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  • Review Article
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Advances in the endoscopic management of common bile duct stones

Nature Reviews Gastroenterology & Hepatology volume 11, pages 535–544 (2014)Cite this article

Subjects

Key Points

  • Endoscopic papillary large-balloon dilation after sphincterotomy appears to reduce complications and the need for mechanical lithotripsy during extraction of large bile duct stones; mechanical lithotripsy is the mainstay of difficult stone removal

  • Cholangioscopically directed electrohydraulic and laser lithotripsy enables fragmentation of refractory stones

  • Cholangioscopy can be performed using single-operator mother–daughter systems or by direct peroral cholangioscopy using ultraslim endoscopes

  • Percutaneous cholangioscopy enables visualization, fragmentation and removal of intrahepatic stones

  • Balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) has limited efficacy for stone removal in patients with altered surgical anatomy

  • Laparoscopic-access ERCP and percutaneous and endoscopic ultrasonography-guided access provide alternatives to ERCP for patients who have undergone Roux-en-Y gastric bypass

Abstract

Extraction of common bile duct stones by endoscopic retrograde cholangiopancreatography generally involves biliary sphincterotomy, endoscopic papillary balloon dilation or a combination of both. Endoscopic papillary large-balloon dilation after sphincterotomy has increased the safety of large stone extraction. Cholangioscopically directed electrohydraulic and laser lithotripsy using single-operator mother–daughter systems or direct peroral cholangioscopy using ultraslim endoscopes are increasingly utilized for the management of refractory stones. In this Review, we focus on advances in endoscopic approaches and techniques, with a special emphasis on management strategies for 'difficult' common bile duct stones.

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Figure 1: Pancreatic stent placement prior to endoscopic papillary balloon dilatation.
Figure 2: Difficult bile duct stones.
Figure 3: Basket mechanical lithotripsy of a large stone.
Figure 4: Endoscopic papillary large-balloon dilatation.
Figure 5: Very large stone requiring direct cholangioscopy and laser lithotripsy.
Figure 6: SpyGlass® (Boston Scientific, Natick, MA, USA) access to cystic duct stump with electrohydraulic lithotripsy of retained cystic duct stump stone.
Figure 7: Percutaneous cholangioscopy with basket and balloon extraction of intrahepatic stones above stenotic Roux-en-Y hepaticojejunostomy.

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References

  1. Classen, M. & Demling, L. Endoscopic sphincterotomy of the papilla of vater and extraction of stones from the choledochal duct [in German]. Dtsch. Med. Wochenschr. 99, 496–497 (1974).

    CAS  PubMed  Google Scholar 

  2. Kawai, K., Akasaka, Y., Murakami, K., Tada, M. & Koli, Y. Endoscopic sphincterotomy of the ampulla of vater. Gastrointest. Endosc. 20, 148–151 (1974).

    CAS  PubMed  Google Scholar 

  3. Staritz, M., Ewe, K. & Meyer zum Büschenfelde, K. H. Endoscopic papillary dilatation, a possible alternative to endoscopic papillotomy. Lancet 319, 1306–1307 (1982).

    Google Scholar 

  4. Attam, R. & Freeman, M. L. Endoscopic papillary balloon dilation for stone extraction: if, when, and for how long? Gastrointest. Endosc. 72, 1163–1166 (2010).

    PubMed  Google Scholar 

  5. Disario, J. A. et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology 127, 1291–1299 (2004).

    PubMed  Google Scholar 

  6. Fujita, N. et al. Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: a prospective randomized controlled multicenter trial. Gastrointest. Endosc. 57, 151–155 (2003).

    PubMed  Google Scholar 

  7. Liao, W.-C. et al. Randomized trial of 1-minute versus 5-minute endoscopic balloon dilation for extraction of bile duct stones. Gastrointest. Endosc. 72, 1154–1162 (2010).

    PubMed  Google Scholar 

  8. Liao, W.-C. et al. Balloon dilation with adequate duration is safer than sphincterotomy for extracting bile duct stones: a systematic review and meta-analyses. Clin. Gastroenterol. Hepatol. 10, 1101–1109 (2012).

