Endoscopic management of difficult common bile duct stones

Guru Trikudanathan, Udayakumar Navaneethan, Mansour A. Parsi

Research output: Contribution to journalArticlepeer-review

64 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)165-173
Number of pages9
JournalWorld journal of gastroenterology
Issue number2
StatePublished - 2013

Bibliographical note

Copyright 2021 Elsevier B.V., All rights reserved.


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


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