gastroenterol, 99, pp.2330~2334 (2004)
- McHenry L, "Difficult bile duct stones", Curr Treat Options Gastroenterol, 9, pp.123~132 (2006)
- Larghi A, "Endoscopic direct cholangioscopy by using an ultra- slim upper endoscope: a feasibility study", Gastrointest Endosc, 63, pp.853~857 (2006)
- Chen YK, "SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video)", Gastrointest Endosc, 65, pp.832~841 (2007)
- Mo LR, "Percutaneous transhepatic choledochoscopic electrohydraulic lithotripsy (PTCS-EHL) of common bile duct stones", Gastrointest Endosc, 34, pp.122~125 (1988)
- Adamek HE, "Clinical comparison of extracorporeal piezoelectric lithotripsy (EPL) and intracorporeal electrohydraulic lithotripsy (EHL) in difficult bile duct stones: a prospective randomized trial", Dig Dis Sci, 40, pp.1185~1192 (1995)
- Jan YY, "Percutaneous trans-hepatic cholangioscopic lithotomy for hepatolithiasis: long-term results", Gastrointest Endosc, 42, pp.1~5 (1995)
- Lee SK, "Percutaneous transhepatic cholangioscopic treatment for hepatolithiasis: an evaluation of long-term results and risk factors for recurrence", Gastrointest Endosc, 53, pp.318~323 (2001)
- Huang MH, "Long-term outcome of percutaneous transhepatic cholangioscopic lithotomy for hepatolithiasis", Am J Gastroenterol, 98, pp.2655~2662 (2003)
- Yoshimoto H, "Choledochoscopic electrohydraulic lithotripsy and lithotomy for stones in the common bile duct, intrahepatic ducts, and gallbladder", Ann Surg, 210, pp.576~582 (1989)
- Jeng KS, "Limitations of percutaneous transhepatic cholangioscopy in the removal of complicated biliary calculi", World J Surg, 13, pp.603~610 (1989)
- Lo CM, "Percutaneous transhepatic choledochoscopic electrohydraulic lithotripsy for common bile duct stones: experience in four high-risk patients", Am J Gastroenterol, 86, pp.840~842 (1991)
- Jeong EJ, "Percutaneous transhepatic choledochoscopic lithotomy as a rescue therapy for removal of bile duct stones in Billroth II gastrectomy patients who are difficult to perform ERCP", Eur J Gastroenterol Hepatol, 21, pp.1358~1362 (2009)
- Costamagna G, "Diagnostic and therapeutic ERCP in patients with Billroth II gastrectomy", Acta Gastroenterol Belg, 57, pp.155~162 (1994)
- Lin LF, "ERCP in post-Billroth II gastrectomy patients: emphasis on technique", Am J Gastroenterol, 94, pp.144~148 (1999)
- Osnes M, "Endoscopic retrograde cholangiography and endoscopic papillotomy in patients with a previous Billroth- II resection", Gut, 27, pp.1193~1198 (1986)
- Prat F, "Endoscopic sphincteroclasy: a useful therapeutic tool for biliary endoscopy in Billroth II gastrectomy patients", Endoscopy, 29, pp.79~81 (1997)
- Freeman ML, "Complications of endoscopic biliary sphincterotomy", N Engl J Med, 335, pp.909~918 (1996)
- Faylona JM, "Small-bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy", Endoscopy, 31, pp.546~549 (1999)
- Stokes KR, "Biliary duct stones: percutaneous transhepatic removal", Cardiovasc Intervent Radiol, 13, pp.240~244 (1990)
- García-García L, "Percutaneous treatment of biliary stones: sphincteroplasty and occlusion balloon for the clearance of bile duct calculi", AJR Am J Roentgenol, 182, pp.663~670 (2004)
- Yong Sung Park, "Percutaneous Treatment of Extrahepatic Bile Duct Stones Assisted by Balloon Sphincteroplasty and Occlusion Balloon", Korean Journal of Radiology, 6(4), pp.235~240 (2005), 대한영상의학회
- Nimura Y, "Percutaneous transhepatic cholangioscopy (PTCS)", Stomach Intest, 16, pp.681~689 (1981)
- Chen MF, "Percutaneous transhepatic removal of common bile duct and intrahepatic duct stones with a fiberoptic choledochoscope", Gastrointest Endosc, 32, pp.347~349 (1986)
- Bonnel DH, "Common bile duct and intrahepatic stones: results of transhepatic electrohydraulic lithotripsy in 50 patients", Radiology, 180, pp.345~348 (1991)