Endoscopic Management of Large and Difficult Common Bile duct Stones

  • Thomas Queen
  • Gulshan ParasherEmail author


Endoscopic retrograde cholangiopancreatography (ERCP) assisted removal of small stones is easily accomplished with standard biliary sphincterotomy and balloon and basket extraction. Common bile duct stones greater than 15 mm are difficult to remove with standard techniques. Besides large stones, impacted and adherent bile duct stones, intrahepatic stones, stones proximal to stricture, Mirizzi syndrome, and stones associated with postsurgical biliary anatomy are often challenging and constitute difficult bile duct stones. Patients with difficult and large bile duct stones are managed best at tertiary academic centers with therapeutic pancreaticobiliary endoscopy expertise. Dedicated techniques such as mechanical lithotripsy (ML), electrohydraulic lithotripsy (EHL), laser lithotripsy (LL), and endoscopic papillary balloon dilation (ELPBD) either used alone or in combination are helpful in the treatment of patients with large and difficult CBD stones. Enteroscopy-assisted ERCP, EUS-guided biliary access, offers helpful alternative in difficult to access papillas. The majority of patients with large and difficult bile duct stone can be successfully treated with these endoscopic modalities. Despite widespread use and success in endoscopic management of patients with large and difficult bile duct stones, a small percentage of patients fail these treatment options and can benefit from surgery or percutaneous approach for stone removal. Identification of large and difficult to treat bile duct stone patients and referral to places with available expertise, equipment, and multidisciplinary teams are helpful in successful treatment and better patient outcomes.


Difficult CBD stones Large bile duct stones Mechanical lithotripsy Electrohydraulic lithotripsy Laser lithotripsy Per oral cholangioscopy Papillary balloon dilation Postsurgical anatomy Mirizzi syndrome Intrahepatic stones 

Supplementary material

Video 2.1

Laser lithotripsy utilized in the fragmentation of a large biliary stone. (155,037 kb)


  1. 1.
    Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology. 1999;117(3):632–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part I: overall and upper gastrointestinal diseases. Gastroenterology. 2009;136(2):376–86. doi: 10.1053/j.gastro.2008.12.015. Epub 2009 Jan 3. Review.PubMedCrossRefGoogle Scholar
  3. 3.
    ASGE Standards of Practice Committee, Maple JT, Ikenberry SO, Anderson MA, Appalaneni V, Decker GA, Early D, Evans JA, Fanelli RD, Fisher D, Fisher L, Fukami N, Hwang JH, Jain R, Jue T, Khan K, Krinsky ML, Malpas P, Ben-Menachem T, Sharaf RN, Dominitz JA. The role of endoscopy in the management of choledocholithiasis. Gastrointest Endosc. 2011;74(4):731–44. doi: 10.1016/j.gie.2011.04.012. Erratum in: Gastrointest Endosc. 2012;75(1):230–230.e14.CrossRefGoogle Scholar
  4. 4.
    Ko CW, Lee SP. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc. 2002;56(6 Suppl):S165–9. Review.PubMedCrossRefGoogle Scholar
  5. 5.
    McHenry L, Lehman G. Difficult bile duct stones. Curr Treat Options Gastroenterol. 2006;9(2):123–32.PubMedCrossRefGoogle Scholar
  6. 6.
    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. doi: 10.1038/nrgastro.2014.76. Epub 2014 May 27. Review.PubMedCrossRefGoogle Scholar
  7. 7.
    Classen M, Demling L. Endoscopic sphincterotomy of the papilla of vater and extraction of stones from the choledochal duct (author’s transl). Dtsch Med Wochenschr. 1974;99(11):496–7. German.PubMedCrossRefGoogle Scholar
  8. 8.
    Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc. 1974;20(4):148–51.PubMedCrossRefGoogle Scholar
  9. 9.
    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. Review.PubMedCrossRefGoogle Scholar
  10. 10.
    Yasuda I, Itoi T. Recent advances in endoscopic management of difficult bile duct stones. Dig Endosc. 2013;25(4):376–85. doi: 10.1111/den.12118. Epub 2013 May 8. Review.PubMedCrossRefGoogle Scholar
  11. 11.
    Trikudanathan G, Navaneethan U, Parsi MA. Endoscopic management of difficult common bile duct stones. World J Gastroenterol. 2013;19(2):165–73. doi: 10.3748/wjg.v19.i2.165. PubMed Central PMCID: PMC3547556, Review.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Riemann JF, Seuberth K, Demling L. Clinical application of a new mechanical lithotripter for smashing common bile duct stones. Endoscopy. 1982;14(6):226–30.PubMedCrossRefGoogle Scholar
  13. 13.
    DiSario J, Chuttani R, Croffie J, Liu J, Mishkin D, Shah R, Somogyi L, Tierney W, Song LM, Petersen BT. Biliary and pancreatic lithotripsy devices. Gastrointest Endosc. 2007;65(6):750–6. Epub 2007 Mar 26. Review.PubMedCrossRefGoogle Scholar
  14. 14.
