ENDOSCOPIC THERAPY OF CHOLANGIOLITHIASIS ON PERCUTANEOUS ROUTE

Patients and methods: In a retrospective study, the results of percuta neous transhepatic therapy of bile duct stones under cholangioscopic c ontrol (PTCS) were evaluated in 32 patients in which a endoscopic retr ograde stone removal was impossible or failed. Results: Previous gastr ic surgery was the most common reason for choosing the percutaneous ro ute (22 cases). Five patients had biliodigestive anastomosis, two pylo ric obstructions, and in three patients the retrograde stone removal f ailed. Complete stone removal was obtained after 3 to 11 (median 5) pe rcutaneous procedures in all cases, in 28 patients by electrohydraulic lithotripsy, and in the remaining 5 cases by mechanical extraction al one. There was no complication due to cholangioscopy and lithotripsy t hemselves. Two cases had major complications which needed laparotomy ( 4 %, one case had capsular bleeding from the liver. another one had ca theter perforation of the duodenum). In addition, three cases (7 %) ha d minor complications which required no therapy during the percutaneou s fistula procedure; Two elderly multimorbid patients (4 %) died durin g hospitalisation after successful stone removal not related to the pe rformed procedure. Conclusion: The percutaneous transhepatic cholangio scopy (PTCS) and lithotripsy are highly effective techniques for endos copic treatment of bile duct stones. Because of an increased rate of c omplications during the fistula procedures, both methods should be res tricted to cases with difficult anatomic situation and high risk of su rgery.