Endoscopic Management of Difficult Bile Duct Stones

  • Murad Aburajab
  • Kulwinder Dua
Pancreas and Biliary Tract (O Haluszka, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pancreas and Biliary Tract


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.”

Recent Findings

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.


Bile 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


Electrohydraulic lithotripsy


Endoscopic sphincterotomy


Endoscopic ultrasound


Laser lithotripsy


Mechanical lithotripsy


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

  1. 1.
    Coelho-Prabhu N, Shah ND, Van Houten H, Kamath PS, Baron TH. Endoscopic retrograde cholangiopancreatography: utilisation and outcomes in a 10-year population-based cohort. BMJ Open. 2013;3(5):e002689. Scholar
  2. 2.
    Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc. 1974;20(4):148–51. Scholar
  3. 3.
    Gupta N, Poreddy V, Al-Kawas F. Endoscopy in the management of choledocholithiasis. Curr Gastroenterol Rep. 2008;10(2):169–76. Scholar
  4. 4.
    Seitz U, Bapaye A, Bohnacker S, Navarrete C, Maydeo A, Soehendra N. Advances in therapeutic endoscopic treatment of common bile duct stones. World J Surg. 1998;22(11):1133–44. Scholar
  5. 5.
    McHenry L, Lehman G. Difficult bile duct stones. Curr Treat Options Gastroenterol. 2006;9(2):123–32. Scholar
  6. 6.
    Christoforidis E, Vasiliadis K, Tsalis K, Patridas D, Blouhos K, Pramateftakis MG, Moysidis M, Lazaridis C Factors significantly contributing to a failed conventional endoscopic stone clearance in patients with “difficult” choledecholithiasis: a single-center experience. Diagn Ther Endosc 2014;2014:861689, 1, 7, DOI:
  7. 7.
    Kim HJ, Choi HS, Park JH, Park DI, Cho YK, Sohn CI, et al. Factors influencing the technical difficulty of endoscopic clearance of bile duct stones. Gastrointest Endosc. 2007;66(6):1154–60. Scholar
  8. 8.
    Stefanidis G, Christodoulou C, Manolakopoulos S, Chuttani R. Endoscopic extraction of large common bile duct stones: a review article. World J Gastrointest Endosc. 2012;4(5):167–79. Scholar
  9. 9.
    Loffeld RJ, Dekkers PE. The impact of duodenal diverticuli and the execution of endoscopic retrograde cholangiopancreaticography. Int Sch Res Notices. 2016;2016(5026289)Google Scholar
  10. 10.
    •• Ersoz G, Tekesin O, Ozutemiz AO, Gunsar F. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointest Endosc. 2003;57(2):156–9. This is a landmark and cornerstone study showing the utility of endoscopic papillary large balloon dilation for removing difficult bile duct stone. PubMedCrossRefGoogle Scholar
  11. 11.
    Lauri A, Horton RC, Davidson BR, Burroughs AK, Dooley JS. Endoscopic extraction of bile duct stones: management related to stone size. Gut. 1993;34(12):1718–21. Scholar
  12. 12.
    Tsuchida K, Iwasaki M, Tsubouchi M, Suzuki T, Tsuchida C, Yoshitake N, et al. Comparison of the usefulness of endoscopic papillary large-balloon dilation with endoscopic sphincterotomy for large and multiple common bile duct stones. BMC Gastroenterol. 2015;15(59)
  13. 13.
    Marin Calderon L, Vera Calderon A, Gomez Correa A, Cervera Reyes Z, Davalos Moscol M, Alva Alva E, et al. Large balloon dilation for removal of choledocholithiasis difficult to extract: clinical experience. Rev Gastroenterol Peru. 2016;36(4):330–5.PubMedGoogle Scholar
  14. 14.
    Shim CS, Kim JW, Lee TY, Cheon YK. Is endoscopic papillary large balloon dilation safe for treating large CBD stones? Saudi J Gastroenterol. 2016;22(4):251–9. Scholar
  15. 15.
    Rouquette O, Bommelaer G, Abergel A, Poincloux L. Large balloon dilation post endoscopic sphincterotomy in removal of difficult common bile duct stones: a literature review. World J Gastroenterol. 2014;20(24):7760–6. Scholar
  16. 16.
    Yasuda I, Itoi T. Recent advances in endoscopic management of difficult bile duct stones. Dig Endosc. 2013;25(4):376–85. Scholar
  17. 17.
