Direct cholangioscopy with standard ultra-slim endoscopes for electrohydraulic lithotripsy of an incarcerated large bile duct stone

Ninety percent of patients with intraductal biliary stones are successfully treated with sphincterotomy and subsequent stone extraction. However, technical difficulty increases with stone size and giant stones require fragmenation to facilitate endoscopic removal. For stones too large to be engaged in a basket for mechanical lithotripsy laser and electrohydraulic lithotripsy have been proposed for stone fragmentation. Application of Electrohydraulic lithotripsy (EHL) is best achieved under direct visualization during cholangioscopy, since shock waves can also injure normal tissue. We present the case of a patient who underwent direct cholangioscopy for EHL of a giant stone that could not be retrieved by ERCP.