Difficult Stones in the Common Bile Duct Successfully Treated by Electrohydraulic Lithotripsy using a Double Lumen Balloon Catheter and Rotating Hemostatic Valve under 180 Degree Revolving X-ray System.

The effectiveness of electrohydraulic lithotripsy (EHL) for stones in the common bile duct (CBD) is well established. It is recommended that the procedure is performed under cholangioscopic control for correct positioning of the probe onto the surface of the stones and prevention of complications arising from contact between the tip of the probe and biliary mucosa. However problems are encountered if insertion of the babyscope into the bile duct is not successful particularly in the presence of duct stenosis or technical difficulties, or when the mother-baby system can not be prepared. For the latter reason, large difficult stones in the CBD were treated by EHL using a double lumen balloon catheter and rotating hemostatic valve (EHLB) under 180 degree revolving X-ray system. The tip of the EHL probe was placed at 2-3 mm out of the balloon catheter, which was used to avoid contact between the tip of the probe and mucosa of the CBD under fluoroscopic control. Rotating hemostatic valve was used to allow examination of the effect of EHL without changing the catheter or pulling out the probe during operation. After endoscopic sphincterotomy, the device was delivered close to the surface of the stone under fluoroscopic guidance. After inflation of the balloon, we confirmed that the tip of the device was set at almost the center of the CBD by 180 degree revolving X-ray system. Partial fragmentation and complete removal of the stones was achieved by combined treatment including EHLB, basket or balloon catheter for stone extraction. There were no serious procedure-related complications