    Maydeo A, Bhandari S. Balloon sphincteroplasty for removing difficult bile duct stones. Endoscopy. 2007;39(11):958–61. Scholar
  18. 18.
    Misra SP, Dwivedi M. Large-diameter balloon dilation after endoscopic sphincterotomy for removal of difficult bile duct stones. Endoscopy. 2008;40(3):209–13. Scholar
  19. 19.
    Rebelo A, Ribeiro PM, Correia AP, Cotter J. Endoscopic papillary large balloon dilation after limited sphincterotomy for difficult biliary stones. World J Gastrointest Endosc. 2012;4(5):180–4. Scholar
  20. 20.
    Attasaranya S, Cheon YK, Vittal H, Howell DA, Wakelin DE, Cunningham JT, et al. Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series. Gastrointest Endosc. 2008;67(7):1046–52. Scholar
  21. 21.
    • Park SJ, Kim JH, Hwang JC, Kim HG, Lee DH, Jeong S, et al. Factors predictive of adverse events following endoscopic papillary large balloon dilation: results from a multicenter series. Dig Dis Sci. 2013;58(4):1100–9. Largest study to date on adverse events using endoscopic papillary large balloon dilation for extracting difficult bile duct stone. PubMedCrossRefGoogle Scholar
  22. 22.
    Guo SB, Meng H, Duan ZJ, Li CY. Small sphincterotomy combined with endoscopic papillary large balloon dilation vs sphincterotomy alone for removal of common bile duct stones. World J Gastroenterol. 2014;20(47):17962–9. Scholar
  23. 23.
    Park JS, Jeong S, Bang BW, Kang AR, Lee DH. Endoscopic papillary large balloon dilatation without sphincterotomy for the treatment of large common bile duct stone: long-term outcomes at a single center. Dig Dis Sci. 2016;61(10):3045–53. Scholar
  24. 24.
    •• Disario JA, Freeman ML, Bjorkman DJ, Macmathuna P, Petersen BT, Jaffe PE, et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology. 2004;127(5):1291–9. This is a pivotal study that highlighted the risk of severe pancreatitis complicated by death in patients who underwent balloon dilation of the sphincter instead of sphincterotomy to extract common bile duct stones. PubMedCrossRefGoogle Scholar
  25. 25.
    Fujisawa T, Kagawa K, Hisatomi K, Kubota K, Nakajima A, Matsuhashi N. Is endoscopic papillary balloon dilatation really a risk factor for post-ERCP pancreatitis? World J Gastroenterol. 2016;22(26):5909–16. Scholar
  26. 26.
    Omuta S, Maetani I, Saito M, Shigoka H, Gon K, Tokuhisa J, et al. Is endoscopic papillary large balloon dilatation without endoscopic sphincterotomy effective? World J Gastroenterol. 2015;21(23):7289–96. Scholar
  27. 27.
    Jin PP, Cheng JF, Liu D, Mei M, Xu ZQ, Sun LM. Endoscopic papillary large balloon dilation vs endoscopic sphincterotomy for retrieval of common bile duct stones: a meta-analysis. World J Gastroenterol. 2014;20(18):5548–56. Scholar
  28. 28.
    Feng Y, Zhu H, Chen X, Xu S, Cheng W, Ni J, et al. Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis: a meta-analysis of randomized controlled trials. J Gastroenterol. 2012;47(6):655–63. Scholar
  29. 29.
    Hwang JC, Kim JH, Lim SG, Kim SS, Shin SJ, Lee KM, et al. Endoscopic large-balloon dilation alone versus endoscopic sphincterotomy plus large-balloon dilation for the treatment of large bile duct stones. BMC Gastroenterol. 2013;13(15)
  30. 30.
    Riemann JF, Seuberth K, Demling L. Mechanical lithotripsy of common bile duct stones. Gastrointest Endosc. 1985;31(3):207–10. Scholar
  31. 31.
    DiSario J, Chuttani R, Croffie J, Liu J, Mishkin D, Shah R, et al. Biliary and pancreatic lithotripsy devices. Gastrointest Endosc. 2007;65(6):750–6. Scholar
  32. 32.
    Chang WH, Chu CH, Wang TE, Chen MJ, Lin CC. Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones. World J Gastroenterol. 2005;11(4):593–6.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Stefanidis G, Viazis N, Pleskow D, Manolakopoulos S, Theocharis L, Christodoulou C, et al. Large balloon dilation vs. mechanical lithotripsy for the management of large bile duct stones: a prospective randomized study. Am J Gastroenterol. 2011;106(2):278–85. Scholar
  34. 34.
