Endoscopic Management of Difficult Biliary Stones: An Evergreen Issue
Magdalini Manti,
Jimil Shah,
Apostolis Papaefthymiou,
Antonio Facciorusso,
Daryl Ramai,
Georgios Tziatzios,
Vasilios Papadopoulos,
Konstantina Paraskeva,
Ioannis S. Papanikolaou,
Konstantinos Triantafyllou,
Marianna Arvanitakis,
Livia Archibugi,
Giuseppe Vanella,
Marcus Hollenbach,
Paraskevas Gkolfakis
Affiliations
Magdalini Manti
Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, 14233 Athens, Greece
Jimil Shah
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Apostolis Papaefthymiou
Endoscopy Unit, Cleveland Clinic London, London SW1X 7HY, UK
Antonio Facciorusso
Gastroenterology Unit, Department of Medical Sciences, University of Foggia, 00161 Foggia, Italy
Daryl Ramai
Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA
Georgios Tziatzios
Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, 14233 Athens, Greece
Vasilios Papadopoulos
Department of Gastroenterology, General University Hospital of Larissa, 41110 Larissa, Greece
Konstantina Paraskeva
Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, 14233 Athens, Greece
Ioannis S. Papanikolaou
Hepatogastroenterology Unit, Second Department of Internal Medicine—Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece
Konstantinos Triantafyllou
Hepatogastroenterology Unit, Second Department of Internal Medicine—Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece
Marianna Arvanitakis
Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, University Hospital of Brussels (HUB), 1070 Brussels, Belgium
Livia Archibugi
Pancreato-Biliary Endoscopy and Endosonography Division, Vita-Salute San Raffaele University, 20132 Milan, Italy
Giuseppe Vanella
Pancreato-Biliary Endoscopy and Endosonography Division, Vita-Salute San Raffaele University, 20132 Milan, Italy
Marcus Hollenbach
Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, D-04103 Leipzig, Germany
Paraskevas Gkolfakis
Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, 14233 Athens, Greece
Choledocholithiasis is one of the most common indications for endoscopic retrograde cholangiopancreatography (ERCP) in daily practice. Although the majority of stones are small and can be easily removed in a single endoscopy session, approximately 10–15% of patients have complex biliary stones, requiring additional procedures for an optimum clinical outcome. A plethora of endoscopic methods is available for the removal of difficult biliary stones, including papillary large balloon dilation, mechanical lithotripsy, and electrohydraulic and laser lithotripsy. In-depth knowledge of these techniques and the emerging literature on them is required to yield the most optimal therapeutic effects. This narrative review aims to describe the definition of difficult bile duct stones based on certain characteristics and streamline their endoscopic retrieval using various modalities to achieve higher clearance rates.
