{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T04:34:56Z","timestamp":1784090096241,"version":"3.55.0"},"reference-count":10,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,1,18]],"date-time":"2019-01-18T00:00:00Z","timestamp":1547769600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:p>Efficacy of cholangioscopy\u2010assisted lithotripsy for difficult stones such as huge stones, multiple large stones and an impacted stone in patients with non\u2010altered anatomy has been reported. Herein, we describe peroral direct digital cholangioscopy (<jats:styled-content style=\"fixed-case\">PDCS<\/jats:styled-content>)\u2010assisted electrohydraulic lithotripsy (<jats:styled-content style=\"fixed-case\">EHL<\/jats:styled-content>) with a new technique in patients with surgically altered anatomy. Five patients received <jats:styled-content style=\"fixed-case\">PDCS<\/jats:styled-content>\u2010assisted <jats:styled-content style=\"fixed-case\">EHL<\/jats:styled-content> with the monorail technique due to failed conventional stone extraction. Balloon enteroscope was removed, leaving the stiff guidewire in the bile duct and an overtube with inflated balloons. The cholangioscope was then inserted into the bile duct over the wire through the overtube. After direct visualization of the stone, <jats:styled-content style=\"fixed-case\">PDCS<\/jats:styled-content>\u2010assisted <jats:styled-content style=\"fixed-case\">EHL<\/jats:styled-content> was carried out. This technique was named the \u2018monorail technique\u2019. Complete removal of biliary stones in one session was accomplished in four patients and only one case required two sessions. There was no adverse event in any of the cases. <jats:styled-content style=\"fixed-case\">PDCS<\/jats:styled-content>\u2010assisted <jats:styled-content style=\"fixed-case\">EHL<\/jats:styled-content> using the monorail technique was effective and safe for difficult biliary stones in patients with surgically altered anatomy.<\/jats:p>","DOI":"10.1111\/den.13310","type":"journal-article","created":{"date-parts":[[2018,12,1]],"date-time":"2018-12-01T12:44:41Z","timestamp":1543668281000},"page":"203-208","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Novel peroral direct digital cholangioscopy\u2010assisted lithotripsy using a monorail technique through the overtube in patients with surgically altered anatomy (with video)"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3999-2847","authenticated-orcid":false,"given":"Ryosuke","family":"Tonozuka","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9433-8437","authenticated-orcid":false,"given":"Takao","family":"Itoi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Sofuni","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayoshi","family":"Tsuchiya","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reina","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuyoshi","family":"Honjo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuntaro","family":"Mukai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo 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