Endoscopic Management of Complex Biliary Stone Disease

Gastrointest Endosc Clin N Am. 2019 Apr;29(2):257-275. doi: 10.1016/j.giec.2018.11.004. Epub 2019 Feb 2.


Choledocholithiasis is a common disorder that is managed universally by endoscopic retrograde cholangiopancreatography (ERCP). For difficult or complex stones, ERCP with conventional techniques may fail to achieve biliary clearance in 10% to 15% of cases. This review summarizes the literature regarding the current available endoscopic techniques for complex stone disease, including mechanical lithotripsy, endoscopic papillary large balloon dilation, cholangioscopy-guided lithotripsy, and endoscopic ultrasound-guided biliary access.

Keywords: Bile duct stone; Cholangioscopy; Choledocholithiasis; ERCP; Laser lithotripsy; Lithotripsy.

Publication types

  • Review
  • Video-Audio Media

MeSH terms

  • Cholangiopancreatography, Endoscopic Retrograde
  • Choledocholithiasis / therapy*
  • Dilatation / instrumentation
  • Dilatation / methods*
  • Gallstones / complications*
  • Gallstones / therapy*
  • Humans
  • Lithotripsy / methods*
  • Sphincterotomy, Endoscopic
  • Stents