    Leung JW, Tu R. Mechanical lithotripsy for large bile duct stones. Gastrointest Endosc. 2004;59(6):688–90.PubMedCrossRefGoogle Scholar
  15. 15.
    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. PubMed Central PMCID: PMC4250818.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Vij JC, Jain M, Rawal KK, Gulati RA, Govil A. Endoscopic management of large bile duct stones by mechanical lithotripsy. Indian J Gastroenterol. 1995;14(4):122–3.PubMedGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    Shaw MJ, Mackie RD, Moore JP, Dorsher PJ, Freeman ML, Meier PB, Potter T, Hutton SW, Vennes JA. 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
  19. 19.
    Cipolletta L, Costamagna G, Bianco MA, Rotondano G, Piscopo R, Mutignani M, Marmo R. Endoscopic mechanical lithotripsy of difficult common bile duct stones. Br J Surg. 1997;84(10):1407–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Thomas M, Howell DA, Carr-Locke D, Mel Wilcox C, Chak A, Raijman I, Watkins JL, Schmalz MJ, Geenen JE, Catalano MF. Mechanical lithotripsy of pancreatic and biliary stones: complications and available treatment options collected from expert centers. Am J Gastroenterol. 2007;102(9):1896–902. Epub 2007 Jun 15.PubMedCrossRefGoogle Scholar
  21. 21.
    Harrison J, Morris DL, Haynes J, Hitchcock A, Womack C, Wherry DC. Electrohydraulic lithotripsy of gall stones--in vitro and animal studies. Gut. 1987;28(3):267–71. PubMed Central PMCID: PMC1432697.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Swahn F, Edlund G, Enochsson L, Svensson C, Lindberg B, Arnelo U. Ten years of Swedish experience with intraductal electrohydraulic lithotripsy and laser lithotripsy for the treatment of difficult bile duct stones: an effective and safe option for octogenarians. Surg Endosc. 2010;24(5):1011–6. doi: 10.1007/s00464-009-0716-8. Epub 2009 Oct 23.PubMedCrossRefGoogle Scholar
  23. 23.
    Yoo KS, Lehman GA. Endoscopic management of biliary ductal stones. Gastroenterol Clin North Am. 2010;39(2):209–27, viii. doi: 10.1016/j.gtc.2010.02.008. Review.PubMedCrossRefGoogle Scholar
  24. 24.
    Monga A, Ramchandani M, Reddy DN. Per-oral cholangioscopy. J Interv Gastroenterol. 2011;1(2):70–7. PubMed Central PMCID: PMC3136857.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Itoi T, Neuhaus H, Chen YK. Diagnostic value of image-enhanced video cholangiopancreatoscopy. Gastrointest Endosc Clin N Am. 2009;19(4):557–66. doi: 10.1016/j.giec.2009.06.002. Review.PubMedCrossRefGoogle Scholar
  26. 26.
    Chen YK. Preclinical characterization of the Spyglass peroral cholangiopancreatoscopy system for direct access, visualization, and biopsy. Gastrointest Endosc. 2007;65(2):303–11.PubMedCrossRefGoogle Scholar
  27. 27.
    Chen YK, Pleskow DK. SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest Endosc. 2007;65(6):832–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Leung JW, Chung SS. Electrohydraulic lithotripsy with peroral choledochoscopy. BMJ. 1989;299(6699):595–8. PubMed Central PMCID: PMC1837426.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Binmoeller KF, Brückner 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.PubMedCrossRefGoogle Scholar
  30. 30.
    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.PubMedCrossRefGoogle Scholar
  31. 31.
    Hui CK, Lai KC, Ng M, Wong WM, Yuen MF, Lam SK, Lai CL, Wong BC. Retained common bile duct stones: a comparison between biliary stenting and complete clearance of stones by electrohydraulic lithotripsy. Aliment Pharmacol Ther. 2003; 17(2):289–96.PubMedCrossRefGoogle Scholar
  32. 32.
    Adamek HE, Maier M, Jakobs R, Wessbecher FR, Neuhauser T, Riemann JF. Management of retained bile duct stones: a prospective open trial comparing extracorporeal and intracorporeal lithotripsy. Gastrointest Endosc. 1996;44(1):40–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Aljebreen AM, Alharbi OR, Azzam N, Almadi MA. Efficacy of spyglass-guided electrohydraulic lithotripsy in difficult bile duct stones. Saudi J Gastroenterol. 2014;20(6):366–70. doi: 10.4103/1319-3767.145329. PubMed Central PMCID: PMC4271012.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Lux G, Ell C, Hochberger J, Müller D, Demling L. The first successful endoscopic retrograde laser lithotripsy of common bile duct stones in man using a pulsed neodymium-YAG laser. Endoscopy. 1986;18(4):144–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Patel SN, Rosenkranz L, Hooks B, Tarnasky PR, Raijman I, Fishman DS, Sauer BG, Kahaleh M. Holmium-yttrium aluminum garnet laser lithotripsy in the treatment of biliary calculi using single-operator cholangioscopy: a multicenter experience(with video). Gastrointest Endosc. 2014;79(2):344–8. doi: 10.1016/j.gie.2013.07.054. Epub 2013 Nov 22.PubMedCrossRefGoogle Scholar
  36. 36.
