Key Points
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Endoscopic papillary large-balloon dilation after sphincterotomy appears to reduce complications and the need for mechanical lithotripsy during extraction of large bile duct stones; mechanical lithotripsy is the mainstay of difficult stone removal
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Cholangioscopically directed electrohydraulic and laser lithotripsy enables fragmentation of refractory stones
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Cholangioscopy can be performed using single-operator mother–daughter systems or by direct peroral cholangioscopy using ultraslim endoscopes
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Percutaneous cholangioscopy enables visualization, fragmentation and removal of intrahepatic stones
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Balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) has limited efficacy for stone removal in patients with altered surgical anatomy
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Laparoscopic-access ERCP and percutaneous and endoscopic ultrasonography-guided access provide alternatives to ERCP for patients who have undergone Roux-en-Y gastric bypass
Abstract
Extraction of common bile duct stones by endoscopic retrograde cholangiopancreatography generally involves biliary sphincterotomy, endoscopic papillary balloon dilation or a combination of both. Endoscopic papillary large-balloon dilation after sphincterotomy has increased the safety of large stone extraction. Cholangioscopically directed electrohydraulic and laser lithotripsy using single-operator mother–daughter systems or direct peroral cholangioscopy using ultraslim endoscopes are increasingly utilized for the management of refractory stones. In this Review, we focus on advances in endoscopic approaches and techniques, with a special emphasis on management strategies for 'difficult' common bile duct stones.
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M.L.F. has received speaking honoraria from Cook Endoscopy and Boston Scientific, and is an unpaid consultant for Hobbs Medical Inc. The other authors declare no competing interests.
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Trikudanathan, G., Arain, M., Attam, R. et al. Advances in the endoscopic management of common bile duct stones. Nat Rev Gastroenterol Hepatol 11, 535–544 (2014). https://doi.org/10.1038/nrgastro.2014.76
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DOI: https://doi.org/10.1038/nrgastro.2014.76
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