Abstract
Endoscopic mechanical lithotripsy has become a popular form of treatment in managing large bile duct stones and its success rate is just over or below 90%. Biliary stones which cannot be crushed by using mechanical lithotripsy are called as“difficult-to-treat-stone”; many of these are huge stones or impacted stones. Extracorporeal shock-wave lithotripsy is an alternative to difficult-to-treat-stones, and its success rate is comparable to intracorooreal lithotripsy. However, it needs many number of lithotripsy-sessions and endoscopic assistance. On the other hand. intracorooreal lithotripsy containing electrohydraulic lithotripsy and laser lithotripsy could be performed under x-ray fluoroscopic or cholangioscopic guidance. Although intracorporeal lithotripsy under strict cholangioscopic guidance is considered as a safe and efficient method, it has technical difficulties to manipulate cholangioscope. Furthermore, it is expected that a new peroral cholangioscope will have longer durability of optical images and better manipulation than previous scopes.
