Successful removal of a confluence stone from the cystic duct using electrohydraulic lithotripsy

Abstract

We report a case involving a 69-year-old woman who presented to our hospital with jaundice 2 months after cholecystectomy for a gallbladder stone. Computed tomography revealed choledocholithiasis measuring 2 cm in diameter in the distal bile duct. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and we tried to remove the bile duct stone. However, the stone could not be entrapped using a mechanical lithotriptor. We suspected that the stone was impacted at the confluence of the residual cystic duct. Therefore, we decided to crush the stone with electrohydraulic lithotripsy (EHL) using cholangioscopy. When standard endoscopic techniques for removal of impacted confluence stones fails, EHL using cholangioscopy should be considered.