Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2018; 24(39): 4489-4498
Published online Oct 21, 2018. doi: 10.3748/wjg.v24.i39.4489
Ursodeoxycholic acid combined with percutaneous transhepatic balloon dilation for management of gallstones after elimination of common bile duct stones
Hai-Yang Chang, Chang-Jun Wang, Bin Liu, Yong-Zheng Wang, Wu-Jie Wang, Wei Wang, Dong Li, Yu-Liang Li
Hai-Yang Chang, Bin Liu, Yong-Zheng Wang, Wu-Jie Wang, Wei Wang, Dong Li, Yu-Liang Li, Department of Intervention Medicine, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
Hai-Yang Chang, Bin Liu, Yong-Zheng Wang, Wu-Jie Wang, Wei Wang, Dong Li, Yu-Liang Li, Interventional Oncology Institute, Shandong University, Jinan 250033, Shandong Province, China
Chang-Jun Wang, Department of Radiology, Jiyang People’s Hospital, Jinan 251400, Shandong Province, China
Author contributions: All authors helped to perform the research; Chang HY contributed to manuscript writing, statistical analysis, and manuscript critical revision; Li YL contributed to study conception and design, manuscript writing, statistical analysis, and manuscript critical revision; Wang CJ, Liu B, Wang YZ, Wang WJ, Wang W, and Li D contributed to manuscript writing.
Supported by the Natural Science Foundation of Shandong Province, No. ZR2014HM050; the Youth Foundation of the Second Hospital of Shandong University, No. Y2014010047; the Nature Science Foundation of Shandong Province, No. ZR2018PH032 and No. ZR2018PH033; and the National Natural Science Foundation of China, No. 61671276.
Institutional review board statement: This study was reviewed and approved by the ethics committee of the Second Hospital of Shandong University.
Informed consent statement: All participants provided written informed consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yu-Liang Li, MD, PhD, Chief Doctor, Doctor, Professor, Department of Intervention Medicine, The Second Hospital of Shandong University, 247 Beiyuan Road, Jinan 250033, Shangdong Province, China. lyl.pro@sdu.edu.cn
Telephone: +86-531-85875927
Received: July 25, 2018
Peer-review started: July 25, 2018
First decision: August 27, 2018
Revised: August 29, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: October 21, 2018
Abstract
AIM

To evaluate the effectiveness and safety of combined ursodeoxycholic acid and percutaneous transhepatic balloon dilation for management of gallstones after expulsion of common bile duct (CBD) stones.

METHODS

From April 2014 to May 2016, 15 consecutive patients (6 men and 9 women) aged 45-86 (mean, 69.07 ± 9.91) years suffering from CBD stones associated with gallstones were evaluated. Good gallbladder contraction function was confirmed by type B ultrasonography. Dilation of the CBD and cystic duct was detected. Percutaneous transhepatic balloon dilation of the papilla was performed, ursodeoxycholic acid was administered, and all patients had a high-fat diet. All subjects underwent repeated cholangiography, and percutaneous transhepatic removal was carried out in patients with secondary CBD stones originating from the gallbladder.

RESULTS

All patients underwent percutaneous transhepatic balloon dilation with a primary success rate of 100%. The combined therapy was successful in 86.7% of patients with concomitant CBD stones and gallstones. No remaining stones were detected in the gallbladder. Transient adverse events include abdominal pain (n = 1), abdominal distension (n = 1), and fever (n = 1). Complications were treated successfully via nonsurgical management without long-term complications. No procedure-related mortality occurred.

CONCLUSION

For patients with concomitant CBD stones and gallstones, after percutaneous transhepatic removal of primary CBD stones, oral ursodeoxycholic acid and a high-fat diet followed by percutaneous transhepatic removal of secondary CBD stones appear to be a feasible and effective option for management of gallstones.

Keywords: Common bile duct stones, Gallstones, Percutaneous transhepatic removal, Ursodeoxycholic acid

Core tip: Percutaneous transhepatic removal combined with oral ursodeoxycholic acid and a high-fat diet appears to be a feasible and safe alternative to surgery or endoscopic procedure for elimination of gallstones, especially for patients with good gallbladder contraction function, diameter of gallstones no greater than 12 mm, and dilation of the cystic duct. It also provides an alternative when operative management is not available for patients in poor condition.