The role of percutaneous transhepatic papillary balloon dilation in percutaneous choledochoscopic lithotomy

Background: When choledochoscopic lithotomy with basket and electrohydrauli c lithotripsy is used to remove intrahepatic duct stones, fragments or smal l stones usually remain in the bile duct that are too small to be captured with a basket. Methods: An attempt was made to remove stone fragments in 16 patients with intrahepatic duct stones by antegrade balloon dilation of the sphincter of Oddi with a conventional balloon catheter. After balloon dilation, remnant stones and sludge were pushed through the papilla with the choledochoscope. Results: Bile duct stones were completely removed in 12 of 16 patients (75% ); stones were removed in 1 session. There was no clinical evidence of proc edure-related pancreatitis or fatal complications. Conclusions: Percutaneous transhepatic papillary balloon dilation of the sp hincter of Oddi and clearance of remnant bile duct stones and stone fragmen ts with the tip of choledochoscope is simple and effective in patients unde rgoing percutaneous transhepatic choledochoscopic lithotomy.