    Shaw MJ, Mackie RD, Moore JP, Dorsher PJ, Freeman ML, Meier PB, et al. Results of a multicenter trial using a mechanical lithotripter for the treatment of large bile duct stones. Am J Gastroenterol. 1993;88(5):730–3.PubMedGoogle Scholar
  35. 35.
    • Garg PK, Tandon RK, Ahuja V, Makharia GK, Batra Y. Predictors of unsuccessful mechanical lithotripsy and endoscopic clearance of large bile duct stones. Gastrointest Endosc. 2004;59(6):601–5. This study addressed the importance of capturing the stone inside the basket irrespective of its size to achieve succesful duct clearance. PubMedCrossRefGoogle Scholar
  36. 36.
    Cipolletta L, Costamagna G, Bianco MA, Rotondano G, Piscopo R, Mutignani M, et al. Endoscopic mechanical lithotripsy of difficult common bile duct stones. Br J Surg. 1997;84(10):1407–9. Scholar
  37. 37.
    Lee SH, Park JK, Yoon WJ, Lee JK, Ryu JK, Kim YT, et al. How to predict the outcome of endoscopic mechanical lithotripsy in patients with difficult bile duct stones? Scand J Gastroenterol. 2007;42(8):1006–10. Scholar
  38. 38.
    Akcakaya A, Ozkan OV, Bas G, Karakelleoglu A, Kocaman O, Okan I, et al. Mechanical lithotripsy and/or stenting in management of difficult common bile duct stones. Hepatobiliary Pancreat Dis Int. 2009;8(5):524–8.PubMedGoogle Scholar
  39. 39.
    Binmoeller KF, Bruckner M, Thonke F, Soehendra N. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy. 1993;25(3):201–6. Scholar
  40. 40.
    Trikudanathan G, Arain MA, Attam R, Freeman ML. Advances in the endoscopic management of common bile duct stones. Nat Rev Gastroenterol Hepatol. 2014;11(9):535–44. Scholar
  41. 41.
    Arya N, Nelles SE, Haber GB, Kim YI, Kortan PK. Electrohydraulic lithotripsy in 111 patients: a safe and effective therapy for difficult bile duct stones. Am J Gastroenterol. 2004;99(12):2330–4. Scholar
  42. 42.
    Easler JJ, Sherman S. Endoscopic retrograde cholangiopancreatography for the management of common bile duct stones and gallstone pancreatitis. Gastrointest Endosc Clin N Am. 2015;25(4):657–75. Scholar
  43. 43.
    Wong JC, Tang RS, Teoh AY, Sung JJ, Lau JY. Efficacy and safety of novel digital single-operator peroral cholangioscopy-guided laser lithotripsy for complicated biliary stones. Endosc Int Open. 2017;5(1):E54–E8. Scholar
  44. 44.
    Ogura T, Imanishi M, Kurisu Y, Onda S, Sano T, Takagi W, et al. Prospective evaluation of digital single-operator cholangioscope for diagnostic and therapeutic procedures (with videos). Dig Endosc. 2017;29(7):782–9. Scholar
  45. 45.
    Wong JC, Wong MY, Lam KL, Lau JY. Second-generation peroral cholangioscopy and holmium: YAG laser lithotripsy for rescue of impacted biliary stone extraction basket. Gastrointest Endosc. 2016;83(4):837–8. Scholar
  46. 46.
    Tsuyuguchi T, Sakai Y, Sugiyama H, Ishihara T, Yokosuka O. Long-term follow-up after peroral cholangioscopy-directed lithotripsy in patients with difficult bile duct stones, including Mirizzi syndrome: an analysis of risk factors predicting stone recurrence. Surg Endosc. 2011;25(7):2179–85. Scholar
  47. 47.
    Moon JH, Ko BM, Choi HJ, Koo HC, Hong SJ, Cheon YK, et al. Direct peroral cholangioscopy using an ultra-slim upper endoscope for the treatment of retained bile duct stones. Am J Gastroenterol. 2009;104(11):2729–33. Scholar
  48. 48.
    • Navaneethan U, Hasan MK, Kommaraju K, Zhu X, Hebert-Magee S, Hawes RH, et al. Digital, single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience (with video). Gastrointest Endosc. 2016;84(4):649–55. This is the first multicenter study that showed the utility of using new generation cholangioscopy in addressing pancreaticobiliary malignancies and diffiuclt stone diseases. PubMedCrossRefGoogle Scholar
  49. 49.
    Shah RJ. Innovations in Intraductal Endoscopy: Cholangioscopy and pancreatoscopy. Gastrointest Endosc Clin N Am. 2015;25(4):779–92.PubMedCrossRefGoogle Scholar
  50. 50.
