Management of complicated biliary stones using spyglass ds per-oral cholangioscopy-guided laser lithotripsy

Here we report a video-case of an 88-year-old woman referred to our unit because of cholangitis in cholecysto-choledochal lithiasis, deemed unfit for surgery (cholecystectomy) due to severe co-morbidities. Endoscopic retrograde cholangiography (ERC) (TJF-160VR; Olympus Co., Tokyo, Japan), performed under deep sedation with anesthesiological assistance, showed severe dilation of biliary tree with a voluminous stone (about 35 mm) impacted in the common hepatic duct. The endoscopic approach was challenging because of the site, the size of the stone and the overall biliary tree dilation. In fact, because of similar dilation of cystic and common bile duct, it was quite difficult to reach the common hepatic duct.