The large-balloon occupation technique: a new technique for removing multiple biliary stones from a large-diameter bile duct.

Multiple stones, a periampullary diverticulum, and advanced patient age are factors that contribute to difficulty in stone removal [1]. We were able to completely remove the bile duct stones in a 93-year-old woman with a periampullary diverticulum, multiple stones (about 100), and common bile duct of 35mm in diameter using the large-balloon occupation technique (LBOT). The patient visited our hospital because of abdominal pain, and gallstone pancreatitis was diagnosed. Computed tomography (CT) scanning showed about 100 stones in the bile duct (▶Fig. 1) and an impacted stone in the papilla. Emergency endoscopic biliary drainage was therefore performed. After the patient’s pancreatitis had improved, endoscopic lithotripsy was performed. Endoscopic retrograde cholangiography (ERC) showed a markedly dilated bile duct (35mm) and many filling defects with diameters of 3–12mm (▶Fig. 2). At the first session of endoscopic lithotripsy, we were unable to grasp the stones because of the considerable space between the stones and E-Videos