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World J Gastroenterol. Jan 14, 2013; 19(2): 165-173
Published online Jan 14, 2013. doi: 10.3748/wjg.v19.i2.165
Endoscopic management of difficult common bile duct stones
Guru Trikudanathan, Udayakumar Navaneethan, Mansour A Parsi
Guru Trikudanathan, Department of Internal Medicine, University of Connecticut Medical Center, Farmington, CT 06269, United States
Udayakumar Navaneethan, Mansour A Parsi, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: Trikulanatham G, and Navaneethan U reviewed the literature and wrote the initial draft manuscript; Parsi MA supervised the process, revised and approved the manuscript for submission.
Correspondence to: Mansour A Parsi, MD, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States.
Telephone: +1-216-4454880 Fax: +1-216-4446305
Received: December 29, 2011
Revised: May 18, 2012
Accepted: May 26, 2012
Published online: January 14, 2013

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities.

Keywords: Choledocholithiasis, Mechanical lithotripsy, Laser lithotripsy, Electrohydra-ulic lithotripsy, Difficult to remove biliary stones, Endoscopic large balloon papillary dilation, Peroral cholangioscopy