Analysis of wire-guided hemostasis introducer for percutaneous therapy of bile duct stones

M Hollenbach; J Feisthammel; J Mössner; A Hoffmeister

doi:10.1055/s-0037-1604900

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2017; 55(08): e57-e299
DOI: 10.1055/s-0037-1604900

Kurzvorträge

Pankreas

Akute Pankreatitis – from bench to bedside: Donnerstag, 14 September 2017, 09:30 – 10:42, Coventry/Forschungsforum 4

Georg Thieme Verlag KG Stuttgart · New York

Analysis of wire-guided hemostasis introducer for percutaneous therapy of bile duct stones

Authors

M Hollenbach

¹Universitätsklinikum Leipzig, Department für Innere Medizin, Neurologie und Dermatologie; Klinik für Gastroenterologie und Rheumatologie, Leipzig, Deutschland
J Feisthammel

¹Universitätsklinikum Leipzig, Department für Innere Medizin, Neurologie und Dermatologie; Klinik für Gastroenterologie und Rheumatologie, Leipzig, Deutschland
J Mössner

¹Universitätsklinikum Leipzig, Department für Innere Medizin, Neurologie und Dermatologie; Klinik für Gastroenterologie und Rheumatologie, Leipzig, Deutschland
A Hoffmeister

¹Universitätsklinikum Leipzig, Department für Innere Medizin, Neurologie und Dermatologie; Klinik für Gastroenterologie und Rheumatologie, Leipzig, Deutschland

Abstract

Full Text

Objectives:

Bile duct stones (BDS) are usually removed via ERCP or, if ERCP remains unsuccessful, PTCD. However, PTCD provides limited access to large BDS. Here we analyzed a modified approach of PTCD with wire-guided hemostasis introducer for percutaneous therapy of BDS.

Methods:

We retrospectively analyzed patients from January 2010 to December 2016. We used a modified approach of PTCD with a 13-french (Fr) hemostasis introducer for transhepatic access to BDS. Either short-wired balloon or basket catheter were applied for safe removal of BDS. Patient characteristics, effectiveness and complications were analyzed.

Results:

We identified 11 patients (55% male gender, mean age 73 years) who underwent PTCD with hemostasis introducer. ERCP failed mainly because of prior abdominal surgery. Mostly multiple concrements < 10 mm (73%) were found. BDS either were pushed forward to the duodenum (36%) or both partly pushed and extracted via hemostasis introducer (64%). In some cases, mechanical lithotripsy was necessary (45%). Complete removal of BDS was initially achieved in 36% of patients, 45% received additional PTCD and in 19% stent implantation was performed. Finally all BDS could be removed. Laboratory analysis revealed significant reduction of AP (p = 0.03) and CRP (p = 0.03). Complications occurred only in 1 patient with post interventional cholangitis.

Conclusions:

Our study showed feasibility and safety of a modified PTCD with hemostasis introducer. In addition, protection of liver tissue from sharp-edged catheters and stones was achieved. Due to high efficiency and marginal complications, our modification revealed an innovational approach for transhepatic removal of BDS.