    PubMed  Google Scholar 

  9. Freeman, M. L. Current status of endoscopic stenting of the pancreatic duct as prophylaxis against post-ERCP pancreatitis. Gastroenterol. Hepatol. 8, 618–620 (2012).

    Google Scholar 

  10. Elmunzer, B. J. et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N. Engl. J. Med. 366, 1414–1422 (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Binmoeller, K. F., Brückner, M., Thonke, F. & Soehendra, N. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy 25, 201–206 (1993).

    CAS  PubMed  Google Scholar 

  12. Trikudanathan, G., Navaneethan, U. & Parsi, M. A. Endoscopic management of difficult common bile duct stones. World J. Gastroenterol. 19, 165–173 (2013).

    PubMed  PubMed Central  Google Scholar 

  13. Kim, H. J. et al. Factors influencing the technical difficulty of endoscopic clearance of bile duct stones. Gastrointest. Endosc. 66, 1154–1160 (2007).

    PubMed  Google Scholar 

  14. Attam, R. & Freeman, M. L. Endoscopic papillary large balloon dilation for large common bile duct stones. J. Hepatobiliary. Pancreat. Surg. 16, 618–623 (2009).

    PubMed  Google Scholar 

  15. Ersoz, G., Tekesin, O., Ozutemiz, A. O. & Gunsar, F. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointest. Endosc. 57, 156–159 (2003).

    PubMed  Google Scholar 

  16. Maydeo, A. & Bhandari, S. Balloon sphincteroplasty for removing difficult bile duct stones. Endoscopy 39, 958–961 (2007).

    CAS  PubMed  Google Scholar 

  17. Minami, A., Hirose, S., Nomoto, T. & Hayakawa, S. Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy. World J. Gastroenterol. 13, 2179–2182 (2007).

    PubMed  PubMed Central  Google Scholar 

  18. Heo, J. H. et al. Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones. Gastrointest. Endosc. 66, 720–726 (2007).

    PubMed  Google Scholar 

  19. Lee, D., Lee, B., Hwhang, S., Baik, Y. & Lee, S. Endoscopic papillary large balloon dilation after endoscopic sphincterotomy for treatment of large common bile duct stone. Dig. Endosc. 19, S52–S56 (2007).

    Google Scholar 

  20. Attasaranya, S. et al. Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series. Gastrointest. Endosc. 67, 1046–1052 (2008).

    PubMed  Google Scholar 

  21. Misra, S. P. & Dwivedi, M. Large-diameter balloon dilation after endoscopic sphincterotomy for removal of difficult bile duct stones. Endoscopy 40, 209–213 (2008).

    CAS  PubMed  Google Scholar 

  22. Kim, H. G. et al. Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy. World J. Gastroenterol. 15, 4298–4304 (2009).

    PubMed  PubMed Central  Google Scholar 

  23. Draganov, P. V., Evans, W., Fazel, A. & Forsmark, C. E. Large size balloon dilation of the ampulla after biliary sphincterotomy can facilitate endoscopic extraction of difficult bile duct stones. J. Clin. Gastroenterol. 43, 782–786 (2009).

    PubMed  Google Scholar 

  24. Itoi, T. et al. Endoscopic sphincterotomy combined with large balloon dilation can reduce the procedure time and fluoroscopy time for removal of large bile duct stones. Am. J. Gastroenterol. 104, 560–565 (2009).

    PubMed  Google Scholar 

  25. Kim, T. H., Oh, H. J., Lee, J. Y. & Sohn, Y. W. Can a small endoscopic sphincterotomy plus a large-balloon dilation reduce the use of mechanical lithotripsy in patients with large bile duct stones? Surg. Endosc. 25, 3330–3337 (2011).

    PubMed  Google Scholar 

  26. Kurita, A., Maguchi, H., Takahashi, K., Katanuma, A. & Osanai, M. Large balloon dilation for the treatment of recurrent bile duct stones in patients with previous endoscopic sphincterotomy: preliminary results. Scand. J. Gastroenterol. 45, 1242–1247 (2010).

