Percutaneous radiologic techniques in therapy of choledocholithiasis

: Interventional radiology offers a variety of techniques for percutaneous manipulation of intrahepatic and extrahepatic bile duct stones via the T-tube be tract and the transhepatic route, including extraction, fragmentation, transpapillary expulsion of stones into the duodenum, and chemolysis. These techniques can be combined with extracorporeal lithotripsy, balloon dilatation and electroincision of stenoses and implantation of metallic stents. Removal of stones via the T-tube tract is just as successful as endoscopic stone manipulation and leaves the papilla of Vater intact. Percutaneous transhepatic stone manipulation is more difficult and potentially more dangerous, and is restricted to patients where the endoscopic approach is not possible or operative techniques have been exhausted.