Post written by Abdulrahman Qatomah, MBBS, from the Department of Gastroenterology and Hepatology, McGill University, Montreal, Quebec, Canada.

A large common bile duct stone was found in a patient with cholangitis. The stone was difficult to manage using the conventional ERCP method. Sessions of cholangioscopy-guided lithotripsy also failed to achieve stone fragmentation.

We wanted to highlight a novel method to help weaken large stones. We created a through-the-stone tunnel using single-operator cholangioscopy-guided electrohydraulic lithotripsy followed by placement of a coaxial stent. The goal is to weaken the core, allowing subsequent stone fragmentation with single-operator cholangioscopy-guided electrohydraulic lithotripsy and complete extraction.

We believe that this technique provides the endoscopist with an option for treating large and difficult common bile duct stones. It also could represent a more cost-effective approach than using multiple electrohydraulic lithotripsy probes and multiple sessions of cholangioscopy for stone fragmentation.

Endoscopic image of a fragmented stone after laser lithotripsy.

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