    Sethi A, Chen YK, Austin GL, Brown WR, Brauer BC, Fukami NN, et al. ERCP with cholangiopancreatoscopy may be associated with higher rates of complications than ERCP alone: a single-center experience. Gastrointest Endosc. 2011;73(2):251–6. Scholar
  51. 51.
    Adler DG, Cox K, Milliken M, Taylor LJ, Loren D, Kowalski T, et al. A large multicenter study analysis of adverse events associated with single operator cholangiopancreatoscopy. Minerva Gastroenterol Dietol. 2015;61(4):179–84.PubMedGoogle Scholar
  52. 52.
    Kim HI, Moon JH, Choi HJ, Lee JC, Ahn HS, Song AR, et al. Holmium laser lithotripsy under direct peroral cholangioscopy by using an ultra-slim upper endoscope for patients with retained bile duct stones (with video). Gastrointest Endosc. 2011;74(5):1127–32. Scholar
  53. 53.
    Lee YN, Moon JH, Choi HJ, Min SK, Kim HI, Lee TH, et al. Direct peroral cholangioscopy using an ultraslim upper endoscope for management of residual stones after mechanical lithotripsy for retained common bile duct stones. Endoscopy. 2012;44(9):819–24. Scholar
  54. 54.
    Moon JH, Choi HJ, Ko BM. Therapeutic role of direct peroral cholangioscopy using an ultra-slim upper endoscope. J Hepatobiliary Pancreat Sci. 2011;18(3):350–6. Scholar
  55. 55.
    Lee SI, Lim BH, Heo WG, Kim YJ, Kim TH. Successful removal of a large common bile duct stone by using direct peroral cholangioscopy and laser lithotripsy in a patient with severe kyphosis. Clin Endosc. 2016;49(4):395–8. Scholar
  56. 56.
    Farnik H, Weigt J, Malfertheiner P, Grutzmann A, Gossner L, Friedrich-Rust M, et al. A multicenter study on the role of direct retrograde cholangioscopy in patients with inconclusive endoscopic retrograde cholangiography. Endoscopy. 2014;46(1):16–21. Scholar
  57. 57.
    Efthymiou M, Raftopoulos S, Antonio Chirinos J, May GR. Air embolism complicated by left hemiparesis after direct cholangioscopy with an intraductal balloon anchoring system. Gastrointest Endosc. 2012;75(1):221–3. Scholar
  58. 58.
    Trikudanathan G, Navaneethan U, Parsi MA. Endoscopic management of difficult common bile duct stones. World J Gastroenterol. 2013;19(2):165–73. Scholar
  59. 59.
    Katanuma A, Maguchi H, Osanai M, Takahashi K. Endoscopic treatment of difficult common bile duct stones. Dig Endosc. 2010;22(Suppl 1):S90–7.PubMedCrossRefGoogle Scholar
  60. 60.
    Slattery E, Kale V, Anwar W, Courtney G, Aftab AR. Role of long-term biliary stenting in choledocholithiasis. Dig Endosc. 2013;25(4):440–3. Scholar
  61. 61.
    Horiuchi A, Nakayama Y, Kajiyama M, Kato N, Kamijima T, Graham DY, et al. Biliary stenting in the management of large or multiple common bile duct stones. Gastrointest Endosc. 2010;71(7):1200–3 e2. Scholar
  62. 62.
    •• Hartery K, Lee CS, Doherty GA, Murray FE, Cullen G, Patchett SE, et al. Covered self-expanding metal stents for the management of common bile duct stones. Gastrointest Endosc. 2017;85(1):181–6. This study has addressed in the largest published case serires on the benefit of using fully covered self expandable metal biliary stents in managing complex bile duct stones which has also cut back on the number of procedures needed to competely remove stones. PubMedCrossRefGoogle Scholar
  63. 63.
    Garcia-Cano J, Reyes-Guevara AK, Martinez-Perez T, Valiente-Gonzalez L, Martinez-Fernandez R, Vinuelas-Chicano M, et al. Fully covered self-expanding metal stents in the management of difficult common bile duct stones. Rev Esp Enferm Dig. 2013;105(1):7–12. Scholar
  64. 64.
    De Koning M, Moreels TG. Comparison of double-balloon and single-balloon enteroscope for therapeutic endoscopic retrograde cholangiography after Roux-en-Y small bowel surgery. BMC Gastroenterol. 2016;16(1):98.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Tomizawa Y, Sullivan CT, Gelrud A. Single balloon enteroscopy (SBE) assisted therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with roux-en-y anastomosis. Dig Dis Sci. 2014;59(2):465–70. Scholar
  66. 66.
    Yamauchi H, Kida M, Imaizumi H, Okuwaki K, Miyazawa S, Iwai T, et al. Innovations and techniques for balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy. World J Gastroenterol. 2015;21(21):6460–9. Scholar
