Endoscopic removal of large common bile duct stones in recurrent pyogenic cholangitis

It is not uncommon to find large stones obstructing the bile duct in patients with recurrent pyogenic cholangitis. In a series of 291 patients with cholangitis, 32 patients had stones more than 2 cm in diameter. Endoscopic extraction using a combination of large baskets, 1% EDTA flushing, and manual or mechanical lithotripsy allowed the common bile duct to be cleared in 50% of patients. Lack of space in the common bile duct to open the retrieval basket because of stone impaction was the major reason for failure.