    Das AK, Chiura A, Conlin MJ, Eschelman D, Bagley DH. Treatment of biliary calculi using holmium: yttrium aluminum garnet laser. Gastrointest Endosc. 1998;48(2):207–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Strunge C, Brinkmann R, Flemming G, Engelhardt R. Interspersion of fragmented fiber’s splinters into tissue during pulsed alexandrite laser lithotripsy. Lasers Surg Med. 1991;11(2):183–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Kozarek RA, Low DE, Ball TJ. Tunable dye laser lithotripsy: in vitro studies and in vivo treatment of choledocholithiasis. Gastrointest Endosc. 1988;34(5):418–21.PubMedCrossRefGoogle Scholar
  39. 39.
    Ell C, Hochberger J, May A, Fleig WE, Bauer R, Mendez L, Hahn EG. Laser lithotripsy of difficult bile duct stones by means of a rhodamine-6G laser and an integrated automatic stone-tissue detection system. Gastrointest Endosc. 1993;39(6):755–62.PubMedCrossRefGoogle Scholar
  40. 40.
    Cho YD, Cheon YK, Moon JH, Jeong SW, Jang JY, Lee JS, Shim CS. Clinical role of frequency-doubled double-pulsed yttrium aluminum garnet laser technology for removing difficult bile duct stones (with videos). Gastrointest Endosc. 2009;70(4):684–9. doi: 10.1016/j.gie.2009.03.1170. Epub 2009 Jul 1.PubMedCrossRefGoogle Scholar
  41. 41.
    Ell C, Hochberger J, Müller D, Zirngibl H, Giedl J, Lux G, Demling L. Laser lithotripsy of gallstone by means of a pulsed neodymium-YAG laser—in vitro and animal experiments. Endoscopy. 1986;18(3):92–4. PubMed.PubMedCrossRefGoogle Scholar
  42. 42.
    Hochberger J, Tex S, Maiss J, Hahn EG. Management of difficult common bile duct stones. Gastrointest Endosc Clin N Am. 2003;13(4):623–34. Review. PubMedPMID: 14986790.PubMedCrossRefGoogle Scholar
  43. 43.
    Weickert U, Mühlen E, Janssen J, Johanns W, Greiner L. The holmium-YAG laser: a suitable instrument for stone fragmentation in choledocholithiasis. The assessment of the results of its use under babyscopic control]. Dtsch Med Wochenschr. 1999;124(17):514–8. German.PubMedCrossRefGoogle Scholar
  44. 44.
    Larghi A, Waxman I. Endoscopic direct cholangioscopy by using an ultra-slim upper endoscope: a feasibility study. Gastrointest Endosc. 2006;63(6):853–7. PubMed.PubMedCrossRefGoogle Scholar
  45. 45.
    Moon JH, Ko BM, Choi HJ, Hong SJ, Cheon YK, Cho YD, Lee JS, Lee MS, Shim CS. Intraductal balloon-guided direct peroral cholangioscopy with an ultraslim upper endoscope (with videos). Gastrointest Endosc. 2009;70(2):297–302. doi: 10.1016/j.gie.2008.11.019. Epub 2009 Apr 25.PubMedCrossRefGoogle Scholar
  46. 46.
    Moon JH, Terheggen G, Choi HJ, Neuhaus H. Peroral cholangioscopy: diagnostic and therapeutic applications. Gastroenterology. 2013;144(2):276–82. doi: 10.1053/j.gastro.2012.10.045. Epub 2012 Nov 2. Review.PubMedCrossRefGoogle Scholar
  47. 47.
    Choi HJ, Moon JH, Ko BM, Hong SJ, Koo HC, Cheon YK, Cho YD, Lee JS, Lee MS, Shim CS. Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos). Gastrointest Endosc. 2009;69(4):935–40. doi: 10.1016/j.gie.2008.08.043.PubMedCrossRefGoogle Scholar
  48. 48.
    Moon JH, Ko BM, Choi HJ, Koo HC, Hong SJ, Cheon YK, Cho YD, Lee MS, Shim CS. 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. doi: 10.1038/ajg.2009.435. Epub 2009 Jul 21.PubMedCrossRefGoogle Scholar
  49. 49.
    Moon JH, Choi HJ. The role of direct peroral cholangioscopy using an ultraslim endoscope for biliary lesions: indications, limitations, and complications. Clin Endosc. 2013;46(5):537–9. doi: 10.5946/ce.2013.46.5.537. PubMed PMID: 24143317, PubMed Central PMCID: PMC3797940, Epub 2013 Sep 30. Review.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Sethi A, Chen YK, Austin GL, Brown WR, Brauer BC, Fukami NN, Khan AH, Shah RJ. 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. doi: 10.1016/j.gie.2010.08.058. Epub 2010 Nov 24.PubMedCrossRefGoogle Scholar
  51. 51.
