{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:51:33Z","timestamp":1793386293351,"version":"4.5.0"},"reference-count":96,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T00:00:00Z","timestamp":1708300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Choledocholithiasis is one of the most common indications for endoscopic retrograde cholangiopancreatography (ERCP) in daily practice. Although the majority of stones are small and can be easily removed in a single endoscopy session, approximately 10\u201315% of patients have complex biliary stones, requiring additional procedures for an optimum clinical outcome. A plethora of endoscopic methods is available for the removal of difficult biliary stones, including papillary large balloon dilation, mechanical lithotripsy, and electrohydraulic and laser lithotripsy. In-depth knowledge of these techniques and the emerging literature on them is required to yield the most optimal therapeutic effects. This narrative review aims to describe the definition of difficult bile duct stones based on certain characteristics and streamline their endoscopic retrieval using various modalities to achieve higher clearance rates.<\/jats:p>","DOI":"10.3390\/medicina60020340","type":"journal-article","created":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T11:23:57Z","timestamp":1708341837000},"page":"340","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Endoscopic Management of Difficult Biliary Stones: An Evergreen Issue"],"prefix":"10.3390","volume":"60","author":[{"given":"Magdalini","family":"Manti","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, \u201cKonstantopoulio-Patision\u201d General Hospital of Nea Ionia, 14233 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimil","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3563-4973","authenticated-orcid":false,"given":"Apostolis","family":"Papaefthymiou","sequence":"additional","affiliation":[{"name":"Endoscopy Unit, Cleveland Clinic London, London SW1X 7HY, UK"},{"name":"Department of Gastroenterology, General University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2107-2156","authenticated-orcid":false,"given":"Antonio","family":"Facciorusso","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Medical Sciences, University of Foggia, 00161 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daryl","family":"Ramai","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2945-6007","authenticated-orcid":false,"given":"Georgios","family":"Tziatzios","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, \u201cKonstantopoulio-Patision\u201d General Hospital of Nea Ionia, 14233 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1277-6362","authenticated-orcid":false,"given":"Vasilios","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, General University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantina","family":"Paraskeva","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, \u201cKonstantopoulio-Patision\u201d General Hospital of Nea Ionia, 14233 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7368-6168","authenticated-orcid":false,"given":"Ioannis S.","family":"Papanikolaou","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology Unit, Second Department of Internal Medicine\u2014Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5183-9426","authenticated-orcid":false,"given":"Konstantinos","family":"Triantafyllou","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology Unit, Second Department of Internal Medicine\u2014Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Arvanitakis","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, University Hospital of Brussels (HUB), 1070 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3979-9553","authenticated-orcid":false,"given":"Livia","family":"Archibugi","sequence":"additional","affiliation":[{"name":"Pancreato-Biliary Endoscopy and Endosonography Division, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7280-1761","authenticated-orcid":false,"given":"Giuseppe","family":"Vanella","sequence":"additional","affiliation":[{"name":"Pancreato-Biliary Endoscopy and Endosonography Division, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2654-3164","authenticated-orcid":false,"given":"Marcus","family":"Hollenbach","sequence":"additional","affiliation":[{"name":"Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, D-04103 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9677-4013","authenticated-orcid":false,"given":"Paraskevas","family":"Gkolfakis","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, \u201cKonstantopoulio-Patision\u201d General Hospital of Nea Ionia, 14233 Athens, Greece"},{"name":"Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, University Hospital of Brussels (HUB), 1070 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,19]]},"reference":[{"key":"ref_1","unstructured":"Tanaja, J., Lopez, R.A., and Meer, J.M. (2023, November 30). Cholelithiasis, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470440\/."},{"key":"ref_2","unstructured":"McNicoll, C.F., Pastorino, A., Farooq, U., Froehlich, M.J., and St. Hill, S.R. (2023, November 30). Choledocholithiasis, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441961\/."