• Magdalini Manti, Jimil Shah, Apostolis Papaefthymiou, Antonio Facciorusso, Daryl Ramai, Georgios Tziatzios, Vasilios Papadopoulos, Konstantina Paraskeva, Ioannis S Papanikolaou, Konstantinos Triantafyllou, Marianna Arvanitakis, Livia Archibugi, Giuseppe Vanella, Marcus Hollenbach, and Paraskevas Gkolfakis.
• Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, 14233 Athens, Greece.
• Medicina (Kaunas). 2024 Feb 19; 60 (2).

AbstractCholedocholithiasis is one of the most common indications for endoscopic retrograde cholangiopancreatography (ERCP) in daily practice. Although the majority of stones are small and can be easily removed in a single endoscopy session, approximately 10-15% of patients have complex biliary stones, requiring additional procedures for an optimum clinical outcome. A plethora of endoscopic methods is available for the removal of difficult biliary stones, including papillary large balloon dilation, mechanical lithotripsy, and electrohydraulic and laser lithotripsy. In-depth knowledge of these techniques and the emerging literature on them is required to yield the most optimal therapeutic effects. This narrative review aims to describe the definition of difficult bile duct stones based on certain characteristics and streamline their endoscopic retrieval using various modalities to achieve higher clearance rates.

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