Endoscopic management of difficult common bile duct stones

Figure 1 Example of a three-layered mechanical lithotripsy device with the basket, inner plastic sheath and an outer metal sheath. The stone is captured by the basket and crushed against the outer metal sheath.

Figure 2 Image of a mechanical lithotripter which can be used as a “salvage device” for removal of impacted baskets.

Figure 3 Laser lithotripsy of a bile duct stone under cholangioscopic guidance.

Figure 4 Direct peroral cholangioscopy guided laser lithotripsy of a bile duct stone. The red laser light makes targeting of the stone easier).

Figure 5 Large diameter papillary balloon dilatation to remove bile duct stone.