Percutaneous biliary stone removal

Gallstones are hard lumps that form from bile. They can sit in the gallbladder, a small pouch under the liver, or slip into the bile ducts, the tubes that carry bile to the intestine. A stone in a duct can block bile and cause jaundice (yellow skin), pain and infection. A stone blocking the gallbladder can cause cholecystitis, a painful, infected gallbladder.

Most stones are treated with ERCP (a camera through the mouth to the bile duct) or surgery to remove the gallbladder. But some people cannot have these, because of surgery that changed their anatomy, other serious illnesses, or failed earlier attempts. For them, we can remove stones from the outside, through a drain track.

Surgery to remove the gallbladder is the standard long-term fix for gallbladder stones, because new stones can form in a gallbladder that stays in place. Removing stones through a cholecystostomy track can let you have your tube removed and avoid surgery, but stones can come back. We discuss this openly so you can choose.

1. 1
   Getting ready

   You lie on the X-ray table and receive moderate sedation or general anesthesia, antibiotics and heart and oxygen monitors.

2. 2
   Mapping the stones

   We remove your drain over a guidewire and inject contrast dye to show the stones. If needed, we gently widen the track with a small balloon to make room for our tools.

3. 3
   Clearing the stones

   Small stones can be pushed into the intestine after we gently stretch the duct opening with a balloon. Others are caught with a tiny wire basket, or broken up with a thin camera and a laser or shock-wave probe.

4. 4
   Checking and finishing

   A final dye study checks for leftover stones. We usually leave a drain in place so we can check again, and remove it at a later visit once the ducts are clear.

Each session usually takes 1 to 2 hours. Larger or many stones may need more than one session, a few days to weeks apart.

What we see

1. Same day
   Rest for a few hours, or overnight in the hospital. Soreness at the tube site is common.
2. First 2–3 days
   Mild pain, sometimes a low fever for a few hours. Care for your drain as before.
3. 1–2 weeks
   Follow-up dye study. If clear, we cap the tube and then remove it.
4. After removal
   The small hole closes in a few days. Keep a dry dressing on it until it stops leaking.

Keep caring for your drain while it is in, as described on the biliary drain page and in managing your drain.

In published series, stones are fully cleared through the drain track in about 9 out of 10 people, though some need more than one session. Clearing the stones usually lets the outside tube come out. When the gallbladder stays in place, new stones can form over the years, so we will talk about what to watch for.

Many of the people I see for this had a gallbladder tube placed when they were very sick, and they are tired of living with it. If surgery is still too risky, I explain that we can often clear the stones through the tube they already have and get it out. I am upfront that it may take more than one session and that stones can come back, so we decide together.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos