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Endoscopic Management of Difficult Bile Duct Stones

  • Pancreas and Biliary Tract (O Haluszka, Section Editor)
  • Published:
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Abstract

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.

Summary

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.

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Abbreviations

CBD:

Common bile duct

DPOC:

Direct per-oral cholangioscopy

ERCP:

Endoscopic retrograde cholangiopancreatography

EPLBD:

Endoscopic papillary large balloon dilation

EHL:

Electrohydraulic lithotripsy

EST:

Endoscopic sphincterotomy

EUS:

Endoscopic ultrasound

LL:

Laser lithotripsy

ML:

Mechanical lithotripsy

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200, West Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Murad Aburajab & Kulwinder Dua

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  1. Murad Aburajab
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  2. Kulwinder Dua
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Correspondence to Kulwinder Dua.

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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.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Pancreas and Biliary Tract

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Aburajab, M., Dua, K. Endoscopic Management of Difficult Bile Duct Stones. Curr Gastroenterol Rep 20, 8 (2018). https://doi.org/10.1007/s11894-018-0613-1

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