Published online Apr 30, 2019. doi: 10.13105/wjma.v7.i4.162
Peer-review started: March 13, 2019
First decision: March 27, 2019
Revised: April 3, 2019
Accepted: April 18, 2019
Article in press: April 18, 2019
Published online: April 30, 2019
Processing time: 49 Days and 19 Hours
Endoscopic sphincterotomy (EST) is widely regarded as the first choice in the management of common bile duct (CBD) stones. However, for some patients, this treatment is not possible. The percutaneous transhepatic balloon dilation (PTBD) technique has been suggested as an alternative but has yet to gain wide acceptance.
To review cases of PTBD for removing CBD stones and explore the safety and efficacy of this treatment.
We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched EMBASE, PubMed, and Web of Science for cases of PTBD that underwent CBD stone removal from 1981 to January 2019. We analyzed all relevant articles available in full text. We extracted data on patient’s age, gender, overall technique success rate, reasons for technique failure, and the presence and type of major and minor complications. We analyzed the data and reported the results in a table and text. Altogether, we retrieved 12 case series and 6 case reports, for a total of 1347 patients. Thirty cases were excluded due to a lack of patient data.
The overall technique success rate for removing a CBD stone was 98.5% (1327/1347) and 98.1% (109/111) for removing concurrent CBD and gallbladder stones. Based on available data (n = 1312), mean age of all patients (687 males and 625 females) was 68.9 years. The total number of procedures in the remaining 1317 patients (after exclusion) was 3237 (average 2.4 procedures per patient). The total number of failures for eliminating a CBD stone was 20, and the reasons for failure included: Stone impaction (n = 10), intrahepatic bile duct stricture (n = 5), large stone (n = 2), severe CBD dilation (n = 1), multiple stones (n = 1), and duodenal perforation (n = 1). Various major complications related to the procedure were reported, but the incidence rate was low (1.4%). No pancreatitis or procedure related mortality was reported. Minor complications including transient hyperamylasemia, nausea, vomiting, abdominal pain, fever, and mild hemobilia were reported. For 218 patients (88 patients with unsuccessful endoscopic removal due to anatomical change and large or impacted stone and 130 cases who refused endoscopic procedure due to poor general condition or other additional disease), the CBD stones were successfully pushed into the duodenum by performing the PTBD procedure.
PTBD is a safe and effective approach in the nonoperative management of CBD stones. PTBD provides an alternative treatment when endoscopic procedures fail or are unsuitable for the patient.
Core tip: Endoscopic treatment for common bile duct (CBD) stones has been widely accepted. However, for specific patients, such as those with gastrointestinal anatomical changes, duodenal diverticulum, esophageal varices, or other conditions, endoscopic treatment is unsuitable and difficult to perform. Under these circumstances, it has been shown that percutaneous transhepatic balloon dilation (PTBD) can remove CBD stones via a percutaneous transhepatic route after papilla dilation. However, no review on this technique has been published. Therefore, we performed a systematic review to confirm the safety and efficacy of PTBD in removing CBD stones in terms of the key outcomes, success rate, reasons for failure, and procedure-related complications.