Abstract
The first step to treating stones occurring in the bile duct is endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy followed by a balloon or basket extraction. This is successful in extracting common bile duct stones in the majority of cases. However, there are stones that are characterized as difficult bile duct stones. These include very large stones (>15 mm in diameter), stones in a bile duct that is difficult to access (patients with altered anatomy like Roux-en-Y gastrojejunostomy, Billroth II gastrectomy), or impacted stones. When standard techniques fail, other endoscopic techniques must be explored. These techniques involve increasing the diameter of the biliary orifice with a sphincterotomy, balloon dilation, or a combination of both followed by basket or balloon stone removal. In some cases, large stones may still be difficult to remove in which case lithotripsy can be performed either by mechanical means or by laser and electrohydraulic means. Biliary stents can be placed as a bridge to curative therapy, and they also assist in softening and fragmenting of stones.
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Mahmood, R., Gupta, N. (2019). Difficult Bile Duct Stones. In: Mullady, D. (eds) Dilemmas in ERCP. Springer, Cham. https://doi.org/10.1007/978-3-030-12741-1_4
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DOI: https://doi.org/10.1007/978-3-030-12741-1_4
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