Current endoscopic strategies for managing large bile duct stones

Common bile duct stones are a relatively common occurrence and can often lead to devastating complications. Endoscopic retrograde cholangiopancreatography was introduced in the 1970s for management of common bile duct stones. Most common bile duct stones can be removed with simple techniques such as endoscopic sphincterotomy and balloon trawling. However, large bile duct stones continue to pose some difficulty in achieving complete extraction. In this article, we will review some of the established techniques such as the use of endoscopic papillary large balloon dilatation, mechanical lithotripsy, and cholangioscopy-assisted techniques. We will look at the recent literature to help clarify the particular methods and answer some of the questions surrounding these methods.