1/10. New wire-guided basket for intrahepatic stone extraction.BACKGROUND: Endoscopic extraction of intrahepatic ductal stones with conventional stone retrieval baskets sometimes is difficult when the stones are deep in the segmental ducts or in a tortuous duct. We evaluated the use of a new wire-guided basket for endoscopic bile duct stone extraction. methods: The new wire-guided basket has a separate lumen for the guidewire on one side of the catheter. It is rail-loaded and advanced over a guidewire into the desired segmental duct. After they are engaged, the stones are dragged into the duodenum and the guidewire is left in the segmental duct. The basket then can be reinserted into that particular ductal segment over the wire for further stone extraction. RESULTS: The basket was used to treat three patients. Two patients had multiple intrahepatic stones. Repeated passage of the basket back to the desired location was accomplished without difficulty. All stones were removed successfully. CONCLUSION: The new wire-guided basket is a useful device for removing intrahepatic stones, particularly from patients with multiple ductal stones.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/10. Modification of a choledochoscope for extraction of difficult biliary stones.cholelithiasis is a common problem in the united states, affecting 10 to 15 per cent of the population. Although only one per cent of these patients have intrahepatic gallstones their discovery intraoperatively may present a technical challenge for the surgeon. This paper describes a simple method for dislodging difficult intrahepatic biliary stones: modification of a rigid choledochoscope to permit use of a biliary Fogarty catheter and Segura basket under direct visualization.- - - - - - - - - - ranking = 0.57142857142857keywords = extraction (Clic here for more details about this article) |
3/10. Percutaneous hepatolithotomy: the Northwestern University experience.Obstruction of intrahepatic ducts by calculi can lead to abdominal pain, cholestasis, abscesses, and cholangitis. patients with stones recalcitrant to extraction using endoscopic retrograde cholangiopancreatography (ERCP) have traditionally been referred to a general surgeon for open stone extraction or hepatic lobectomy despite its great potential morbidity. Borrowing techniques, instrumentation, and experience in performing percutaneous nephrolithotomy, we describe our experience with percutaneous hepatolithotomy (PHL), a minimally invasive, safe, and effective alternative to open surgery for recalcitrant biliary stones.- - - - - - - - - - ranking = 0.28571428571429keywords = extraction (Clic here for more details about this article) |
4/10. Biliary ascariasis: percutaneous transhepatic management.In a 60-year-old woman who underwent cholecystectomy and T-tube drainage for biliary ascariasis, postoperative bilirubin levels continued to increase. T-tube cholangiography revealed multiple filling defects in the bile ducts, which suggested roundworm reinfestation. Because the patient could not tolerate endoscopy, a percutaneous transhepatic approach with balloon dilatation of the ampulla of vater and subsequent advancement of roundworms into the duodenum with an embolectomy balloon was used. The procedure was successful, with no major complications. The use of a percutaneous transhepatic treatment to advancement of roundworms into the duodenum is a feasible alternative to surgery when endoscopic extraction fails.- - - - - - - - - - ranking = 0.14285714285714keywords = extraction (Clic here for more details about this article) |
5/10. Retained bile duct stones in a patient with Billroth II gastrectomy: extracorporeal shock wave lithotripsy and papillary dilatation via T tube.A postoperative T tube cholangiogram after cholecystectomy in a 62 year old patient showed two retained calculi of 14 mm diameter each. Endoscopic sphincterotomy was not possible because of previous Billroth II gastrectomy. The stones were disintegrated by electromagnetically generated extracorporeal shock waves. The T tube was replaced by a balloon catheter and the papilla of Vater was dilatated allowing passage of stone fragments. We conclude that retained bile duct stones can be removed without sphincterotomy or percutaneous extraction by extracorporeal shock wave lithotripsy and papillary dilatation. This method should be considered especially in patients with Billroth II gastrectomy.- - - - - - - - - - ranking = 0.14285714285714keywords = extraction (Clic here for more details about this article) |
