Endoscopic and Percutaneous Treatment of Difficult Bile Duct Stones

About 90 % of ductal stones can be extracted after endoscopic sphincterotomy (EST) with routine endoscopic maneuvers. The main reasons for failure are a difficult gastroduodenal or biliary anatomy, or impacted or excessively large stones which cannot be grasped with basket catheters. Various nonsurgical procedures complementary to endoscopic retrograde cholangiopancreatography (ERCP) are available for these selected cases. For each of these methods, risks and benefits must be weighed against a surgical common bile duct exploration.

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