ERCP for Large CBD Stones

ERCP for large CBD stones.

Patient: 75 years old, underwent laparoscopic cholecystectomy 10 years ago. 

Presenting Symptoms: Abdominal pain and abnormal liver function tests. 

Imaging: MRI revealed two CBD stones measuring 10 mm and 15 mm. 

Required Devices: - Sphincterotome and guidewire 

- Extraction balloon (12–15 mm) 

- Biliary balloon dilatation (15–18 mm)

- Biliary plastic stent 

Procedure: During ERCP, inspection identified a Type 3 bulging intra-diverticular papilla. This allowed for a large sphincterotomy without the need for extensive balloon dilatation. Stone extraction was performed with ease. 

Key Tip: Always maintain the guidewire in place while extracting stones with the balloon. If a stone becomes lodged in the papilla, the guidewire allows for easy repositioning.