6/10. Percutaneous cholangioscopy for management of retained biliary tract stones and intrahepatic stones.Over the last 13 years starting from 1975 when the first improved cholangiofiberscope was developed at the Teikyo University Hospital, 216 patients with retained biliary tract stones and 93 patients with intrahepatic stones have been seen; stone extraction was successful in 210 and 83 cases with percutaneous cholangioscopy, the success rate being 97.2 and 89.4% respectively. In particular, the advent of sophisticated technology for smashing stones, such as electrohydraulic lithotripsy, and cholangiofiberscope instrumentation have certainly helped to improve the therapeutic results in biliary tract stones. Today it can be claimed that visible stones are readily removable with percutaneous cholangioscopy. Moreover, percutaneous transhepatic cholangioscopy has been proved to be an indispensable tool for the management of intrahepatic stones and benign or malignant biliary tract diseases. Another advantage of percutaneous transhepatic cholangioscopy is that it may be indicated, even in patients in whom the transduodenal approach is considered too difficult to apply. The author firmly believes that even better therapeutic results can be expected if this endoscopic approach becomes more routine.- - - - - - - - - - ranking = 0.14285714285714keywords = extraction (Clic here for more details about this article) |
7/10. Extracorporeal shock wave lithotripsy (ESWL) in the management of complex biliary tract stone disease.The use of extracorporeal shock wave lithotripsy (ESWL) in the management of ten patients with complex biliary tract stones is described. General or epidural anesthesia was used in all cases, and stone fragmentation was performed, using an unmodified Dornier HM3 waterbath lithotripter (Dornier Medical Systems Inc., Marietta, GA). In all cases, biliary drainage was established before the procedure to allow contrast visualization during and after the procedure, as well as to ensure free drainage of the common bile duct. Indications for ESWL included failure of basket extraction (4 cases), unfavorable anatomy (duodenal diverticulum, previous Billroth II reconstruction, hepatic duct stone, gallbladder stone, cystic duct remnant stone), and immaturity of the T-tube tract (2 cases). cholangitis was the presenting diagnosis in four cases. Fragmentation of the stones was successful in all patients; in two cases, two ESWL sessions were needed for stone disruption. morbidity was minimal (there was a minor elevation of LDH and transaminases and asymptomatic hemobilia and hematuria); pancreatitis did not occur. After ESWL, hospital stays ranged from 1 to 13 days (mean of 5.3 days). ESWL can be a valuable adjunct in the management of patients with complex biliary stones.- - - - - - - - - - ranking = 0.14285714285714keywords = extraction (Clic here for more details about this article) |
8/10. Endoscopic diagnosis and extraction of biliary ascaris.A woman was admitted to hospital after several episodes of severe upper right abdominal pain and vomiting. Previously she had had cholecystectomy for gallbladder stones, and later endoscopic papillotomy to treat common duct stone. Endoscopic retrograde cholangiography diagnosed an ascaris worm in the common bile duct. One end of the 20 cm long living worm was caught in a Dormia basket when it protruded through the papillotomy opening, and the worm extracted with the endoscope.- - - - - - - - - - ranking = 0.57142857142857keywords = extraction (Clic here for more details about this article) |
9/10. Endoscopic papillotomy in Caroli's disease twenty-year follow-up of a previously reported case.A patient diagnosed in 1963 as having congenital dilation of intrahepatic bile ducts, presented in 1982 with common bile duct lithiasis. Endoscopic papillotomy and stone extraction were followed by an unusual complication, hiccups lasting one week. We suggest that endoscopic papillotomy should be considered in selected patients with Caroli's disease. Typical and atypical features of this case presentation are discussed.- - - - - - - - - - ranking = 0.14285714285714keywords = extraction (Clic here for more details about this article) |
10/10. Percutaneous transhepatic stone extraction technique for management of retained biliary tract stones.Postoperative choledochoscopy is a great armament for management of retained biliary tract stones and intrahepatic stones. Choledochoscopy can also be safely carried out through a sinus tract artificially established by PTBD and other procedures. The number of sessions and the time required for retrieval of stones are reduced with an endoscopic approach carried out through multiple sinus tracts. This endoscopic approach is more reliable because the interior of the biliary tract is visible. If this endoscopic stone extraction technique becomes more routine, better therapeutic results for biliary tract stones may be expected.- - - - - - - - - - ranking = 0.71428571428571keywords = extraction (Clic here for more details about this article) |
| | Next -> |