    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. doi: 10.1016/j.gie.2011.01.038. Epub 2011 Apr 5.PubMedCrossRefGoogle Scholar
  52. 52.
    Neuhaus H, Zillinger C, Born P, Ott R, Allescher H, Rösch T, Classen M. Randomized study of intracorporeal laser lithotripsy versus extracorporeal shock-wave lithotripsy for difficult bile duct stones. Gastrointest Endosc. 1998;47(5):327–34.PubMedCrossRefGoogle Scholar
  53. 53.
    Jakobs R, Adamek HE, Maier M, Krömer M, Benz C, Martin WR, Riemann JF. Fluoroscopically guided laser lithotripsy versus extracorporeal shock wave lithotripsy for retained bile duct stones: a prospective randomised study. Gut. 1997;40(5):678–82. PubMed PMID: 9203950, PubMed Central PMCID: PMC1027174.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Bland KI, Jones RS, Maher JW, Cotton PB, Pennell TC, Amerson JR, Munson JL, Berci G, Fuchs GJ, Way LW, et al. Extracorporeal shock-wave lithotripsy of bile duct calculi. An interim report of the Dornier U.S. Bile Duct Lithotripsy Prospective Study. Ann Surg. 1989;209(6):743–53. PubMed PMID: 2658883, PubMed Central PMCID: PMC1494134, discussion 753–5.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Meyenberger C, Meierhofer U, Michel-Harder C, Knuchel J, Wirth HP, Bühler H, Münch R, Altorfer J. Long-term follow-up after treatment of common bile duct stones by extracorporeal shock-wave lithotripsy. Endoscopy. 1996;28(5):411–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Ellis RD, Jenkins AP, Thompson RP, Ede RJ. Clearance of refractory bile duct stones with extracorporeal shockwave lithotripsy. Gut. 2000;47(5):728–31. PubMed PMID: 11034593, PubMed Central PMCID: PMC1728118.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Nicholson DA, Martin DF, Tweedle DE, Rao PN. Management of common bile duct stones using a second-generation extracorporeal shockwave lithotriptor. Br J Surg. 1992;79(8):811–4.PubMedCrossRefGoogle Scholar
  58. 58.
    Muratori R, Azzaroli F, Buonfiglioli F, Alessandrelli F, Cecinato P, Mazzella G, Roda E. ESWL for difficult bile duct stones: a 15-year single centre experience. World J Gastroenterol. 2010;16(33):4159–63. PubMed PMID: 20806432, PubMed Central PMCID: PMC2932919.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Tandan M, Reddy DN, Santosh D, Reddy V, Koppuju V, Lakhtakia S, Gupta R, Ramchandani M, Rao GV. Extracorporeal shock wave lithotripsy of large difficult common bile duct stones: efficacy and analysis of factors that favor stone fragmentation. J Gastroenterol Hepatol. 2009;24(8):1370–4. doi: 10.1111/j.1440-1746.2009.05919.x.PubMedCrossRefGoogle Scholar
  60. 60.
    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.PubMedCrossRefGoogle Scholar
  61. 61.
    Lee DK, Han JW. Endoscopic papillary large balloon dilation: guidelines for pursuing zero mortality. Clin Endosc. 2012;45(3):299–304. doi: 10.5946/ce.2012.45.3.299. PubMed PMID: 22977823, PubMed Central PMCID: PMC3429757, Epub 2012 Aug 22.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Attam R, Freeman ML. Endoscopic papillary large balloon dilation for large common bile duct stones. J Hepatobiliary Pancreat Surg. 2009;16(5):618–23. doi: 10.1007/s00534-009-0134-2. Epub 2009 Jun 24. Review.PubMedCrossRefGoogle Scholar
  63. 63.
    Donatelli G, Vergeau B, Dhumane P, Cereatti F, Fiocca F, Tuszynski T, Meduri B. Endoscopic partial sphincterotomy coupled with large balloon papilla dilation – Single stage approach for management of extra-hepatic bile ducts macro-lithiasis. Video J Encycl GI Endosc. 2013;1(3):636–9. Retrieved March 14, 2015, from Scholar
  64. 64.
    Minami A, Hirose S, Nomoto T, Hayakawa S. Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy. World J Gastroenterol. 2007;13(15):2179–82. PubMed PMID: 17465497, PubMed Central PMCID: PMC4146840.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Maydeo A, Bhandari S. Balloon sphincteroplasty for removing difficult bile duct stones. Endoscopy. 2007;39(11):958–61. Epub 2007 Aug 15.PubMedCrossRefGoogle Scholar
  66. 66.
    Stefanidis G, Viazis N, Pleskow D, Manolakopoulos S, Theocharis L, Christodoulou C, Kotsikoros N, Giannousis J, Sgouros S, Rodias M, Katsikani A, Chuttani R. 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. doi: 10.1038/ajg.2010.421. Epub 2010 Nov 2.PubMedCrossRefGoogle Scholar
  67. 67.
