Abstract：
Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or patient\'s needs could make the stone extraction with the standard techniques difficult. Traditionally, mechanical lithotripsy with baskets has been reported as a safe and effective technique to achieve stone clearance. More recently, the increasing use of endoscopic papillary large balloon dilation and the diffusion of single-operator cholangioscopy with laser or electrohydraulic lithotripsy have brought new, safe, and effective therapeutic possibilities to the management of such challenging cases. We here summarize the available evidence about the endoscopic management of difficult common bile duct stones and discuss current indications of different lithotripsy techniques.
摘要：
胆道结石是治疗性内镜逆行胰胆管造影术的最常见适应症。许多病例通过胆道括约肌切开术和球囊或篮式导管拔除结石成功治疗。然而,更复杂的条件仅次于石头的特定特征，胆道,或患者的需求可能会使使用标准技术的结石提取困难。传统上,据报道，篮式机械碎石术是一种安全有效的结石清除技术。最近,内镜下乳头状大球囊扩张术和单操作胆道镜与激光或液压电液碎石术的扩散术的越来越多的使用带来了新的，安全,以及管理此类具有挑战性的病例的有效治疗可能性。我们在这里总结了有关内镜下治疗困难的胆总管结石的现有证据，并讨论了不同碎石技术的当前适应症。
