Treatment of Difficult Bile Duct Stones in Patients with Biliary Strictures

Endoscopic retrograde cholangiopancreatography (ERCP) successfully removes bile duct stones in 90% to 95% of patients. If ERCP fails, patients often are referred for percutaneous intervention or surgery. An alternative to these more-invasive techniques is transpapillary cholangioscopy-directed lithotripsy. What is the outlook for patients who undergo this procedure?

Investigators performed a prospective study of cholangioscopy-directed lithotripsy (electrohydraulic or mechanical) among 32 patients with difficult-to-remove stones. Eight patients had primary sclerosing cholangitis (PSC), and 20 had strictures. Stones were located in the intrahepatic ducts (8 patients), extrahepatic ducts (18 patients), or both (6 patients). All the patients ha…