    PubMed  Google Scholar 

  27. Stefanidis, G. et al. Large balloon dilation vs. mechanical lithotripsy for the management of large bile duct stones: a prospective randomized study. Am. J. Gastroenterol. 106, 278–285 (2011).

    CAS  PubMed  Google Scholar 

  28. Rebelo, A., Ribeiro, P. M., Correia, A. P. & Cotter, J. Endoscopic papillary large balloon dilation after limited sphincterotomy for difficult biliary stones. World J. Gastrointest. Endosc. 4, 180–184 (2012).

    PubMed  PubMed Central  Google Scholar 

  29. Teoh, A. Y. B. et al. Randomized trial of endoscopic sphincterotomy with balloon dilation versus endoscopic sphincterotomy alone for removal of bile duct stones. Gastroenterology 144, 341–345. e1 (2013).

    PubMed  Google Scholar 

  30. Yang, X. M. & Hu, B. Endoscopic sphincterotomy plus large-balloon dilation vs endoscopic sphincterotomy for choledocholithiasis: a meta-analysis. World J. Gastroenterol. 19, 9453–9460 (2013).

    PubMed  PubMed Central  Google Scholar 

  31. Jeong, S. et al. Endoscopic large-balloon sphincteroplasty without preceding sphincterotomy for the removal of large bile duct stones: a preliminary study. Gastrointest. Endosc. 70, 915–922 (2009).

    PubMed  Google Scholar 

  32. Chan, H.-H. et al. Endoscopic papillary large balloon dilation alone without sphincterotomy for the treatment of large common bile duct stones. BMC Gastroenterol. 11, 69 (2011).

    PubMed  PubMed Central  Google Scholar 

  33. Jang, H. W. et al. Endoscopic papillary large balloon dilatation alone is safe and effective for the treatment of difficult choledocholithiasis in cases of Billroth II gastrectomy: a single center experience. Dig. Dis. Sci. 58, 1737–1743 (2013).

    PubMed  Google Scholar 

  34. Itoi, T. et al. New large-diameter balloon-equipped sphincterotome for removal of large bile duct stones (with videos). Gastrointest. Endosc. 72, 825–830 (2010).

    PubMed  Google Scholar 

  35. Park, S. J. et al. Factors predictive of adverse events following endoscopic papillary large balloon dilation: results from a multicenter series. Dig. Dis. Sci. 58, 1100–1109 (2013).

    PubMed  Google Scholar 

  36. Yoo, K.-S. & Lehman, G. A. Endoscopic management of biliary ductal stones. Gastroenterol. Clin. North Am. 39, 209–227 (2010).

    PubMed  Google Scholar 

  37. Yasuda, I. & Itoi, T. Recent advances in endoscopic management of difficult bile duct stones. Dig. Endosc. 25, 376–385 (2013).

    PubMed  Google Scholar 

  38. Seitz, U. et al. Advances in therapeutic endoscopic treatment of common bile duct stones. World J. Surg. 22, 1133–1144 (1998).

    CAS  PubMed  Google Scholar 

  39. Maydeo, A., Kwek, B. E. A., Bhandari, S., Bapat, M. & Dhir, V. Single-operator cholangioscopy-guided laser lithotripsy in patients with difficult biliary and pancreatic ductal stones (with videos). Gastrointest. Endosc. 74, 1308–1314 (2011).

    PubMed  Google Scholar 

  40. Chen, Y. K. & Pleskow, D. K. SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest. Endosc. 65, 832–841 (2007).

    PubMed  Google Scholar 

  41. Fishman, D. S., Tarnasky, P. R., Patel, S. N. & Raijman, I. Management of pancreaticobiliary disease using a new intra-ductal endoscope: the Texas experience. World J. Gastroenterol. 15, 1353–1358 (2009).

