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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
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Meaning of Cystoscopic Examination:Cystoscopy is an essential diagnostic tool in urology that is used to assess the structure and function of the genitourinary system. It provides a direct view of the urethra, bladder, and, in some cases, the ureteral openings. This procedure helps detect structural abnormalities, infections, cancers, and blockages in the urinary tract. There are two types of cystoscopy:Flexible cystoscopy is commonly performed in outpatient settings due to its less invasive...
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Related Experiment Video

Updated: Nov 16, 2025

Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
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Dilation assisted stone extraction for complex biliary lithiasis: Technical aspects and practical principles.

Giuseppe Grande1, Silvia Cocca2, Helga Bertani2

  • 1Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria di Modena, Modena 41126, Italy. grande.giuseppe@aou.mo.it.

World Journal of Gastrointestinal Endoscopy
|February 24, 2021
PubMed
Summary

Dilation-assisted stone extraction (DASE), combining endoscopic papillary large balloon dilation (EPLBD) and endoscopic sphincterotomy (EST), safely removes large bile duct stones. This paper offers guidance on DASE techniques and addresses challenges in outcome analysis.

Keywords:
Common bile duct stonesDifficult choledochiolithiasisDilation-assisted stone extractionEndoscopic papillary large balloon dilationEndoscopic retrograde cholangiopancreatographyMacrolithiasisStone treatment

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Area of Science:

  • Gastroenterology
  • Endoscopic procedures
  • Biliary tract interventions

Background:

  • Common bile duct stones (choledocholithiasis) are a frequent diagnosis globally, often requiring endoscopic retrograde cholangiopancreatography (ERCP).
  • Endoscopic sphincterotomy (EST) has been the standard for bile duct stone removal for decades.
  • Complicated choledocholithiasis necessitates advanced techniques beyond standard EST.

Purpose of the Study:

  • To provide technical guidance for Dilation-Assisted Stone Extraction (DASE).
  • To clarify main issues and standardize definitions for DASE.
  • To consolidate current literature and clinical experience on DASE for large bile duct stones.

Main Methods:

  • DASE combines Endoscopic Papillary Large Balloon Dilation (EPLBD) with sub-maximal EST.
  • EPLBD, used with or without EST, facilitates the passage of large or multiple stones.
  • Review of current literature and clinical experience from biliary referral centers.

Main Results:

  • DASE has been reported as safe and effective for large bile duct stones.
  • No increased risk of adverse events like pancreatitis, bleeding, or perforation observed.
  • Challenges in outcome analysis exist due to non-standardized techniques and definitions across studies.

Conclusions:

  • DASE is a valuable technique for managing large bile duct stones.
  • Standardization of DASE techniques and outcome reporting is crucial for better analysis.
  • Further research and consensus are needed to optimize DASE protocols.