Being Creative with Old Tools: The Dilating Balloon as a Weapon Against Difficult Bile Duct Stones

Excerpt

One of the joys of practicing therapeutic endoscopy is the resourcefulness that is often required to solve the most difficult challenges with existing or available tools that are not necessarily designed for the problem at hand, with large or difficult-to-remove bile duct stones as prime examples. While 90 % of stones can be removed via endoscopic retrograde cholangiopancreatography (ERCP) using conventional methods and instruments (e.g., biliary sphincterotomy and balloon or basket extraction), approximately 10 % are “difficult” either because of their large size, impaction in the bile duct, the presence of bile duct strictures or relative stenoses distal to the stone(s), or of a massively dilated or distorted bile duct confounding stone capture [1]. In these circumstances, more advanced technologies and sophisticated techniques have been developed (see Table 1), but are often more expensive and unavailable at smaller medical centers. …