{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T10:41:12Z","timestamp":1772102472047,"version":"3.50.1"},"reference-count":13,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T00:00:00Z","timestamp":1616976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: To evaluate the efficacy and safety of percutaneous transhepatic lithotripsy (PTL) using an electro-hydraulic (EH) system for difficult bile stones. Methods: We retrospectively evaluated two patients with recurrent cholangitis, jaundice and fever for the presence of difficult bile stones, inaccessible by an endoscopic approach, treated with PTL. Both procedures were conducted using the same protocol, with two different accesses. The treatments were performed using a 10 Fr flexible choledoscopy SpyGlass DSTM for visualization and an EH system for lithotripsy. Results: Technical success, clinical success and complications were evaluated. The two procedures were successfully concluded in both patients without any residual stones in the biliary tree. For both patients, a short follow-up period of six months was available, during which they remained asymptomatic. Neither major nor minor complications were registered. Conclusion: PTL was determined to be an effective and safe technique. This procedure allows a direct visualization of the stone, reducing fluoroscopy time and permitting a less invasive and less traumatic method for the percutaneous management of difficult bile stones. Advances in knowledge: The direct visualization, the high quality of the digital view, the adequate length of the device and the less traumatic approach of EH systems represent advantages compared with other available technologies.<\/jats:p>","DOI":"10.3390\/jcm10071372","type":"journal-article","created":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T16:01:57Z","timestamp":1617033717000},"page":"1372","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Percutaneous Transhepatic Electrohydraulic Lithotripsy for the Treatment of Difficult Bile Stones"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4160-8018","authenticated-orcid":false,"given":"Anna Maria","family":"Ierardi","sequence":"first","affiliation":[{"name":"Radiology Department, Fondation IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4201-3147","authenticated-orcid":false,"given":"Giovanni Maria","family":"Rod\u00e0","sequence":"additional","affiliation":[{"name":"Postgraduation School in Radiodiagnostics, University of Milan, via Festa del Perdono, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Letizia","family":"Di Meglio","sequence":"additional","affiliation":[{"name":"Postgraduation School in Radiodiagnostics, University of Milan, via Festa del Perdono, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Pellegrino","sequence":"additional","affiliation":[{"name":"Postgraduation School in Radiodiagnostics, University of Milan, via Festa del Perdono, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Cant\u00f9","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Fondation IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan Via F. Sforza 35, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele","family":"Dondossola","sequence":"additional","affiliation":[{"name":"General and Liver Transplant Surgery Unit, Fondation IRCCS C\u00e0 Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgio","family":"Rossi","sequence":"additional","affiliation":[{"name":"General and Liver Transplant Surgery Unit, Fondation IRCCS C\u00e0 Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianpaolo","family":"Carrafiello","sequence":"additional","affiliation":[{"name":"Radiology Department, Fondation IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy"},{"name":"Department of Health Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"167","DOI":"10.4253\/wjge.v4.i5.167","article-title":"Endoscopic extraction of large common bile duct stones: A review article","volume":"4","author":"Stefanidis","year":"2012","journal-title":"World J. 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