Published online May 26, 2019. doi: 10.12998/wjcc.v7.i10.1149
Peer-review started: February 13, 2019
First decision: March 9, 2019
Revised: March 20, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: May 26, 2019
Processing time: 105 Days and 0.4 Hours
In patients with large stones in the common bile duct (CBD), advanced treatment modalities are generally needed. Here, we present an interesting case of a huge CBD stone treated with electrohydraulic lithotripsy (EHL) by the percutaneous approach and rendezvous endoscopic retrograde cholangiography (ERC) using a nasal endoscope.
A 91-year-old woman underwent ERC for a symptomatic large CBD stone with a diameter of 50 mm. She was referred to our institution after the failure of lithotomy by ERC, and after undergoing percutaneous transhepatic biliary drainage. We attempted to fragment the stone by transhepatic cholangioscopy using EHL. However, the stones were too large and partly soft clay-like for lithotripsy. Next, we attempted lithotomy with ERC and cholangioscopy by the rendezvous technique using a nasal endoscope and achieved complete lithotomy. No complication was observed at the end of this procedure.
Cholangioscopy by rendezvous technique using a nasal endoscope is a feasible and safe endoscopic method for removing huge CBD stones.
Core tip: Common bile duct (CBD) stones that are very large may require choledochotomy or lithotomy. However, surgery may be contra indicated in very elderly patients, and alternate treatments are required. Recent reports indicate that electrohydraulic lithotripsy (EHL) is an effective treatment for bile duct stones. We used EHL, followed by retrograde cholangiography and the rendezvous technique via nasal endoscope to successfully treat an elderly patient with a 50 mm diameter CBD stone.