Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2019; 7(10): 1149-1154
Published online May 26, 2019. doi: 10.12998/wjcc.v7.i10.1149
Electrohydraulic lithotripsy and rendezvous nasal endoscopic cholangiography for common bile duct stone: A case report
Koichi Kimura, Kensuke Kudo, Tomoharu Yoshizumi, Takeshi Kurihara, Shohei Yoshiya, Yohei Mano, Kazuki Takeishi, Shinji Itoh, Noboru Harada, Toru Ikegami, Tetsuo Ikeda
Koichi Kimura, Kensuke Kudo, Tetsuo Ikeda, Department of Endoscopy and Endoscopic Surgery, Fukuoka Dental College, Fukuoka 814-0175, Japan
Koichi Kimura, Kensuke Kudo, Tomoharu Yoshizumi, Takeshi Kurihara, Shohei Yoshiya, Yohei Mano, Kazuki Takeishi, Shinji Itoh, Noboru Harada, Toru Ikegami, Tetsuo Ikeda, Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Author contributions: Kimura K was responsible for the study conception, design and drafting of the manuscript; Kudo K, Kurihara T, Yoshiya S, Mano Y, Takeishi K, Itoh S, Harada N, and Ikegami T were responsible for data collection; Yoshizumi T and Ikeda T were responsible for critical revision of the manuscript, and all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Koichi Kimura, MD, PhD, Assistant Professor, Doctor, Surgeon, Department of Endoscopy and Endoscopic Surgery, Fukuoka Dental College, 2-15-1, Tamura, Sawaraku, Fukuoka 814-0175, Japan.
Telephone: +81-92-8010411 Fax: +81-92-8010459
Received: February 12, 2019
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

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.

Keywords: Common bile duct stone, Electrohydraulic lithotripsy, Rendezvous technique, Endoscopic retrograde cholangiography, Nasal endoscop, Case report

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.