Utilisation of cholecystostomy and cystic duct as a route for percutaneous cutting balloon papillotomy and expulsion of common bile duct stones.

1 of 2 DESCRIPTION A 78-year-old male presented with jaundice, fever, rigors and right upper quadrant pain. Ultrasound demonstrated gallbladder empyema and common bile duct (CBD) stones with mild CBD dilatation. Medical morbidity and prior partial gastrectomy precluded endoscopic treatment. Under ultrasound guidance an 8fr Navarre pigtail drain (Bard Limited, UK) was inserted into the gall bladder and left insitu for 4 weeks. After 4 weeks, an 8fr Brite tip vascular sheath (Cordis-Europa, Netherlands) was introduced over a guidewire into the gallbladder via the cholecystostomy tract. A 5fr hydrophilic catheter (Cobra C2) and 0.035 guidewire (Terumo, Belgium) was used to traverse the cystic duct and CBD into the duodenum ( fi gure 1A,B ). The 0.035 wire was exchanged for a 0.018 VI8 Control Wire (Boston-Scientifi c, Natick, Massachusetts, USA) and an 8 mm peripheral cutting balloon was used to perform the papillotomy ( fi gure 1C ). Following papillotomy an 8 mm Images in...