    PubMed  PubMed Central  Google Scholar 

  42. Farrell, J. J. et al. Single-operator duodenoscope-assisted cholangioscopy is an effective alternative in the management of choledocholithiasis not removed by conventional methods, including mechanical lithotripsy. Endoscopy 37, 542–547 (2005).

    CAS  PubMed  Google Scholar 

  43. Chen, Y. K. et al. Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest. Endosc. 74, 805–814 (2011).

    PubMed  Google Scholar 

  44. Moon, J. H., Terheggen, G., Choi, H. J. & Neuhaus, H. Peroral cholangioscopy: diagnostic and therapeutic applications. Gastroenterology 144, 276–282 (2013).

    PubMed  Google Scholar 

  45. Sethi, A. et al. ERCP with cholangiopancreatoscopy may be associated with higher rates of complications than ERCP alone: a single-center experience. Gastrointest. Endosc. 73, 251–256 (2011).

    PubMed  Google Scholar 

  46. Larghi, A. & Waxman, I. Endoscopic direct cholangioscopy by using an ultra-slim upper endoscope: a feasibility study. Gastrointest. Endosc. 63, 853–857 (2006).

    PubMed  Google Scholar 

  47. Moon, J. H. et al. Intraductal balloon-guided direct peroral cholangioscopy with an ultraslim upper endoscope (with videos). Gastrointest. Endosc. 70, 297–302 (2009).

    PubMed  Google Scholar 

  48. Choi, H. J. et al. Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos). Gastrointest. Endosc. 69, 935–940 (2009).

    PubMed  Google Scholar 

  49. Tsou, Y.-K., Lin, C.-H., Tang, J.-H., Liu, N.-J. & Cheng, C.-L. Direct peroral cholangioscopy using an ultraslim endoscope and overtube balloon-assisted technique: a case series. Endoscopy 42, 681–684 (2010).

    PubMed  Google Scholar 

  50. Huang, S.-W., Lin, C.-H., Lee, M.-S., Tsou, Y.-K. & Sung, K.-F. Residual common bile duct stones on direct peroral cholangioscopy using ultraslim endoscope. World J. Gastroenterol. 19, 4966–4972 (2013).

    PubMed  PubMed Central  Google Scholar 

  51. Lee, Y. N. et al. Direct peroral cholangioscopy using an ultraslim upper endoscope for management of residual stones after mechanical lithotripsy for retained common bile duct stones. Endoscopy 44, 819–824 (2012).

    CAS  PubMed  Google Scholar 

  52. Itoi, T. et al. Evaluation of residual bile duct stones by peroral cholangioscopy in comparison with balloon-cholangiography. Dig. Endosc. 22 (Suppl. 1), S85–S89 (2010).

    PubMed  Google Scholar 

  53. Moon, J. H. et al. Direct peroral cholangioscopy using an ultra-slim upper endoscope for the treatment of retained bile duct stones. Am. J. Gastroenterol. 104, 2729–2733 (2009).

    PubMed  Google Scholar 

  54. Kim, H. I. et al. Holmium laser lithotripsy under direct peroral cholangioscopy by using an ultra-slim upper endoscope for patients with retained bile duct stones (with video). Gastrointest. Endosc. 74, 1127–1132 (2011).

    PubMed  Google Scholar 

  55. Benninger, J. et al. Extracorporeal shockwave lithotripsy of gallstones in cystic duct remnants and Mirizzi syndrome. Gastrointest. Endosc. 60, 454–459 (2004).

    PubMed  Google Scholar 

  56. England, R. E. & Martin, D. F. Endoscopic management of Mirizzi's syndrome. Gut 40, 272–276 (1997).

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Tsuyuguchi, T., Sakai, Y., Sugiyama, H., Ishihara, T. & Yokosuka, O. Long-term follow-up after peroral cholangioscopy-directed lithotripsy in patients with difficult bile duct stones, including Mirizzi syndrome: an analysis of risk factors predicting stone recurrence. Surg. Endosc. 25, 2179–2185 (2011).

    PubMed  Google Scholar 

  58. Huang, M.-H. et al. Long-term outcome of percutaneous transhepatic cholangioscopic lithotomy for hepatolithiasis. Am. J. Gastroenterol. 98, 2655–2662 (2003).

