Feasibility of endoscopic papillary large balloon dilation to remove difficult stones in patients with nondilated distal bile ducts

Figure 1 Large balloon dilation in a patient with tapered distal duct. A: A 60-year-old female patient with a nondilated distal common duct; B: Large balloon dilation of the distal duct; C: Full dilation to 15 mm was performed; D: Stone retrieval without intracorporeal or mechanical lithotripsy was allowed by this technique.

Figure 2 Large balloon dilation in a patient with a long nondilated distal duct segment. A: A patient with a long non-dilated distal duct and impacted stone; B: Beginning of balloon dilation with choledochal waist; C: Full dilation to 15mm was obtained; D: Stone removal without the need of lithotripsy.

Figure 3 Large balloon dilation technique. A: Cholangiography demonstrates an impacted stone above a nondilated distal duct in a young patient; B: Balloon dilation at the tapered distal common duct segment with a balloon waist still observed; C: Full dilation up to 15 mm pushing the stone upstream; D: Balloon stone extraction is achieved.