    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. doi: 10.4253/wjge.v4.i5.180. PubMed Central PMCID: PMC3355240.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Heo JH, Kang DH, Jung HJ, Kwon DS, An JK, Kim BS, Suh KD, Lee SY, Lee JH, Kim GH, Kim TO, Heo J, Song GA, Cho M. Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones. Gastrointest Endosc. 2007;66(4):720–6. quiz 768, 771.PubMedCrossRefGoogle Scholar
  69. 69.
    Itoi T, Itokawa F, Sofuni A, Kurihara T, Tsuchiya T, Ishii K, Tsuji S, Ikeuchi N, Moriyasu F. Endoscopic sphincterotomy combined with large balloon dilation can reduce the procedure time and fluoroscopy time for removal of large bile duct stones. Am J Gastroenterol. 2009;104(3):560–5. doi: 10.1038/ajg.2008.67. Epub 2009 Jan 27.PubMedCrossRefGoogle Scholar
  70. 70.
    Kim TH, Oh HJ, Lee JY, Sohn YW. Can a small endoscopic sphincterotomy plus a large-balloon dilation reduce the use of mechanical lithotripsy in patients with large bile duct stones? Surg Endosc. 2011;25(10):3330–7. doi: 10.1007/s00464-011-1720-3. Epub 2011 Apr 30.PubMedCrossRefGoogle Scholar
  71. 71.
    Draganov PV, Evans W, Fazel A, Forsmark CE. Large size balloon dilation of the ampulla after biliary sphincterotomy can facilitate endoscopic extraction of difficult bile duct stones. J Clin Gastroenterol. 2009;43(8):782–6. doi: 10.1097/MCG.0b013e31818f50a2.PubMedCrossRefGoogle Scholar
  72. 72.
    Kim HG, Cheon YK, Cho YD, Moon JH, Park DH, Lee TH, Choi HJ, Park SH, Lee JS, Lee MS. Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy. World J Gastroenterol. 2009;15(34):4298–304. PubMed PMID: 19750573, PubMed Central PMCID: PMC2744186.PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Attasaranya S, Cheon YK, Vittal H, Howell DA, Wakelin DE, Cunningham JT, Ajmere N, Ste Marie Jr RW, Bhattacharya K, Gupta K, Freeman ML, Sherman S, McHenry L, Watkins JL, Fogel EL, Schmidt S, Lehman GA. Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series. Gastrointest Endosc. 2008;67(7):1046–52. doi: 10.1016/j.gie.2007.08.047. Epub 2008 Feb 21.PubMedCrossRefGoogle Scholar
  74. 74.
    Misra SP, Dwivedi M. Large-diameter balloon dilation after endoscopic sphincterotomy for removal of difficult bile duct stones. Endoscopy. 2008;40(3):209–13. doi: 10.1055/s-2007-967040. Epub 2008 Feb 11.PubMedCrossRefGoogle Scholar
  75. 75.
    Witte CL. Choledochal obstruction by cystic duct stone. Mirizzi’s syndrome. Am Surg. 1984;50(5):241–3.PubMedGoogle Scholar
  76. 76.
    Mithani R, Schwesinger WH, Bingener J, Sirinek KR, Gross GW. The Mirizzi syndrome: multidisciplinary management promotes optimal outcomes. J Gastrointest Surg. 2008;12(6):1022–8. Epub 2007 Sep 14.PubMedCrossRefGoogle Scholar
  77. 77.
    Schäfer M, Schneiter R, Krähenbühl L. Incidence and management of Mirizzi syndrome during laparoscopic cholecystectomy. Surg Endosc. 2003;17(8):1186–90. discussion 1191–2. Epub 2003 May 13.PubMedCrossRefGoogle Scholar
  78. 78.
    McSherry CK, Ferstenberg H, Virshup H. The Mirizzi syndrome: suggested classification and surgical therapy. Surg Gastroenterol. 1982;1:219–25.Google Scholar
  79. 79.
    England RE, Martin DF. Endoscopic management of Mirizzi’s syndrome. Gut. 1997;40(2):272–6. PubMed Central PMCID: PMC1027061.PubMedPubMedCentralCrossRefGoogle Scholar
  80. 80.
    Benninger J, Rabenstein T, Farnbacher M, Keppler J, Hahn EG, Schneider HT. Extracorporeal shockwave lithotripsy of gallstones in cystic duct remnants and Mirizzi syndrome. Gastrointest Endosc. 2004;60(3):454–9.PubMedCrossRefGoogle Scholar
  81. 81.
    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. doi: 10.1007/s00464-010-1520-1. Epub 2010 Dec 24.PubMedCrossRefGoogle Scholar
  82. 82.
    Huang MH, Chen CH, Yang JC, Yang CC, Yeh YH, Chou DA, Mo LR, Yueh SK, Nien CK. Long-term outcome of percutaneous transhepatic cholangioscopic lithotomy for hepatolithiasis. Am J Gastroenterol. 2003;98(12):2655–62.PubMedCrossRefGoogle Scholar
  83. 83.
