Direct cholangioscopy combined with double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography

Figure 1 X-ray images. A: Cholangiography revealed a dilated bile duct and multiple stones piled up at the lower to middle part of the bile duct; B: Papillary dilation using a large balloon catheter; C: An ultra-slim gastroscope was introduced directly into the bile duct.

Figure 2 Endoscopic images. A: The papilla of Vater after balloon dilation; B: Cholangioscopy showed multiple stones inside the bile duct; C, D: The stones were all removed with a 5-Fr basket catheter under direct visual control.

Figure 3 Cholangiography. A smaller stone located distally was extracted with a basket catheter. Another stone was impacted inside the bile duct (arrow).

Figure 4 Direct cholangioscopy with an ultra-slim gastroscope. A: Cholangioscopy revealed an impacted stone inside the bile duct; B: The stone was removed with a 5-Fr basket catheter under direct visual control; C: The proximal bile duct was also investigated.

Figure 5 X-ray and endoscopic images. A: Cholangiography revealed several small stones inside the bile duct; B: The papilla of Vater after endoscopic sphincterotomy; C: The bile duct stones were extracted with a basket catheter and a retrieval balloon.

Figure 6 Direct cholangioscopy. A: An ultra-slim gastroscope was introduced directly into the bile duct after removal of bile duct stones; B: Cholangioscopy confirmed complete clearance of the duct.