Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques

Abstract

Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or patient’s needs could make the stone extraction with the standard techniques difficult. Traditionally, mechanical lithotripsy with baskets has been reported as a safe and effective technique to achieve stone clearance. More recently, the increasing use of endoscopic papillary large balloon dilation and the diffusion of single-operator cholangioscopy with laser or electrohydraulic lithotripsy have brought new, safe, and effective therapeutic possibilities to the management of such challenging cases. We here summarize the available evidence about the endoscopic management of difficult common bile duct stones and discuss current indications of different lithotripsy techniques.

Cholangioscopy for biliary diseases

“…2). Adverse event rates are similar compared to conventional ERCP, including pancreatitis (2%) cholangitis (4%) and perforation (1%) [16]. However, POCS is less costly compared to repeat ERCPs, and is noninferior and less invasive compared to laparoscopic common bile duct exploration [17,18].…”

A nehezen eltávolítható epeúti kövek nem sebészi kezelési lehetőségei

“…Epeúti sztentek behelyezése után a kövek kisebbé válhatnak a kő és a sztent közötti folyamatos súrlódás miatt. Ilyen esetekben a második ülésben végzett kőeltávolítás 90%-ban is sikeres lehet, bár a betegek akár negyedénél is szükség lehet mechanikus kőzúzásra a sztent eltávolítása után (12).…”

Gel-immersion electrohydraulic lithotripsy during digital single-operator cholangioscopy is helpful when bleeding occurs

“…Electrohydraulic lithotripsy (EHL) during digital single-operator cholangioscopy (dSOC) is a useful technique for difficult bile duct stones 1 2 ; however, visibility during dSOC can be poor in the presence of bleeding or infected bile juice. In such situations, EHL may be challenging.…”