Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2020; 26(27): 3929-3937
Published online Jul 21, 2020. doi: 10.3748/wjg.v26.i27.3929
Modified percutaneous transhepatic papillary balloon dilation for patients with refractory hepatolithiasis
Bin Liu, Pi-Kun Cao, Yong-Zheng Wang, Wu-Jie Wang, Shi-Lin Tian, Yancu Hertzanu, Yu-Liang Li
Bin Liu, Yong-Zheng Wang, Wu-Jie Wang, Yancu Hertzanu, Yu-Liang Li, Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
Bin Liu, Yong-Zheng Wang, Wu-Jie Wang, Yancu Hertzanu, Yu-Liang Li, Interventional Oncology Institute of Shandong University, Jinan 250033, Shandong Province, China
Pi-Kun Cao, Department of Cancer Center, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong Province, China
Shi-Lin Tian, School of Medicine, Shandong University, Jinan 250014, Shandong Province, China
Author contributions: Liu B contributed to the study concept and design, analysis and interpretation of the data, drafting of the manuscript, and statistical analysis, and obtained funding; Cao PK contributed to the acquisition of data, analysis and interpretation of data, and statistical analysis; Wang YZ contributed to the technical support and critical revision of the manuscript for important intellectual content; Wang WJ contributed to the technical support and statistical analysis; Tian SL contributed to the acquisition of data and material support; Hertzanu Y contributed to the critical revision of the manuscript for important intellectual content; Li YL contributed to the study concept and design, study supervision, critical revision of the manuscript for important intellectual content, and obtained funding.
Supported by Natural Science Foundation of Shandong Province, No. ZR2018PH032 and No. ZR2018PH033; and National Natural Science Foundation of China, No. 61671276 and No. 11971269.
Institutional review board statement: This study was approved by the ethics committee of the Second Hospital of Shandong University, No. KYLL-2014(LW)02.
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 that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Yu-Liang Li, MD, Chief Doctor, Professor, Department of Interventional Medicine, The Second Hospital of Shandong University; Interventional Oncology Institute of Shandong University, No. 247, Beiyuan Road, Jinan 250033, Shandong Province, China. lyl.pro@sdu.edu.cn
Received: May 6, 2020
Peer-review started: May 6, 2020
First decision: May 21, 2020
Revised: May 24, 2020
Accepted: July 4, 2020
Article in press: July 4, 2020
Published online: July 21, 2020
Abstract
BACKGROUND

Some patients with hepatolithiasis cannot tolerate surgery due to severe cardiac or pulmonary comorbidities, or cannot be endoscopically treated because of altered gastrointestinal anatomies.

AIM

To propose a modified percutaneous transhepatic papillary balloon dilation procedure, and evaluate the clinical efficacy and safety of this modality.

METHODS

Data from 21 consecutive patients who underwent modified percutaneous transhepatic papillary balloon dilation with hepatolithiasis were retrospectively analyzed. Using auxiliary devices, intrahepatic bile duct stones were pushed into the common bile duct and expelled into the duodenum with an inflated balloon catheter. The outcomes recorded included success rate, procedure time, hospital stay, causes of failure, and procedure-related complications. Patients with possible long-term complications were followed up for 2 years.

RESULTS

Intrahepatic bile duct stones were successfully removed in 20 (95.23%) patients. Mean procedure time was 65.8 ± 5.3 min. Mean hospital stay was 10.7 ± 1.5 d. No pancreatitis, gastrointestinal, or biliary duct perforation was observed. All patients were followed up for 2 years, and there was no evidence of reflux cholangitis or calculi recurrence.

CONCLUSION

Modified percutaneous transhepatic papillary balloon dilation was feasible and safe with a small number of patients with hepatolithiasis, and may be a treatment option in patients with severe comorbidities or in patients in whom endoscopic procedure was not successful.

Keywords: Intrahepatic cholestasis, Sphincter of Oddi, Dilation, Common bile duct, Percutaneous, Balloon

Core tip: Some patients with hepatolithiasis cannot tolerate surgery due to severe cardiac or pulmonary comorbidities, or cannot be endoscopically treated because of altered gastrointestinal anatomies. For these patients, modified percutaneous transhepatic papillary balloon dilation, providing a path with compliance and only requiring intravenous anesthesia, should be considered as a treatment option, especially when the endoscopic procedure is not successful.