    PubMed  Google Scholar 

  59. Jeng, K., Sheen, I. & Yang, F. Are expandable metallic stents better than conventional methods for treating difficult intrahepatic biliary strictures with recurrent hepatolithiasis? Arch. Surg. 134, 267–273 (1999).

    CAS  PubMed  Google Scholar 

  60. Okugawa, T. et al. Peroral cholangioscopic treatment of hepatolithiasis: Long-term results. Gastrointest. Endosc. 56, 366–371 (2002).

    PubMed  Google Scholar 

  61. Neuhaus, H. Endoscopic and percutaneous treatment of difficult bile duct stones. Endoscopy 35, S31–S34 (2003).

    CAS  PubMed  Google Scholar 

  62. Jan, Y. Y. & Chen, M. F. Percutaneous trans-hepatic cholangioscopic lithotomy for hepatolithiasis: long-term results. Gastrointest. Endosc. 42, 1–5 (1995).

    CAS  PubMed  Google Scholar 

  63. Lee, S. K. et al. Percutaneous transhepatic cholangioscopic treatment for hepatolithiasis: an evaluation of long-term results and risk factors for recurrence. Gastrointest. Endosc. 53, 318–323 (2001).

    CAS  PubMed  Google Scholar 

  64. Chen, C.-H. et al. Reappraisal of percutaneous transhepatic cholangioscopic lithotomy for primary hepatolithiasis. Surg. Endosc. 19, 505–509 (2005).

    PubMed  Google Scholar 

  65. Moon, J. H. et al. The role of percutaneous transhepatic papillary balloon dilation in percutaneous choledochoscopic lithotomy. Gastrointest. Endosc. 54, 232–236 (2001).

    CAS  PubMed  Google Scholar 

  66. Di Giorgio, P. et al. Endoscopic plastic stenting for bile duct stones: stent changing on demand or every 3 months. A prospective comparison study. Endoscopy 45, 1014–1017 (2013).

    PubMed  Google Scholar 

  67. Lee, T. H. et al. Is the addition of choleretic agents in multiple double-pigtail biliary stents effective for difficult common bile duct stones in elderly patients? A prospective, multicenter study. Gastrointest. Endosc. 74, 96–102 (2011).

    PubMed  Google Scholar 

  68. Han, J. et al. Effect of biliary stenting combined with ursodeoxycholic acid and terpene treatment on retained common bile duct stones in elderly patients: a multicenter study. Am. J. Gastroenterol. 104, 2418–2421 (2009).

    CAS  PubMed  Google Scholar 

  69. Lee, A. & Shah, J. N. Endoscopic approach to the bile duct in the patient with surgically altered anatomy. Gastrointest. Endosc. Clin. N. Am. 23, 483–504 (2013).

    PubMed  Google Scholar 

  70. Park, C.-H. et al. Cap-assisted ERCP in patients with a Billroth II gastrectomy. Gastrointest. Endosc. 66, 612–615 (2007).

    PubMed  Google Scholar 

  71. Saleem, A. et al. Endoscopic retrograde cholangiopancreatography using a single-balloon enteroscope in patients with altered Roux-en-Y anatomy. Endoscopy 42, 656–660 (2010).

    CAS  PubMed  Google Scholar 

  72. Itoi, T. et al. Single-balloon enteroscopy-assisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis (with video). Am. J. Gastroenterol. 105, 93–99 (2010).

    PubMed  Google Scholar 

  73. Dellon, E. S., Kohn, G. P., Morgan, D. R. & Grimm, I. S. Endoscopic retrograde cholangiopancreatography with single-balloon enteroscopy is feasible in patients with a prior Roux-en-Y anastomosis. Dig. Dis. Sci. 54, 1798–1803 (2009).

    PubMed  Google Scholar 

  74. Neumann, H., Fry, L. C., Meyer, F., Malfertheiner, P. & Monkemuller, K. Endoscopic retrograde cholangiopancreatography using the single balloon enteroscope technique in patients with Roux-en-Y anastomosis. Digestion 80, 52–57 (2009).