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1055\/a-0862-0346","article-title":"Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline","volume":"51","author":"Manes","year":"2019","journal-title":"Endoscopy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1136\/gutjnl-2016-312317","article-title":"Updated guideline on the management of common bile duct stones (CBDS)","volume":"66","author":"Williams","year":"2017","journal-title":"Gut"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.gie.2018.10.001","article-title":"ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis","volume":"89","author":"Buxbaum","year":"2019","journal-title":"Gastrointest. Endosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s11894-018-0613-1","article-title":"Endoscopic Management of Difficult Bile Duct Stones","volume":"20","author":"Aburajab","year":"2018","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Troncone, E., Mossa, M., De Vico, P., Monteleone, G., and Blanco, G.D.V. (2022). Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques. Medicina, 58.","DOI":"10.3390\/medicina58010120"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4195","DOI":"10.1007\/s10620-021-07305-7","article-title":"Factors Influencing Performance of Cholangioscopy-Guided Lithotripsy Including Available Different Technologies: A Prospective Multicenter Study with 94 Patients","volume":"67","author":"Alexandrino","year":"2022","journal-title":"Dig. Dis. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1080\/00365521.2018.1441434","article-title":"Advanced ERCP techniques for the extraction of complex biliary stones: A single referral center\u2019s 12-year experience","volume":"53","author":"Brown","year":"2018","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1038\/nrgastro.2014.76","article-title":"Advances in the endoscopic management of common bile duct stones","volume":"11","author":"Trikudanathan","year":"2014","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"63","DOI":"10.4253\/wjge.v14.i2.63","article-title":"Peroral cholangioscopy: Update on the state-of-the-art","volume":"14","author":"Subhash","year":"2022","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1007\/s00464-018-6317-7","article-title":"The ASGE grading system for ERCP can predict success and complication rates in a tertiary referral hospital","volume":"33","author":"Sahar","year":"2019","journal-title":"Surg. Endosc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1111\/den.12118","article-title":"Recent advances in endoscopic management of difficult bile duct stones","volume":"25","author":"Yasuda","year":"2013","journal-title":"Dig. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1055\/a-1547-2282","article-title":"Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update","volume":"53","author":"Veitch","year":"2021","journal-title":"Endoscopy"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/S0016-5107(74)73914-1","article-title":"Endoscopic sphincterotomy of the ampulla of Vater","volume":"20","author":"Kawai","year":"1974","journal-title":"Gastrointest. Endosc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.12998\/wjcc.v6.i16.1073","article-title":"Biliary endoscopic sphincterotomy: Techniques and complications","volume":"6","author":"Eminler","year":"2018","journal-title":"World J. Clin. Cases"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1055\/s-0043-114411","article-title":"Complete endoscopic sphincterotomy with vs. without large-balloon dilation for the removal of large bile duct stones: Randomized multicenter study","volume":"49","author":"Karsenti","year":"2017","journal-title":"Endoscopy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"167","DOI":"10.4253\/wjge.v4.i5.167","article-title":"Endoscopic extraction of large common bile duct stones: A review article","volume":"4","author":"Stefanidis","year":"2012","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8258","DOI":"10.3748\/wjg.v19.i45.8258","article-title":"Endoscopic papillary balloon dilation: Revival of the old technique","volume":"19","author":"Jeong","year":"2013","journal-title":"World J. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1055\/s-0042-108641","article-title":"Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline","volume":"48","author":"Testoni","year":"2016","journal-title":"Endoscopy"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1016\/j.cgh.2017.05.049","article-title":"Comparable Long-term Outcomes of 1-Minute vs. 5-Minute Endoscopic Papillary Balloon Dilation for Bile Duct Stones","volume":"15","author":"Kuo","year":"2017","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Chou, C.-K., Lee, K.-C., Luo, J.-C., Chen, T.-S., Perng, C.-L., Huang, Y.-H., Lin, H.-C., and Hou, M.