Cracking Difficult Biliary Stones
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Apart from difficult biliary cannulation, biliary stone removal is considered one of the hurdles in endoscopic retrogradecholangiopancreatography. Generally, simple common bile duct (CBD) stones can be removed either with an extraction balloon or abasket. However, there are difficult stones that cannot be removed using these standard methods. The most difficult stones are largeCBD stones and impacted stones in a tapering CBD. A few decades ago, mechanical lithotripsy was usually required to manage thesestones. At present, endoscopic papillary large balloon dilation (EPLBD) of the biliary orifice has become the gold standard for largeCBD stones up to 1.5 cm. EPLBD can reduce the procedural time by shortening the stone removal process. It can also save the costof the devices, especially multiple baskets, used in mechanical lithotripsy. Unfortunately, very large CBD stones, stones impacted ina tapering CBD, and some intrahepatic duct stones still require lithotripsy. Peroral cholangioscopy provides direct visualization ofthe stone, which helps the endoscopist perform a probe-based lithotripsy either with an electrohydraulic probe or a laser probe. Thistechnique can facilitate the management of difficult CBD stones with a high success rate and save procedural time without significanttechnical complications.
Abstract
Apart from difficult biliary cannulation, biliary stone removal is considered one of the hurdles in endoscopic retrogradecholangiopancreatography. Generally, simple common bile duct (CBD) stones can be removed either with an extraction balloon or abasket. However, there are difficult stones that cannot be removed using these standard methods. The most difficult stones are largeCBD stones and impacted stones in a tapering CBD. A few decades ago, mechanical lithotripsy was usually required to manage thesestones. At present, endoscopic papillary large balloon dilation (EPLBD) of the biliary orifice has become the gold standard for largeCBD stones up to 1.5 cm. EPLBD can reduce the procedural time by shortening the stone removal process. It can also save the costof the devices, especially multiple baskets, used in mechanical lithotripsy. Unfortunately, very large CBD stones, stones impacted ina tapering CBD, and some intrahepatic duct stones still require lithotripsy. Peroral cholangioscopy provides direct visualization ofthe stone, which helps the endoscopist perform a probe-based lithotripsy either with an electrohydraulic probe or a laser probe. Thistechnique can facilitate the management of difficult CBD stones with a high success rate and save procedural time without significanttechnical complications.
참고문헌 (52)
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