Endoscopic sphincterotomy and mechanical basket lithotripsy for management of difficult common bile duct stones

Endoscopic sphincterotomy (EST) for removal of stones is a major therapeutic advance in the management of choledocholithiasis. However, this technique, using a standard Dormia basket or balloon catheters, often fails with large stones (exceeding 15mm in diameter). Mechanical basket lithotripsy (MBL) has been developed to overcome this deficiency. With recently improved devices, consisting of an entirely, i.e., one self-contained system which can be used without removing the endoscope, the overall efficacy of stone removal is more than 93%, regardless of the size of the stones. This MBL is a simple, safe, effective and inexpensive procedure in experienced hands and has emerged as the procedure of choice for endoscopic management of difficult stones.