-C. (2020). Endoscopic papillary balloon dilatation less than three minutes for biliary stone removal increases the risk of post-ERCP pancreatitis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0233388"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Niwa, H., Tajiri, H., Nakajima, M., and Yasuda, K. (2008). New Challenges in Gastrointestinal Endoscopy, Springer. Available online: http:\/\/link.springer.com\/10.1007\/978-4-431-78889-8_39.","DOI":"10.1007\/978-4-431-78889-8"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1111\/j.1572-0241.2004.30151.x","article-title":"Endoscopic Balloon Dilation of the Biliary Sphincter Compared to Endoscopic Biliary Sphincterotomy for Removal of Common Bile Duct Stones During ERCP: A Meta-analysis of Randomized, Controlled Trials","volume":"99","author":"Baron","year":"2004","journal-title":"Am. J. Gastroenterol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/j.1440-1746.2011.06912.x","article-title":"Endoscopic papillary balloon dilatation versus endoscopic sphincterotomy in the treatment for choledocholithiasis: A meta-analysis","volume":"27","author":"Liu","year":"2012","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_26","first-page":"CD004890","article-title":"Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones","volume":"2010","author":"Weinberg","year":"2006","journal-title":"Emergencias"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1055\/a-0848-8271","article-title":"Sphincterotomy plus balloon dilation versus sphincterotomy alone for choledocholithiasis: A meta-analysis","volume":"51","author":"Dong","year":"2019","journal-title":"Endoscopy"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/den.13029","article-title":"Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation","volume":"30","author":"Itoi","year":"2018","journal-title":"Dig. Endosc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"5909","DOI":"10.3748\/wjg.v22.i26.5909","article-title":"Is endoscopic papillary balloon dilatation really a risk factor for post-ERCP pancreatitis?","volume":"22","author":"Fujisawa","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"8580","DOI":"10.3748\/wjg.v19.i46.8580","article-title":"Endoscopic papillary large balloon dilation for the removal of bile duct stones","volume":"19","author":"Kim","year":"2013","journal-title":"World J. Gastroenterol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Chiu, Y.-C., Liang, C.-M., Wu, C.-K., Lu, L.-S., Tai, W.-C., Kuo, Y.-H., Wu, K.-L., Chuah, S.-K., and Kuo, C.-H. (2019). The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon dilation for removal of large bile duct stones. BMC Gastroenterol., 19.","DOI":"10.1186\/s12876-019-1017-x"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1055\/a-1145-3377","article-title":"Multicenter randomized trial of endoscopic papillary large balloon dilation without sphincterotomy versus endoscopic sphincterotomy for removal of bile duct stones: MARVELOUS trial","volume":"52","author":"Kogure","year":"2020","journal-title":"Endoscopy"},{"key":"ref_33","first-page":"125","article-title":"Comparison of endoscopic papillary large balloon dilation with or without endoscopic sphincterotomy for the treatment of large bile duct stones","volume":"51","author":"Park","year":"2018","journal-title":"Endoscopy"},{"key":"ref_34","first-page":"2607","article-title":"A Preliminary Comparison of Endoscopic Sphincterotomy, Endoscopic Papillary Large Balloon Dilation, and Combination of the Two in Endoscopic Choledocholithiasis Treatment","volume":"21","author":"Guo","year":"2015","journal-title":"J. Pharmacol. Exp. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"91","DOI":"10.2147\/TCRM.S182615","article-title":"Comparison of endoscopic papillary large balloon dilation with and without a prior endoscopic sphincterotomy for the treatment of patients with large and\/or multiple common bile duct stones: A systematic review and meta-analysis","volume":"15","author":"Liu","year":"2019","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/den.13001","article-title":"Japan Gastroenterological Endoscopy Society guidelines for endoscopic sphincterotomy","volume":"30","author":"Ryozawa","year":"2018","journal-title":"Dig. Endosc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.gie.2017.07.038","article-title":"Comparative efficacy of various endoscopic techniques for the treatment of common bile duct stones: A network meta-analysis","volume":"87","author":"Park","year":"2018","journal-title":"Gastrointest. Endosc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S2468-1253(19)30075-5","article-title":"Optimal dilation time for combined small endoscopic sphincterotomy and balloon dilation for common bile duct stones: A multicentre, single-blinded, randomised controlled trial","volume":"4","author":"Meng","year":"2019","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1007\/s10620-010-1438-4","article-title":"The Increase in Balloon Size to Over 15 mm Does Not Affect the Development of Pancreatitis After Endoscopic Papillary Large Balloon Dilatation for Bile Duct Stone Removal","volume":"56","author":"Youn","year":"2011","journal-title":"Dig. Dis. Sci."},{"key":"ref_40","unstructured":"Omnimed (2023, November 30). Retrieval Baskets & Nets. Available online: https:\/\/www.omnimed.co.uk\/products\/retrieval-baskets-nets."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1159\/000534458","article-title":"Comparison of Outcomes between a Basket Catheter and a Balloon Catheter for Endoscopic Common Bile Duct Stone Removal","volume":"42","author":"Saito","year":"2023","journal-title":"Dig. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"E1447","DOI":"10.1055\/a-1905-0251","article-title":"Outcomes of balloon vs basket catheter for clearance of choledocholithiasis: A systematic review and meta-analysis","volume":"10","author":"Sharma","year":"2022","journal-title":"Endosc. Int. Open"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1007\/s12664-023-01396-y","article-title":"Comparison of the mechanical properties of retrieval basket catheters for bile duct stones: An experimental study","volume":"42","author":"Inoue","year":"2023","journal-title":"Indian J. Gastroenterol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"7597","DOI":"10.3748\/wjg.v27.i44.7597","article-title":"Endoscopic management of difficult common bile duct stones: Where are we now? A comprehensive review","volume":"27","author":"Tringali","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.vgie.2018.07.010","article-title":"Biliary and pancreatic lithotripsy devices","volume":"3","author":"Watson","year":"2018","journal-title":"VideoGIE"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"593","DOI":"10.3748\/wjg.v11.i4.593","article-title":"Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones","volume":"11","author":"Chang","year":"2004","journal-title":"World J. Gastroenterol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1089\/lap.2023.0274","article-title":"Addition of Mechanical Lithotripsy to Endoscopic Papillary Large Balloon Dilation in Patients with Difficult Common Bile Duct Stones: A Retrospective Single-Center Study","volume":"33","author":"Kamezaki","year":"2023","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e150","DOI":"10.1097\/MCG.0000000000001000","article-title":"Large Balloon Dilatation Versus Mechanical Lithotripsy After Endoscopic Sphincterotomy in the Management of Large Common Bile Duct Stones in Cirrhotic Patients: A Randomized Study","volume":"53","author":"Radwan","year":"2019","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_49","unstructured":"Narula, V.K., Fung, E.C., Overby, D.W., Richardson, W., Stefanidis, D., and SAGES Guidelines Committee (2023, November 30). Clinical Spotlight Review: Management of Choledocholithiasis. Available online: https:\/\/www.sages.org\/publications\/guidelines\/clinical-spotlight-review-management-of-choledocholithiasis\/."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"4950","DOI":"10.3748\/wjg.v23.i27.4950","article-title":"Outcome of a session of extracorporeal shock wave lithotripsy before endoscopic retrograde cholangiopancreatography for problematic and large common bile duct stones","volume":"23","author":"Tao","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"556","DOI":"10.5946\/ce.2019.011","article-title":"The Role of Peroral Cholangioscopy in Evaluating Indeterminate Biliary Strictures","volume":"52","author":"Parsa","year":"2019","journal-title":"Clin. Endosc."},{"key":"ref_52","first-page":"469","article-title":"The SpyGlass\u00ae Direct Visualization System for Cholangioscopy","volume":"4","author":"Draganov","year":"2008","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.hpb.2017.09.002","article-title":"\u201cApple Far from the Tree\u201d: Comparative effectiveness of fiberoptic single-operator cholangiopancreatoscopy (FSOCP) and digital SOCP (DSOCP)","volume":"20","author":"Mizrahi","year":"2018","journal-title":"HPB"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2","DOI":"10.18528\/gii160035","article-title":"The role and utility of cholangioscopy for diagnosing indeterminate biliary strictures","volume":"6","author":"Thaker","year":"2017","journal-title":"Int. J. Gastrointest. Interv."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Yang, J.-J., Liu, X.-C., Chen, X.-Q., Zhang, Q.-Y., and Liu, T.-R. (2019). Clinical value of DPOC for detecting and removing residual common bile duct stones (video). BMC Gastroenterol., 19.","DOI":"10.1186\/s12876-019-1045-6"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Sliney, D.H., and Trokel, S.L. (1993). Medical Lasers and Their Safe Use, Springer Science and Business Media LLC.","DOI":"10.1007\/978-1-4613-9252-1"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.gie.2013.07.054","article-title":"Holmium-yttrium aluminum garnet laser lithotripsy in the treatment of biliary calculi using single-operator cholangioscopy: A multicenter experience (with video)","volume":"79","author":"Patel","year":"2014","journal-title":"Gastrointest. Endosc."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/S0016-5107(80)73252-2","article-title":"Endoscopic lithotripsy in the common bile duct","volume":"26","author":"Koch","year":"1980","journal-title":"Gastrointest. Endosc."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/BF00187883","article-title":"Evaluation of the shock-wave pattern for endoscopic electrohydraulic lithotripsy","volume":"9","author":"Vorreuther","year":"1995","journal-title":"Surg. Endosc."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"457","DOI":"10.5009\/gnl17352","article-title":"Electrohydraulic Lithotripsy for Difficult Bile Duct Stones under Endoscopic Retrograde Cholangiopancreatography and Peroral Transluminal Cholangioscopy Guidance","volume":"12","author":"Kamiyama","year":"2018","journal-title":"Gut Liver"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/j.gie.2017.08.021","article-title":"Randomized trial of cholangioscopy-guided laser lithotripsy versus conventional therapy for large bile duct stones (with videos)","volume":"87","author":"Buxbaum","year":"2018","journal-title":"Gastrointest. Endosc."