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.