[Extraction of a big-sized common bile duct stone by means of biliary sphincterotomy followed by papillary dilatation with a hydrostatic balloon].

An 83-year-old woman was admitted because of colicky pain in the abdominal right upper quadrant and a cholestatic pattern in liver chemistry. Transcutaneous abdominal ultrasound showed a huge dilation of the extrahepatic bile duct. A distal common bile duct stone was also observed. An endoscopic retrograde cholangio-pancreatography (ERCP) was performed. Vater’s papilla was located in the right rim of a duodenal diverticulum. At cholangiography a common bile duct stone was observed. It was ovoid in shape and had a size of 19 mm in the largest diameter (Fig. 1). An endoscopic biliary sphincterotomy procedure was performed. As Vater’s papilla was in a juxtadiverticular position, sphincterotomy size could not be extended beyond approximately 5 mm. This papillary opening seemed unlikely to allow common bile duct stone extraction. Then a sphincterotomy dilatation was performed. A 15-mm in diameter hydrostatic balloon was employed (Figs. 2 and 3). Afterwards, the common bile duct was swept with an extraction balloon and choledocholithiasis was removed (Fig. 4). The common bile duct stone slipped easily through the dilated papillary opening even though its size was greater than the papillary dilatation.