    Pitt HA, Venbrux AC, Coleman J, Prescott CA, Johnson MS, Osterman Jr FA, Cameron JL. Intrahepatic stones. The transhepatic team approach. Ann Surg. 1994;219(5):527–35. PubMed Central PMCID: PMC1243184, discussion 535–7.PubMedPubMedCentralCrossRefGoogle Scholar
  84. 84.
    Yoshimoto H, Ikeda S, Tanaka M, Matsumoto S, Kuroda Y. Choledochoscopic electrohydraulic lithotripsy and lithotomy for stones in the common bile duct, intrahepatic ducts, and gallbladder. Ann Surg. 1989;210(5):576–82. PubMed Central PMCID: PMC1357789.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Liu CL, Fan ST, Wong J. Primary biliary stones: diagnosis and management. World J Surg. 1998;22(11):1162–6.PubMedCrossRefGoogle Scholar
  86. 86.
    Mori T, Sugiyama M, Atomi Y. Gallstone disease: management of intrahepatic stones. Best Pract Res Clin Gastroenterol. 2006;20(6):1117–37. Review.PubMedCrossRefGoogle Scholar
  87. 87.
    Cheon YK, Cho YD, Moon JH, Lee JS, Shim CS. Evaluation of long-term results and recurrent factors after operative and nonoperative treatment for hepatolithiasis. Surgery. 2009;146(5):843–53. doi: 10.1016/j.surg.2009.04.009. Epub 2009 Jun 28.PubMedCrossRefGoogle Scholar
  88. 88.
    Jan YY, Chen MF. Percutaneous trans-hepatic cholangioscopic lithotomy for hepatolithiasis: long-term results. Gastrointest Endosc. 1995;42(1):1–5.PubMedCrossRefGoogle Scholar
  89. 89.
    Lee SK, Seo DW, Myung SJ, Park ET, Lim BC, Kim HJ, Yoo KS, Park HJ, Joo YH, Kim MH, Min YI. Percutaneous transhepatic cholangioscopic treatment for hepatolithiasis: an evaluation of long-term results and risk factors for recurrence. Gastrointest Endosc. 2001;53(3):318–23.PubMedCrossRefGoogle Scholar
  90. 90.
    Chen C, Huang M, Yang J, Yang C, Yeh Y, Wu H, Chou D, Yueh S, Nien C. Reappraisal of percutaneous transhepatic cholangioscopic lithotomy for primary hepatolithiasis. Surg Endosc. 2005;19(4):505–9. Epub 2005 Feb 3.PubMedCrossRefGoogle Scholar
  91. 91.
    Neuhaus H. Endoscopic and percutaneous treatment of difficult bile duct stones. Endoscopy. 2003;35(8):S31–4. Review.PubMedCrossRefGoogle Scholar
  92. 92.
    Kennedy RH, Thompson MH. Are duodenal diverticula associated with choledocholithiasis? Gut. 1988;29(7):1003–6. PubMed Central PMCID: PMC1433758.PubMedPubMedCentralCrossRefGoogle Scholar
  93. 93.
    Lee A, Shah JN. Endoscopic approach to the bile duct in the patient with surgically altered anatomy. Gastrointest Endosc Clin N Am. 2013;23(2):483–504. doi: 10.1016/j.giec.2012.12.005. Epub 2013 Jan 12. Review.PubMedCrossRefGoogle Scholar
  94. 94.
    García-Cano J. A simple technique to aid intubation of the duodenoscope in the afferent limb of Billroth II gastrectomies for endoscopic retrograde cholangiopancreatography. Endoscopy. 2008;40 Suppl 2:E21–2. doi: 10.1055/s-2007-966950. Epub 2008 Feb 19.PubMedCrossRefGoogle Scholar
  95. 95.
    Park CH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS. Cap-assisted ERCP in patients with a Billroth II gastrectomy. Gastrointest Endosc. 2007;66(3):612–5.PubMedCrossRefGoogle Scholar
  96. 96.
    Osnes M, Rosseland AR, Aabakken L. Endoscopic retrograde cholangiography and endoscopic papillotomy in patients with a previous Billroth-II resection. Gut. 1986;27(10):1193–8. PubMed Central PMCID: PMC1433853.PubMedPubMedCentralCrossRefGoogle Scholar
  97. 97.
    Tyagi P, Sharma P, Sharma BC, Puri AS. Periampullary diverticula and technical success of endoscopic retrograde cholangiopancreatography. Surg Endosc. 2009;23(6):1342–5. doi: 10.1007/s00464-008-0167-7. Epub 2008 Sep 26.PubMedCrossRefGoogle Scholar
  98. 98.
    Bergman JJ, van Berkel AM, Bruno MJ, Fockens P, Rauws EA, Tijssen JG, Tytgat GN, Huibregtse K. A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy. Gastrointest Endosc. 2001;53(1):19–26.PubMedCrossRefGoogle Scholar
  99. 99.
    Hintze RE, Adler A, Veltzke W, Abou-Rebyeh H. Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with Billroth II or Roux-en-Y gastrojejunostomy. Endoscopy. 1997;29(2):69–73.PubMedCrossRefGoogle Scholar
  100. 100.
