Abstract

GOMEZ ZULETA, Martin; GUTIERREZ, Oscar  and  JARAMILLO, Mario. Case series: Management of difficult gallstones obstructing bile ducts. Rev Col Gastroenterol [online]. 2015, vol.30, n.4, pp.461-468. ISSN 0120-9957.

Standard endoscopic techniques of sphincterotomy combined with Dormia basket and/or balloon catheterization can manage 85-90% of the gallstones found obstructing bile ducts. However, when there are several large calculi, when a stone is in an unusual location, or when there are anatomic abnormalities of the bile duct, they become refractory to standard management. Other therapeutic modalities become essential for management of these gallstones. Large or impacted calculi are generally handled with fragmentation techniques such as mechanical lithotripsy. When this fails, electrohydraulic lithotripsy (LEH) or laser lithotripsy (LL) guided by conventional cholangioscopy are usually resorted to. More recently, a system of direct cholangioscopy called Spyglass has been introduced. Endoscopic papillary dilation with a large balloon has also proven useful for management of large and multiple calculi. In cases with altered anatomy that makes access to the papilla difficult, the preferred technique is a transhepatic approach combined with percutaneous fragmentation. In elderly patients whose overall condition is poor, the placement of a biliary stent is the definite choice of technique because it can improve the patient’s condition to make possible further endoscopic therapy

Keywords : Choledocholithiasis; difficult calculi; lithotripsy; cholangioscopy; Spyglass.

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