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1016\/j.cgh.2020.02.003","article-title":"Efficacy of Single-Operator Cholangioscopy-Guided Lithotripsy Compared with Large Balloon Sphincteroplasty in Management of Difficult Bile Duct Stones in a Randomized Trial","volume":"18","author":"Bang","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1055\/a-0848-8373","article-title":"Digital cholangioscopy-guided laser versus mechanical lithotripsy for large bile duct stone removal after failed papillary large-balloon dilation: A randomized study","volume":"51","author":"Angsuwatcharakon","year":"2019","journal-title":"Endoscopy"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"3981","DOI":"10.1007\/s00464-018-6141-0","article-title":"Diagnostic and therapeutic single-operator cholangiopancreatoscopy with SpyGlassDSTM: Results of a multicenter retrospective cohort study","volume":"32","author":"Turowski","year":"2018","journal-title":"Surg. Endosc."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1016\/j.dld.2022.04.019","article-title":"Digital single-operator cholangioscopy in diagnostic and therapeutic bilio-pancreatic diseases: A prospective, multicenter study","volume":"54","author":"Fugazza","year":"2022","journal-title":"Dig. Liver Dis."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1055\/a-1200-8064","article-title":"Efficacy and safety of peroral cholangioscopy with intraductal lithotripsy for difficult biliary stones: A systematic review and meta-analysis","volume":"53","author":"McCarty","year":"2021","journal-title":"Endoscopy"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/j.cgh.2017.10.017","article-title":"Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones","volume":"16","author":"Gutierrez","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.cgh.2021.10.013","article-title":"Endoscopic Treatment of Large Bile Duct Stones: A Systematic Review and Network Meta-Analysis","volume":"21","author":"Facciorusso","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1055\/a-1850-6717","article-title":"An artificial intelligence difficulty scoring system for stone removal during ERCP: A prospective validation","volume":"55","author":"Huang","year":"2023","journal-title":"Endoscopy"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1053\/j.gastro.2012.10.027","article-title":"Randomized Trial of Endoscopic Sphincterotomy with Balloon Dilation Versus Endoscopic Sphincterotomy Alone for Removal of Bile Duct Stones","volume":"144","author":"Teoh","year":"2013","journal-title":"Gastroenterology"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"438","DOI":"10.5009\/gnl.2014.8.4.438","article-title":"Which Is the Better Treatment for the Removal of Large Biliary Stones? Endoscopic Papillary Large Balloon Dilation versus Endoscopic Sphincterotomy","volume":"8","author":"Paik","year":"2014","journal-title":"Gut Liver"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/00004836-200603000-00008","article-title":"Clearance of Irretrievable Bile Duct and Pancreatic Duct Stones by Extracorporeal Shockwave Lithotripsy, Using a Transportable Device: Effectiveness and Medium-term Results","volume":"40","author":"Conigliaro","year":"2006","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"175628482110313","DOI":"10.1177\/17562848211031388","article-title":"Early cholangioscopy-assisted electrohydraulic lithotripsy in difficult biliary stones is cost-effective","volume":"14","author":"Alrajhi","year":"2021","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1055\/s-0043-121268","article-title":"The economic impact of using single-operator cholangioscopy for the treatment of difficult bile duct stones and diagnosis of indeterminate bile duct strictures","volume":"50","author":"Deprez","year":"2018","journal-title":"Endoscopy"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"E1193","DOI":"10.1055\/a-1873-0884","article-title":"Cost-effective analysis of preliminary single-operator cholangioscopy for management of difficult biliary stones","volume":"10","author":"Sljivic","year":"2022","journal-title":"Endosc. Int. Open"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1055\/s-0034-1377875","article-title":"Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline\u2014Updated June 2014","volume":"46","author":"Dumonceau","year":"2014","journal-title":"Endoscopy"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"E459","DOI":"10.1055\/a-1167-0904","article-title":"Broken handle cord of impacted biliary basket\u2014Rescue by cholangioscopy with laser lithotripsy","volume":"52","author":"Bokun","year":"2020","journal-title":"Endoscopy"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.vgie.2017.12.011","article-title":"Cholangioscopy-guided holmium laser lithotripsy of a stone trapped in a mechanical lithotripter","volume":"3","author":"Giestas","year":"2018","journal-title":"VideoGIE"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"235","DOI":"10.3904\/kjim.2020.425","article-title":"Recent advances in the management of difficult bile-duct stones: A focus on single-operator cholangioscopy-guided lithotripsy","volume":"36","author":"Oh","year":"2021","journal-title":"Korean J. Intern. Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"E263","DOI":"10.1055\/s-0042-100194","article-title":"The efficacy of peroral cholangioscopy for difficult bile duct stones and indeterminate strictures: A systematic review and meta-analysis","volume":"4","author":"Korrapati","year":"2016","journal-title":"Endosc. Int. Open"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"e14912020","DOI":"10.1590\/0102-672020190001e1491","article-title":"Cholangioscopy-guided lithotripsy vs. conventional therapy for complex bile duct stones: A systematic review and meta-analysis","volume":"33","author":"Galetti","year":"2020","journal-title":"ABCD Arq. Bras. Cir. Dig."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1016\/j.gie.2017.12.024","article-title":"Spiral enteroscopy-assisted ERCP in bariatric-length Roux-en-Y anatomy: A large single-center series and review of the literature (with video)","volume":"87","author":"Ali","year":"2018","journal-title":"Gastrointest. Endosc."},{"key":"ref_83","first-page":"929","article-title":"Single-balloon enteroscopy-assisted ERCP in patients with Roux-en-Y anatomy and choledocholithiasis: Do technical improvements mean better outcomes?","volume":"112","year":"2020","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1053\/j.gastro.2014.05.045","article-title":"Internal EUS-Directed Transgastric ERCP (EDGE): Game Over","volume":"147","author":"Kedia","year":"2014","journal-title":"Gastroenterology"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s11695-018-3531-2","article-title":"Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE): A Single-Center US Experience with Follow-up Data on Fistula Closure","volume":"29","author":"James","year":"2019","journal-title":"Obes. Surg."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"E163","DOI":"10.1055\/a-1067-4411","article-title":"EDGE in Roux-en-Y gastric bypass: How does it compare to laparoscopy-assisted and balloon enteroscopy ERCP: A systematic review and meta-analysis","volume":"8","author":"Dhindsa","year":"2020","journal-title":"Endosc. Int. Open"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.gie.2023.09.001","article-title":"ERCP using balloon-assisted endoscopes versus EUS-guided treatment for common bile duct stones in Roux-en-Y gastrectomy","volume":"99","author":"Sato","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1055\/a-1022-4453","article-title":"Endoscopic ultrasound-guided gastrojejunostomy-assisted ERCP in a Billroth II gastrectomy patient","volume":"52","author":"Casellas","year":"2020","journal-title":"Endoscopy"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1111\/den.13053","article-title":"Peroral cholangioscopy-guided laser lithotripsy to treat regional hepatolithiasis without stricture","volume":"30","author":"Liu","year":"2018","journal-title":"Dig. Endosc."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.gastrohep.2019.11.008","article-title":"New management of hepatolithiasis: Can surgery be avoided? (with video)","volume":"43","year":"2020","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.diii.2019.05.007","article-title":"Percutaneous transhepatic Laser lithotripsy for intrahepatic cholelithiasis","volume":"100","author":"Lamanna","year":"2019","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1055\/a-0659-9864","article-title":"Endoscopic biliary stenting: Indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline\u2014Updated October 2017","volume":"50","author":"Dumonceau","year":"2018","journal-title":"Endoscopy"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1136\/flgastro-2015-100566","article-title":"Endoscopic biliary stenting in irretrievable common bile duct stones: Stent exchange or expectant management\u2014Tertiary-centre experience and systematic review","volume":"7","author":"Mohammed","year":"2016","journal-title":"Front. Gastroenterol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"505","DOI":"10.4103\/ejs.ejs_167_19","article-title":"Role of biliary stenting for large impacted stone in common bile duct","volume":"39","author":"Omar","year":"2020","journal-title":"Egypt. J. Surg."},{"key":"ref_95","unstructured":"Young, M., and Mehta, D. (2023, November 30). Percutaneous Transhepatic Cholangiogram, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK493190\/."},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Ierardi, A.M., Rod\u00e0, G.M., Di Meglio, L., Pellegrino, G., Cant\u00f9, P., Dondossola, D., Rossi, G., and Carrafiello, G. (2021). Percutaneous Transhepatic Electrohydraulic Lithotripsy for the Treatment of Difficult Bile Stones. J. Clin. Med., 10.","DOI":"10.3390\/jcm10071372"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/2\/340\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:02:05Z","timestamp":1760104925000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/2\/340"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,19]]},"references-count":96,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["medicina60020340"],"URL":"https:\/\/doi.org\/10.3390\/medicina60020340","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,19]]}}}