    Faylona JM, Qadir A, Chan AC, Lau JY, Chung SC. Small-bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy. Endoscopy. 1999;31(7):546–9.PubMedCrossRefGoogle Scholar
  101. 101.
    Neumann H, Fry LC, Meyer F, Malfertheiner P, Monkemuller K. Endoscopic retrograde cholangiopancreatography using the single balloon enteroscope technique in patients with Roux-en-Y anastomosis. Digestion. 2009;80(1):52–7. doi: 10.1159/000216351.PubMedCrossRefGoogle Scholar
  102. 102.
    Gostout CJ, Bender CE. Cholangiopancreatography, sphincterotomy, and common duct stone removal via Roux-en-Y limb enteroscopy. Gastroenterology. 1988;95(1):156–63.PubMedGoogle Scholar
  103. 103.
    Elton E, Hanson BL, Qaseem T, Howell DA. Diagnostic and therapeutic ERCP using an enteroscope and a pediatric colonoscope in long-limb surgical bypass patients. Gastrointest Endosc. 1998;47(1):62–7.PubMedCrossRefGoogle Scholar
  104. 104.
    Shimatani M, Matsushita M, Takaoka M, Koyabu M, Ikeura T, Kato K, Fukui T, Uchida K, Okazaki K. Effective “short” double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series. Endoscopy. 2009;41(10):849–54. doi: 10.1055/s-0029-1215108. Epub 2009 Sep 11.PubMedCrossRefGoogle Scholar
  105. 105.
    Itoi T, Ishii K, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, Tsuji S, Ikeuchi N, Umeda J, Moriyasu F. Single-balloon enteroscopy-assisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis (with video). Am J Gastroenterol. 2010;105(1):93–9. doi: 10.1038/ajg.2009.559. Epub 2009 Oct 6.PubMedCrossRefGoogle Scholar
  106. 106.
    Emmett DS, Mallat DB. Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series. Gastrointest Endosc. 2007;66(5):1038–41.PubMedCrossRefGoogle Scholar
  107. 107.
    Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc. 2002;56(2):225–32.PubMedCrossRefGoogle Scholar
  108. 108.
    Saleem A, Baron TH, Gostout CJ, Topazian MD, Levy MJ, Petersen BT, Petersen BT, Wong Kee Song LM. Endoscopic retrograde cholangiopancreatography using a single-balloon enteroscope in patients with altered Roux-en-Y anatomy. Endoscopy. 2010;42(8):656–60. doi: 10.1055/s-0030-1255557. Epub 2010 Jun 29.PubMedCrossRefGoogle Scholar
  109. 109.
    Aabakken L, Bretthauer M, Line PD. Double-balloon enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis. Endoscopy. 2007;39(12):1068–71.PubMedCrossRefGoogle Scholar
  110. 110.
    Wagh MS, Draganov PV. Prospective evaluation of spiral overtube-assisted ERCP in patients with surgically altered anatomy. Gastrointest Endosc. 2012;76(2):439–43. doi: 10.1016/j.gie.2012.04.444.PubMedCrossRefGoogle Scholar
  111. 111.
    Shah RJ, Smolkin M, Yen R, Ross A, Kozarek RA, Howell DA, Bakis G, Jonnalagadda SS, Al-Lehibi AA, Hardy A, Morgan DR, Sethi A, Stevens PD, Akerman PA, Thakkar SJ, Brauer BC. A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). Gastrointest Endosc. 2013;77(4):593–600. doi: 10.1016/j.gie.2012.10.015. Epub 2013 Jan 3.PubMedCrossRefGoogle Scholar
  112. 112.
    Rimon U, Kleinmann N, Bensaid P, Golan G, Garniek A, Khaitovich B, Winkler H. Percutaneous transhepatic endoscopic holmium laser lithotripsy for intrahepatic and choledochal biliary stones. Cardiovasc Intervent Radiol. 2011;34(6):1262–6. doi: 10.1007/s00270-010-0058-x. Epub 2010 Dec 16.PubMedCrossRefGoogle Scholar
  113. 113.
    van der Velden JJ, Berger MY, Bonjer HJ, Brakel K, Laméris JS. Percutaneous treatment of bile duct stones in patients treated unsuccessfully with endoscopic retrograde procedures. Gastrointest Endosc. 2000;51(4 Pt 1):418–22.PubMedCrossRefGoogle Scholar
  114. 114.
    Stage JG, Moesgaard F, Grønvall S, Stage P, Kehlet H. Percutaneous transhepatic cholelithotripsy for difficult common bile duct stones. Endoscopy. 1998;30(3):289–92.PubMedCrossRefGoogle Scholar
  115. 115.
    Jeong EJ, Kang DH, Kim DU, Choi CW, Eum JS, Jung WJ, Kim PJ, Kim YW, Jung KS, Bae YM, Cho M. Percutaneous transhepatic choledochoscopic lithotomy as a rescue therapy for removal of bile duct stones in Billroth II gastrectomy patients who are difficult to perform ERCP. Eur J Gastroenterol Hepatol. 2009;21(12):1358–62. doi: 10.1097/MEG.0b013e328326caa1.PubMedCrossRefGoogle Scholar
  116. 116.
