Percutaneous transpapillary extraction of biliary calculus for symptomaticcholedocholithiasis after unsuccessfully endoscopic treatment.

Purpose: Evaluation of a percutaneous transhepatic treatment of symptomatic choledocholithiasis in bile ducts that cannot be reached with the endoscop e. Methods: From January 1996 to August 2000 a transhepatic extraction of b iliary calculus was performed in four patients. Endoscopic retrograde chola ngiography (ERC) was not successful in any Of the cases. Clinical symptoms were icterus in four cases, additional cholangitis or colics in two cases. First, a ballon dilation of the papilla was performed by a percutaneous tra nshepatic approach. For removal of bile duct stones, occlusion catheters an d Dormia baskets were used. Technical success was defined as complete remov al of bile duct stones. Clinical success was defined as normalization of ch olestasis and inflammation parameters. In the follow-up an ultrasound exami nation was performed and blood samples were taken for control of cholestasi s parameters. Results: In all four cases treatment was technically and clin ically successful. For complete removal of biliary calculus a second interv ention was necessary in two cases. In each case an internal to external dra inage was left over a mean of 7 days (3 -13 days). In the mean follow-up of 30.5 months (6-50 months) all patients had persistent relief of symptoms. No further interventions were necessary. No complications were present. Con clusion: Percutaneous transpapillary extraction of biliary calculus is an e ffective alternative to surgery in patients with bile ducts, that cannot be reached with the endoscope.