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Phonthep Angsuwatcharakon 2 Articles
Cracking Difficult Biliary Stones
Phonthep Angsuwatcharakon, Rungsun Rerknimitr
Clin Endosc 2021;54(5):660-668.   Published online March 16, 2021
AbstractAbstract PDFPubReaderePub
Apart from difficult biliary cannulation, biliary stone removal is considered one of the hurdles in endoscopic retrograde cholangiopancreatography. Generally, simple common bile duct (CBD) stones can be removed either with an extraction balloon or a basket. However, there are difficult stones that cannot be removed using these standard methods. The most difficult stones are large CBD stones and impacted stones in a tapering CBD. A few decades ago, mechanical lithotripsy was usually required to manage these stones. At present, endoscopic papillary large balloon dilation (EPLBD) of the biliary orifice has become the gold standard for large CBD stones up to 1.5 cm. EPLBD can reduce the procedural time by shortening the stone removal process. It can also save the cost of the devices, especially multiple baskets, used in mechanical lithotripsy. Unfortunately, very large CBD stones, stones impacted in a tapering CBD, and some intrahepatic duct stones still require lithotripsy. Peroral cholangioscopy provides direct visualization of the stone, which helps the endoscopist perform a probe-based lithotripsy either with an electrohydraulic probe or a laser probe. This technique can facilitate the management of difficult CBD stones with a high success rate and save procedural time without significant technical complications.


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  • Endoscopic Treatment of Large Bile Duct Stones: A Systematic Review and Network Meta-Analysis
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    Clinical Gastroenterology and Hepatology.2023; 21(1): 33.     CrossRef
  • First experience of endoscopic treatment of large biliary stones by contact lithotripsy
    L.L. Generdukayev, D.A. Blagovestnov, Yu.S. Teterin, P.A. Yartsev
    Endoskopicheskaya khirurgiya.2023; 29(2): 51.     CrossRef
  • Percutaneous transhepatic cholangioscopy for benign and malignant biliary disease using a novel short single-operator cholangioscope
    A. K. Uribe Rivera, B. Seeliger, C. A. Saldivar, E. Houghton, F. Rodríguez, P. Acquafresca, M. Palermo, M. E. Giménez
    Surgical Endoscopy.2023; 37(10): 7774.     CrossRef
  • Outcomes of balloon vs basket catheter for clearance of choledocholithiasis: a systematic review and meta-analysis
    Ruchi Sharma, Vikram Sharma, Umang Singhal, Madhusudhan Sanaka
    Endoscopy International Open.2022; 10(11): E1447.     CrossRef
  • 4,751 View
  • 212 Download
  • 3 Web of Science
  • 5 Crossref
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Unfortunately, a “Back Light System” As a Global Positioning System Failed to Guide the Route in 25-G Fine-Needle Aspiration
Rungsun Rerknimitr, Phonthep Angsuwatcharakon
Clin Endosc 2019;52(4):295-296.   Published online July 30, 2019


Citations to this article as recorded by  
  • The Association of “GOOP” on Gross Examination of Fine Needle Aspiration Samples and On-Site Adequacy
    Nikhil Meena, Thaddeus Bartter, Roshen Mathew, Abhishek Kumar, Winnie Elma Roy, Sunil Kumar Kakadia, Maggie Machiarella
    Respiration.2022; 101(1): 63.     CrossRef
  • 3,884 View
  • 66 Download
  • 1 Web of Science
  • 1 Crossref
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