    PubMed  Google Scholar 

  75. Wagh, M. S. & Draganov, P. V. Prospective evaluation of spiral overtube-assisted ERCP in patients with surgically altered anatomy. Gastrointest. Endosc. 76, 439–443 (2012).

    PubMed  Google Scholar 

  76. Lennon, A. M. et al. Spiral assisted ERCP is equivalent to single balloon assisted ERCP in patients with Roux-en-Y anatomy. Dig. Dis. Sci. 57, 1391–1398 (2012).

    PubMed  Google Scholar 

  77. Shah, R. J. et al. A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). Gastrointest. Endosc. 77, 593–600 (2013).

    PubMed  Google Scholar 

  78. Pimentel, R. R., Mehran, A., Szomstein, S. & Rosenthal, R. Laparoscopy-assisted transgastrostomy ERCP after bariatric surgery: case report of a novel approach. Gastrointest. Endosc. 59, 325–328 (2004).

    PubMed  Google Scholar 

  79. Nguyen, N. T. et al. Laparoscopic transgastric access to the biliary tree after Roux-en-Y gastric bypass. Obes. Surg. 17, 416–419 (2007).

    PubMed  Google Scholar 

  80. Ceppa, F. A., Gagné, D. J., Papasavas, P. K. & Caushaj, P. F. Laparoscopic transgastric endoscopy after Roux-en-Y gastric bypass. Surg. Obes. Relat. Dis. 3, 21–24 (2007).

    PubMed  Google Scholar 

  81. Mutignani, M. et al. Laparoscopy-assisted ERCP after biliopancreatic diversion. Obes. Surg. 17, 251–254 (2007).

    PubMed  Google Scholar 

  82. Lopes, T. L., Clements, R. H. & Wilcox, C. M. Laparoscopy-assisted ERCP: experience of a high-volume bariatric surgery center (with video). Gastrointest. Endosc. 70, 1254–1259 (2009).

    PubMed  Google Scholar 

  83. Bertin, P. M., Singh, K. & Arregui, M. E. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography (ERCP) after gastric bypass: case series and a description of technique. Surg. Endosc. 25, 2592–2596 (2011).

    PubMed  Google Scholar 

  84. Schreiner, M. A. et al. Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients. Gastrointest. Endosc. 75, 748–756 (2012).

    PubMed  Google Scholar 

  85. Attam, R., Leslie, D., Freeman, M., Ikramuddin, S. & Andrade, R. EUS-assisted, fluoroscopically guided gastrostomy tube placement in patients with Roux-en-Y gastric bypass: a novel technique for access to the gastric remnant. Gastrointest. Endosc. 74, 677–682 (2011).

    PubMed  Google Scholar 

  86. Weilert, F., Binmoeller, K. F., Marson, F., Bhat, Y. & Shah, J. N. Endoscopic ultrasound-guided anterograde treatment of biliary stones following gastric bypass. Endoscopy 43, 1105–1108 (2011).

    CAS  PubMed  Google Scholar 

  87. Iwashita, T. et al. Endoscopic ultrasound-guided antegrade papillary balloon dilation for treating a common bile duct stone. Dig. Endosc. 25, 89–90 (2013).

    PubMed  Google Scholar 

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  1. Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, MMC 36, 406 Harvard Street SE, Minneapolis, 55455, MN, USA

    Guru Trikudanathan, Mustafa A. Arain, Rajeev Attam & Martin L. Freeman

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All authors contributed equally to the manuscript.

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M.L.F. has received speaking honoraria from Cook Endoscopy and Boston Scientific, and is an unpaid consultant for Hobbs Medical Inc. The other authors declare no competing interests.

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Trikudanathan, G., Arain, M., Attam, R. et al. Advances in the endoscopic management of common bile duct stones. Nat Rev Gastroenterol Hepatol 11, 535–544 (2014). https://doi.org/10.1038/nrgastro.2014.76

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