• Edoardo Troncone, Michelangela Mossa, Pasquale De Vico, Giovanni Monteleone, and Giovanna Del Vecchio Blanco.
• Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
• Medicina (Kaunas). 2022 Jan 13; 58 (1).

AbstractBiliary 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.

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