Modified percutaneous transhepatic papillary balloon dilation for patients with refractory hepatolithiasis

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.

Percutaneous transhepatic extraction and balloon dilation for simultaneous gallbladder stones and common bile duct stones:A novel technique

AIM To evaluate the clinical efficacy and safety of an innovative percutaneous transhepatic extraction and balloon dilation(PTEBD) technique for clearance of gallbladder stones in patients with concomitant stones in the common bile duct(CBD).METHODS The data from 17 consecutive patients who underwent PTEBD for clearance of gallbladder stones were retrospectively analyzed. After removal of the CBD stones by percutaneous transhepatic balloon dilation(PTBD), the gallbladder stones were extracted to the CBD and pushed into the duodenum with a balloon after dilation of the sphincter of Oddi. Large stones were fragmented using a metallic basket. The patients were monitored for immediate adverse events including hemorrhage, perforation, pancreatitis, and cholangitis. During the two-year follow-up, they were monitored for stone recurrence, reflux cholangitis, and other longterm adverse events.RESULTS Gallbladder stones were successfully removed in 16(94.1%) patients. PTEBD was repeated in one patient. The mean hospitalization duration was 15.9 ± 2.2 d. Biliary duct infection and hemorrhage occurred in one(5.9%) patient. No severe adverse events, including pancreatitis or perforation of the gastrointestinal or biliary tract occurred. Neither gallbladder stone recurrence nor refluxing cholangitis had occurred two years after the procedure.CONCLUSION Sequential PTBD and PTEBD are safe and effective for patients with simultaneous gallbladder and CBD stones. These techniques provide a new therapeutic approach for certain subgroups of patients in whom endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy or surgery is not appropriate.

Safety and efficacy of percutaneous transhepatic balloon dilation in removing common bile duct stones:A systematic review

BACKGROUND 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.AIM To review cases of PTBD for removing CBD stones and explore the safety and efficacy of this treatment.METHODS 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.RESULTS 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 and625 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 and130 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.CONCLUSION 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.

FABRICATION OF SELF-ASSEMBLY DNA-C_(60) MULTILAYER FILMS

Electrostatic layer-by-layer self-assembly multilayer films were successfully fabricated from C-60-ethylenediamine adduct (C-60-EDA) and DNA. Under visible light irradiation, DNA is ready to be cleaved and the films are destroyed.

Experimental Computed Tomography-guided Vena Cava Puncture in Pigs for Percutaneous Brachytherapy of Middle Mediastinal Lymph Node Metastases

Background： Percutaneous brachytherapy is a valuable method for the treatment of lung cancer and mediastinal lymph nodes metastasis. However, in some of the metastatic lymph nodes in the middle mediastinum, the percutaneous approach cannot be used safely due to possible damage to surrounding anatomical structures. We established an animal model （group of 12 pigs） to assess the safety and feasibility of computed tomography （CT）-guided vena cava puncture. Methods： Under CT guidance, an 18G needle was used to puncture the anterior wall of the anterior vena cava （AVC） in 12 pigs. The 18G needle was chosen as it is similar in size to the needles employed for clinical application in brachytherapy. The incidence of complications and vital signs was monitored during the procedure. Thoracotomy was performed to remove AVC specimens, which were analyzed for histological evidence of vessel wall damage and repair. Results： Following postoperative enhanced CT, two animals were found to have a small pneumothorax （one being hemopneumothorax）. The intraoperative oxygen saturation of both animals was not significantly decreased and was maintained at 93-100%. No animals developed mediastinal hematoma. Preoperative, intraoperative, and postoperative changes in blood pressure, heart rate, hemoglobin, and blood oxygen saturation were not significant. Histological evaluation of AVC specimens showed that by 7 days following the procedure, the endothelial layer was smooth with notable scar repair in the muscularis layer. Conclusions： CT performed after the procedure and histological preparations confirmed the safety of the procedure. This indicates that percutaneous brachytherapy for metastatic middle mediastinal lymph nodes can be carried out via the superior vena cava.