Current endoscopic strategies for managing large bile duct stones

Abstract

Common bile duct stones are a relatively common occurrence and can often lead to devastating complications. Endoscopic retrograde cholangiopancreatography was introduced in the 1970s for management of common bile duct stones. Most common bile duct stones can be removed with simple techniques such as endoscopic sphincterotomy and balloon trawling. However, large bile duct stones continue to pose some difficulty in achieving complete extraction. In this article, we will review some of the established techniques such as the use of endoscopic papillary large balloon dilatation, mechanical lithotripsy, and cholangioscopy-assisted techniques. We will look at the recent literature to help clarify the particular methods and answer some of the questions surrounding these methods.

Single‐operator peroral cholangioscope in treating difficult biliary stones: A systematic review and meta‐analysis

“…SOPOC, introduced in 2007, is composed of a reusable optical probe and a disposable delivery catheter. With the upgrade in the SpyGlass system, SOPOC with EHL or LL has become a promising tool for removing DBDS . Various studies have assessed the effectiveness of SOPOC.…”

Endoscopic ultrasonography‐guided hepaticogastrostomy with novel two‐step puncture technique following peroral cholangioscopy‐assisted stone removal

“…Antegrade intervention through the fistula created by endoscopic ultrasonography (EUS)‐guided hepaticogastrostomy (EUS‐HGS), so‐called EUS‐guided antegrade intervention (EUS‐AI), for intrahepatic bile duct (IHBD) stone in patients with surgically altered anatomy has been developed . EUS‐AI is sometimes technically challenging as a result of the non‐dilated bile duct or huge stones.…”

Efficient clearance of intractable biliary calculi by combination of mechanical clamping and electrohydraulic lithotripsy

“…Cholangioscopy‐guided electrohydraulic lithotripsy (EHL) is a feasible treatment for biliary calculi . However, some intractable calculi are unable to be fragmented despite long‐term exposure to repeated EHL with high voltage . Furthermore, the diffused energy may cause persistent damage to the wall of the bile duct, which results in serious complications .…”