Gel immersion transpapillary stone removal for recurrent choledocholithiasis

Gel immersion transpapillary stone removal for recurrent choledocholithiasisEndoscopic retrograde cholangiopancreatography (ERCP)-guided stone removal using a balloon catheter is a promising approach for patients with small choledocholithiasis (diameter: 10 mm [1, 2]).The recurrence of choledocholithiasis significantly increases in patients with certain characteristics, such as dilated common bile duct (CBD), advanced age, history of cholecystectomy, and multiple stones [3].However, data on endoscopic strategies for the frequent recurrence of choledocholithiasis, debris, or sludge formation are scarce.Gel immersion endoscopy has emerged as a novel technique and has also been reported in ERCP-related procedures [4,5].Here, we report the potential of gel immersion ERCP-guided clearance for recurrent choledocholithiasis.A 94-year-old woman with a history of ERCP-guided stone removals presented with acute cholangitis due to a suspected third recurrence of choledocholithiasis. Fig. 2 Gel immersion endoscopic retrograde cholangiopancreatography (ERCP)-guided stone removal using a balloon catheter.a Cholangiography using a gel with contrast medium.b In an endoscopic view, a significant amount of the gel-stone/debris complex is removed.