  67. 67.
    Liu K, Joshi V, Saxena P, Kaffes AJ. Predictors of success for double balloon-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anastomosis. Dig Endosc. 2017;29(2):190–7. Scholar
  68. 68.
    Schreiner MA, Chang L, Gluck M, Irani S, Gan SI, Brandabur JJ, et al. Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients. Gastrointest Endosc. 2012;75(4):748–56. Scholar
  69. 69.
    Bertin PM, Singh K, Arregui ME. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography (ERCP) after gastric bypass: case series and a description of technique. Surg Endosc. 2011;25(8):2592–6. Scholar
  70. 70.
    Snauwaert C, Laukens P, Dillemans B, Himpens J, De Looze D, Deprez PH, et al. Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography in bariatric Roux-en-Y gastric bypass patients. Endosc Int Open. 2015;3(5):E458–63. Scholar
  71. 71.
    Frederiksen NA, Tveskov L, Helgstrand F, Naver L, Floyd A. Treatment of common bile duct stones in gastric bypass patients with laparoscopic transgastric endoscopic retrograde cholangiopancreatography. Obes Surg. 2017;27(6):1409–13. Scholar
  72. 72.
    •• Abbas AM, Strong AT, Diehl DL, Brauer BC, Lee IH, Burbridge R, et al. Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass. Gastrointest Endosc. 2017. It is the largest study todate on using laprascopic apporach to perform ERCP which showed the easiness of peforming this procedure with excllent clinical outcome. Google Scholar
  73. 73.
    Sakai Y, Tsuyuguchi T, Mikata R, Sugiyama H, Yasui S, Miyazaki M, et al. Utility of endoscopic retrograde cholangiopancreatography on biliopancreatic diseases in patients with Billroth II-reconstructed stomach. World J Gastrointest Endosc. 2017;9(3):127–32. Scholar
  74. 74.
    Park SB, Kim HW, Kang DH, Choi CW, Yoon KT, Cho M, et al. Sphincterotomy by triple lumen needle knife using guide wire in patients with Billroth II gastrectomy. World J Gastroenterol. 2013;19(48):9405–9. Scholar
  75. 75.
    Bove V, Tringali A, Familiari P, Gigante G, Boskoski I, Perri V, et al. ERCP in patients with prior Billroth II gastrectomy: report of 30 years’ experience. Endoscopy. 2015;47(7):611–6. Scholar
  76. 76.
    Iwashita T, Nakai Y, Hara K, Isayama H, Itoi T, Park DH. Endoscopic ultrasound-guided antegrade treatment of bile duct stone in patients with surgically altered anatomy: a multicenter retrospective cohort study. J Hepatobiliary Pancreat Sci. 2016;23(4):227–33. Scholar
  77. 77.
    Jang JS, Lee S, Lee HS, Yeon MH, Han JH, Yoon SM, et al. Efficacy and safety of endoscopic papillary balloon dilation using cap-fitted forward-viewing endoscope in patients who underwent Billroth II gastrectomy. Clin Endosc. 2015;48(5):421–7. Scholar
  78. 78.
    Sportes A, Camus M, Greget M, Leblanc S, Coriat R, Hochberger J, et al. Endoscopic ultrasound-guided hepaticogastrostomy versus percutaneous transhepatic drainage for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography: a retrospective expertise-based study from two centers. Therap Adv Gastroenterol. 2017;10(6):483–93. Scholar
  79. 79.
    Nakai Y, Isayama H, Yamamoto N, Matsubara S, Kogure H, Mizuno S, et al. Indications for endoscopic ultrasonography (EUS)-guided biliary intervention: does EUS always come after failed endoscopic retrograde cholangiopancreatography? Dig Endosc. 2017;29(2):218–25. Scholar
  80. 80.
    Weilert F, Binmoeller KF, Marson F, Bhat Y, Shah JN. Endoscopic ultrasound-guided anterograde treatment of biliary stones following gastric bypass. Endoscopy. 2011;43(12):1105–8. Scholar
  81. 81.
    Iwashita T, Yasuda I, Doi S, Uemura S, Mabuchi M, Okuno M, et al. Endoscopic ultrasound-guided antegrade treatments for biliary disorders in patients with surgically altered anatomy. Dig Dis Sci. 2013;58(8):2417–22. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyMedical College of WisconsinMilwaukeeUSA

Personalised recommendations