    Martinez J, Guerrero L, Byers P, Lopez P, Scagnelli T, Azuaje R, Dunkin B. Endoscopic retrograde cholangiopancreatography and gastroduodenoscopy after Roux-en-Y gastric bypass. Surg Endosc. 2006;20(10):1548–50. Epub 2006 Aug 1.PubMedCrossRefGoogle Scholar
  117. 117.
    Baron TH, Vickers SM. Surgical gastrostomy placement as access for diagnostic and therapeutic ERCP. Gastrointest Endosc. 1998;48(6):640–1.PubMedCrossRefGoogle Scholar
  118. 118.
    Lopes TL, Clements RH, Wilcox CM. Laparoscopy-assisted ERCP: experience of a high-volume bariatric surgery center (with video). Gastrointest Endosc. 2009;70(6):1254–9. doi: 10.1016/j.gie.2009.07.035. Epub 2009 Oct 28.PubMedCrossRefGoogle Scholar
  119. 119.
    Patel JA, Patel NA, Shinde T, Uchal M, Dhawan MK, Kulkarni A, Colella JJ. Endoscopic retrograde cholangiopancreatography after laparoscopic Roux-en-Y gastric bypass: a case series and review of the literature. Am Surg. 2008;74(8):689–93. discussion 693–4. Review.PubMedGoogle Scholar
  120. 120.
    Gutierrez JM, Lederer H, Krook JC, Kinney TP, Freeman ML, Jensen EH. Surgical gastrostomy for pancreatobiliary and duodenal access following Roux en Y gastric bypass. J Gastrointest Surg. 2009;13(12):2170–5. doi: 10.1007/s11605-009-0991-7. Epub 2009 Sep 24.PubMedCrossRefGoogle Scholar
  121. 121.
    Tsuyuguchi T, Saisho H, Ishihara T, Yamaguchi T, Onuma EK. Long-term follow-up after treatment of Mirizzi syndrome by peroral cholangioscopy. Gastrointest Endosc. 2000;52(5):639–44.PubMedCrossRefGoogle Scholar
  122. 122.
    Maranki J, Hernandez AJ, Arslan B, Jaffan AA, Angle JF, Shami VM, Kahaleh M. Interventional endoscopic ultrasound-guided cholangiography: long-term experience of an emerging alternative to percutaneous transhepatic cholangiography. Endoscopy. 2009;41(6):532–8. doi: 10.1055/s-0029-1214712. Epub 2009 Jun 16.PubMedCrossRefGoogle Scholar
  123. 123.
    Dhir V, Bhandari S, Bapat M, Maydeo A. Comparison of EUS-guided rendezvous and precut papillotomy techniques for biliary access (with videos). Gastrointest Endosc. 2012;75(2):354–9. doi: 10.1016/j.gie.2011.07.075.PubMedCrossRefGoogle Scholar
  124. 124.
    Iwashita T, Lee JG, Shinoura S, Nakai Y, Park DH, Muthusamy VR, Chang KJ. Endoscopic ultrasound-guided rendezvous for biliary access after failed cannulation. Endoscopy. 2012;44(1):60–5. doi: 10.1055/s-0030-1256871. Epub 2011 Nov 29.PubMedCrossRefGoogle Scholar
  125. 125.
    Iwashita T, Yasuda I, Doi S, Yamauchi T, Uemura S, Okuno M, Moriwaki H. Endoscopic ultrasound-guided antegrade papillary balloon dilation for treating a common bile duct stone. Dig Endosc. 2013;25(1):89–90. doi: 10.1111/j.1443-1661.2012.01381.x.PubMedCrossRefGoogle Scholar
  126. 126.
    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. doi: 10.1055/s-0030-1256961. Epub 2011 Nov 4.PubMedCrossRefGoogle Scholar
  127. 127.
    Di Giorgio P, Manes G, Grimaldi E, Schettino M, D’Alessandro A, Di Giorgio A, Giannattasio F. Endoscopic plastic stenting for bile duct stones: stent changing on demand or every 3 months. A prospective comparison study. Endoscopy. 2013;45(12):1014–7. doi: 10.1055/s-0033-1344556. Epub 2013 Nov 28.PubMedCrossRefGoogle Scholar
  128. 128.
    Lee TH, Han JH, Kim HJ, Park SM, Park SH, Kim SJ. Is the addition of choleretic agents in multiple double-pigtail biliary stents effective for difficult common bile duct stones in elderly patients? A prospective, multicenter study. Gastrointest Endosc. 2011;74(1):96–102. doi: 10.1016/j.gie.2011.03.005. Epub 2011 Apr 30.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Division of Gastroenterology & HepatologyUniversity of New Mexico School of MedicineAlbuquerqueUSA
  2. 2.Division of Gastroenterology & Hepatology, Department of MedicineUniversity of New Mexico School of MedicineAlbuquerqueUSA

Personalised recommendations