Combined endoscopic sphincterotomy and percutaneous transhepatic cholangioscopic lithotripsy

Endoscopic sphincterotomy (ES) has gained worldwide acceptance as a treatment for bile duct stones. However, large stones (over 2.5 cm in diameter) have remained an indication for surgery when endoscopic lithotripsy has failed. Percutaneous transhepatic choledochoscopic lithotripsy (PTCL) has been used in Japan for the treatment of intrahepatic stones. We have employed a combined technique of ES and PTCL in the management of difficult cases previously amenable to major surgical intervention only. This technique was used successfully to treat large extrahepatic stones and intrahepatic stones, impacted basket and stone, and the medically compromised patient with choledocholithiasis.