Residual common bile duct stones on direct peroral cholangioscopy using ultraslim endoscope

Figure 1 Balloon-occluded cholangiography failed to reveal any filling defects of stones in the biliary tree after endoscopic retrograde cholangiography with bile duct clearance.

Figure 2 Ultraslim endoscope was advanced to the common bile duct (dotted arrow) and up to the left intrahepatic duct (arrow) using an overtube balloon (arrow head)-assisted technique.

Figure 3 Residual stones in the bile duct visualized using direct peroral cholangioscopy.

Figure 4 A basket catheter (arrow head) was used to retrieve the residual bile duct stones (arrow) under direct endoscopic control.