Endoscopic Management of Difficult Bile Duct Stones
Purpose of Review
In 10–15% of the cases, conventional methods for removing bile duct stones by ERCP/balloon-basket extraction fail. The purpose of this review is to describe endoscopic techniques in managing these “difficult bile duct stones.”
Endoscopic papillary large balloon dilation with balloon extraction ± mechanical lithotripsy is the initial approach used to retrieve large bile duct stones. With advent of digital cholangioscopy, electrohydraulic and laser lithotripsy are gaining popularity. Enteroscopy-assisted or laparoscopic-assisted approaches can be used for those with gastric bypass anatomy.
Difficulties in removing bile duct stones can be related to stone-related factors such as the size and location of the stone or to altered anatomy such as stricture in the bile duct or Roux-en-Y anatomy. Several endoscopy approaches and techniques have described in the recent past that have greatly enhanced our ability to remove these “difficult” bile duct stones.
KeywordsBile duct stones Endoscopic papillary large balloon dilation Digital cholangioscopy Lithotripsy
Common bile duct
Direct per-oral cholangioscopy
Endoscopic retrograde cholangiopancreatography
Endoscopic papillary large balloon dilation
Compliance with Ethical Standards
Conflict of Interest
Kulwinder Dua reports fees paid to the Medical College of Wisconsin for a multicenter research study using biliary stents in pancreatic cancer from Boston Scientific, support from Cook Medicals for a Clarity Study using esophageal stents in esophageal stricture, and support for Evolve Study from Merit Medical, outside the submitted work.
Murad Aburajab reports fees for a multicenter research study using biliary stents in pancreatic cancer from Boston Scientific, support from Cook Medicals for a Clarity Study using esophageal stents in esophageal stricture, and support for Evolve Study from Merit Medical and personal fees from the Abbvie Speaker program outside the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as:• Of importance •• Of major importance
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