Cholangioscopic Extraction of Intrahepatic Stones Associated with Biliary Strictures using a Rendezvous Technique

Abstract

Two patients with a severe biliary stricture of one intrahepatic duct and associated intrahepatic stones were successfully treated after dilatation of their stricture by a new endobiliary rendezvous technique with the aid of percutaneous transhepatic cholangioscopy (PTCS). The strictured bile duct was approached from a contralateral percutaneous tract via PTCS and from the diseased duct by introducing a guidewire. This guidewire was then extracted through the other side using a PTCS-guided biopsy forceps to form a communication between both sides which could be used as a pathway for subsequent dilatation. Our technique allows the extraction of intrahepatic stones even in the presence of biliary strictures.