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Picture 1: Initial percutaneous cholangiogram and PTBD placement


Picture 2: Follow-up over the wire cholangiogram status post GI stone extraction


Picture 3: CT abdomen and pelvis revealing dilated intrahepatic bile ducts


Picture 4: Biliary stones present in the gallbladder and common bile duct


resolution of cystic duct obstruction. For internal-external biliary drains, these drains are typically either routinely exchanged every 2–3 months or converted to internal biliary stents.


What specifically prompted you to reach out regarding this case/topic? VJ: Neither the interventional gastroenterologist nor another gastroenterologist had been able to take the patient back for repeat ERCP yet, and he was understandably frustrated. I explained the risks of removing the tube


34 IRQ | SUMMER 2023


with stones still in place. However, the patient still wanted the tube removed.


In medical facilities without access to endoscopists and ERCP, what tools and techniques do IR physicians have to clear CBD stones? VJ: It is possible to upsize the access, place a large sheath and balloon dilate the sphincter of Oddi, followed by pushing the stones through with a balloon. This is performed via percutaneous cholangioscopy and can also be used to directly visualize and treat the stones.


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