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Approximately 90% of bile duct stones can be removed during endoscopic retrograde cholangiopancreatography via simple biliary sphincterotomy and balloon extraction. The other 10% are typically characterized as “difficult” bile duct stones, usually owing to large size, unusual shape, presence above a biliary stricture, or a combination of these factors. In a recent systematic review and meta-analysis, researchers compared three advanced techniques for removing difficult bile duct stones — electrohydraulic lithotripsy, laser lithotripsy, and extracorporeal shock wave lithotripsy (ESWL).
Based on data from 32 studies (none randomized) comprising nearly 2000 patients, laser lithotripsy had a higher duct clearance rate (95%) compared with electro…