Outcomes of Fluoroscopy-guided Percutaneous Transhepatic Removal of Bile Duct Stones: A Multicenter Retrospective Cohort Study

Background Although long-term follow-up data after endoscopic treatment of bile duct stones have been extensively evaluated, most studies investigating percutaneous treatment have had relatively small patient samples and short follow-up periods. Purpose To evaluate immediate and long-term outcomes in patients who underwent percutaneous transhepatic removal of bile duct stones in a multicenter retrospective cohort study. Materials and Methods Patients with bile duct stones who underwent percutaneous transhepatic stone removal at six institutions between May 2001 and December 2019 were included. A Wittich nitinol stone basket with a 12-F sheath was used to extract the stones with fluoroscopic guidance. Immediate technical success rate, incidence of early complications (≤30 days), and long-term outcomes were evaluated. Mixed-effects logistic regression models were used to identify factors predictive of stone recurrence. Results Data from 2431 consecutive patients (median age, 75 years [IQR, 66-81 years]; 1336 male patients) with bile duct stones (1985 patients with extrahepatic duct stones, 217 with intrahepatic duct stones, 229 with both) were evaluated. Technical success was achieved in 2409 of 2431 patients (99.1%). The overall incidence of early complications was 8.1% (197 of 2431 patients; minor complications, 117 of 2431 [4.8%]; major complications, 80 of 2431 [3.3%]). The 30-day mortality rate was 1.9% (47 of 2431). Long-term information was obtained for 1673 patients (68.8%), with a median follow-up period of 41.5 months. During follow-up, bile duct stone recurrence was observed in 415 patients (24.8%), with a median interval of 27.9 months; multiple recurrences occurred in 74 patients (4.4%). Bile duct carcinoma, pancreatic carcinoma, and liver cirrhosis developed in three, one, and two patients, respectively. Age, sex, stone location, stone size, and gallbladder status were identified as risk factors for stone recurrence. Conclusion Percutaneous transhepatic removal of bile duct stones was an effective procedure, with a high initial success rate and acceptable complication rates. The major long-term complication was bile duct stone recurrence. © RSNA, 2025